Surge Capacity Logistics

Abstract

Critical care response to a disaster relies on careful planning for staff and resource augmentation and involves many agencies. Maximizing the use of regional resources, including staff, equipment, and supplies, extends critical care capabilities. Regional coalitions should be established to facilitate agreements, outline operational plans, and coordinate hospital efforts to achieve predetermined goals. Specialized physician oversight is necessary and if not available on site, may be provided through remote consultation. Triage by experienced providers, reverse triage, and service deescalation may be used to minimize ICU resource consumption. During a temporary loss of infrastructure or overwhelmed hospital resources, deployable critical care services should be considered.

Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study

“…The diagnosis of ARDS is important even when resources are limited because two of the management strategies demonstrated to improve mortality in ARDS – lung protective ventilation and proning [ 20 , 21 ] – are cheap and potentially feasible to implement in a range of settings. While some evidence supports more liberal use of lung protective ventilation in respiratory failure [ 22 ], understanding the prevalence of ARDS is one element in a necessary effort to improve detection and treatment of respiratory diseases and critical illness in low-resource settings globally [ 23 – 27 ].…”

Absenteeism of Frontline Healthcare Workers During Covid-19: the Need for a Framework of Support

“…Moreover, the level of care may be affected. This is particularly true in the intensive care unit, where deployment of non-specialised ICU staff to compensate the workforce shortage is inherently associated with an increased risk of adverse events [ 1 ].…”

Response

“…2 We agree that hospitals should attempt to mitigate this effect by following surge capacity principles such as those laid out in the CHEST Consensus Statement. 3 These may include sharing of resources among hospitals in a health care system, as well as timely and safe transportation of patients between centers based on utilization. We also agree that transfer of patients to regional centers that have developed experience and expertise in treating these challenging patients would be useful and may indeed lead to improved outcomes.…”

“…In such situations, it would be most efficient to bring critical care resources to the patients, a concept endorsed by CHEST Consensus Statement. 3 Unfortunately, health care systems cannot do this on their own. Regional control of the critical care supply chain requires the coordination of a patchwork of health systems, private companies, and government agencies.…”