Detailed studies of U.S. disaster preparedness offer recommendations

shortages in many areas. Mechanical ventilators are essential in critical care, and estimates of the number of ventilators in the United States range from about 53,000 to 105,000, the report says. The task force estimates that at least 10,000 ventilators are available nationwide at any given time, but logistical problems would hamper their rapid distribution to areas of need during a disaster. Moreover, all predictions are that the need for ventilators in a major pandemic will far exceed the supply. The U.S. national stockpile has about 4,600 ventilators, the report says. One consumable medical item that may run short in a disaster is oxygen, the report says. The number of oxygen suppliers and the number of tanker trucks for shipping oxygen are limited. Concerning personnel, the report says staff shortages have not typically been a problem in past disasters, but absenteeism has been high in some crises that were prolonged or affected employees personally. In addition, critical care physicians in general are poorly prepared for mass-casualty disasters, and there is evidence that other physician groups are not well prepared for bioterrorism or other public health emergencies, according to the task force. As for space, the report says that a recent study in Ontario showed that occupancy rates for critical care beds approached 90 percent. To some extent, hospitals can expand critical care to other areas, such as post-anesthesia care units, but shortages of equipment and staff are likely to limit that option. A hospital facing a major surge of critical care patients might consider sending them to another facility, but for a variety of reasons, this is not likely to be a good immediate option in a disaster, the report says. The possibility of bringing in outside help is not very promising either, the task force asserts. One possible source of help is the National Disaster Medical System, which was set up to deal with disasters causing a large number of casualties that can’t be accommodated by military or Veterans Affairs hospitals. But there are “significant concerns that the system is not equipped to respond to an event involving large numbers of critically ill patients, particularly a biological event, such as a pandemic,” the report says.

In a separate article, the task force seeks to define the limited level of critical care that hospitals could try to provide in a major disaster and suggests what level of surge capacity hospitals should