Detailed studies of U.S. disaster preparedness offer recommendations

days to arrive, and yet critically ill patients remain at high risk for bad outcomes unless critical practice is rationally modified,” the article states.

The task force, in another article focusing on surge capacity, shared guidance on the medical equipment, treatment space, and staffing that will be needed to deliver critical care during a major disaster. The task force said most of the Department of Homeland Security’s disaster scenarios represent a double-edged sword. Events, such as a terrorist attack or influenza pandemic, have the potential not only to raise the demand for critical care medical supplies, they also can also sever supply lines. Hospitals typically rely on “just-in-time” inventories to reduce supply, equipment, and storage costs, they note. “Critical care equipment is no exception, so the quantity of additional critically ill patients a hospital can care for without re-supply is impressively small,” they wrote. The task force acknowledged, however, that expecting hospitals to stockpile mass quantities of critical care supplies for use during rare catastrophic events is “unrealistic and perhaps even reckless.” Instead, the group said its streamlined EMCC framework allows for a more restricted resource list for critical care surge capacity that most communities can accommodate. They include two tables that list recommended treatment supplies, from endotracheal tubing to blood pressure cuffs, along with minimum quantities for ten treatment spaces over a span of 10 days. To factor in the uncertainties of patient turnover, the task force suggests increasing stock of consumable supplies above what one patient would require for 10 days. The authors said they focused a large portion of their surge-capacity equipment recommendations on ventilators because there is little guidance in the medical literature and they anticipate that most patients who will require mechanical ventilation in a mass critical care event will have severe airflow obstruction or lung injury. Given that each patient will probably require several days of ventilation, the task force recommends that each should have his or her own ventilator.

The guidance includes suggestions on short-term strategies to boost ventilator capacity, such as repurposing other types of ventilators, such as anesthesia machines, noninvasive devices, and transport devices, and borrowing from other hospitals that aren’t having critical care shortages. “Hospitals should work with their local, regional, and state partners to perform a PPV [positive-pressure ventilation] need analysis for all plausible mass critical care events, such as a severe influenza pandemic,” the task force wrote. In a surge