Detailed studies of U.S. disaster preparedness offer recommendations

aim for in this regard. “Provision of essential rather than limitless critical care will be needed to allow many additional community members to have access to key life-sustaining interventions during disasters,” the report states. It stresses that hospitals should use limited, essential critical care, or “emergency mass critical care (EMCC),” only in overwhelming events. The task force says that EMCC should include the following:

  • Mechanical ventilation
  • Intravenous fluid resuscitation
  • Vasopressor administration
  • Antidote or antimicrobial administration for specific diseases
  • Sedation and analgesia
  • Select practices to reduce adverse consequences of critical illness and critical care delivery
  • Optimal therapeutics and interventions, such as renal replacement therapy and nutrition for patients unable to take food by mouth, if warranted by hospital or regional preference

The report states that every hospital with an intensive care unit should plan to provide EMCC and should coordinate with regional hospital planning efforts in doing so. As for exactly how much EMCC capacity to aim for, the task force says that multiple uncertainties make it impossible to confidently predict critical care needs for particular types of disasters, but the panel offers recommendations anyway: Hospitals with ICUs should prepare to provide EMCC for at least three times the usual number of critically ill patients and to maintain such care for ten days without “sufficient external assistance.” Ten days is reasonable because most disaster victims’ critical care needs are not expected to resolve rapidly, the report says. The panel also offers a progressive list of changes in resource use for coping with shortages. It starts with substitution and runs through adaptation, conservation, reuse, and finally reallocation, the last meaning taking a resource from one patient and giving it to another with a better prognosis or greater need. Further, the panel asserts, “All communities should develop a graded response plan for events across the spectrum from multiple casualty to catastrophic critical care events. These plans should clearly delineate what levels of modification of critical care practices are appropriate for the different surge requirements.” The report offers a detailed chart of tiered responses to critical care needs, listing criteria for moving from one level of response to the next. The chart suggests moving to EMCC only at tier 6+, meaning after calls for assistance from local, regional, state, interstate, and federal authorities have been exhausted. “Sustained EMCC is appropriate when calls for assistance are exhausted and resources are not available or will take