Detailed studies of U.S. disaster preparedness offer recommendations
setting, ventilators should be able to operate without high-pressure medical gas, the task force emphasized. In health facilities, patient care areas outside of critical care units don’t typically have the equipment to deliver high-pressure medical gas. Also, a disaster-and subsequent supply chain and transportation disruptions-may require critical care providers to use a patchwork of different oxygen sources. When addressing where critical care patients should be treated, the expert team discouraged communities from using alternate care sites because of logistical hurdles. Instead, they recommended that general medical patients be discharged to homes or other nonacute settings to allow more critical care patients to be treated in hospitals.
The task force suggested several strategies that healthcare groups could use to augment critical care staffing:
- Physicians willing to serve in intensivist roles could be encouraged to join critical care teams.
- Critical care nurses could help mentor noncritical care caregivers.
- Noncritical care nurses and pharmacists could become responsible for medication delivery to all of the critical care patients.
- Paramedics could help maintain airways of critical care patients.
- Respiratory therapists who specialize in critical care could oversee groups of their noncritical care colleagues who could quickly ramp up their skills with just-in-time training materials.
- Pharmacists from regional health systems could help redistribute scarce pharmaceutical resources.
The last of the task force’s five articles has generated most of the news headlines because it offers a roadmap on which patients should be considered when disaster demands and shortages exhaust the medical system so that not all can receive critical care. “The lack of a plan to address these issues will result in the perception of unjust allocation of resources, or actual injustice may take place,” task force members wrote. The shift from individual to population-based care is best achieved before a disaster occurs, they added. Though previous antiviral rationing guidance in the event of an influenza pandemic has generally placed healthcare providers in top-priority tiers, the task force does not recommend that health workers-or any other population group-receive preferred status. According to the group’s critical care triage recommendations, critical care resources should be reallocated to other patients in instances when a given patient has a high risk of death and little likelihood of long-term survival and is unlikely to benefit from critical care. Clinicians should consider two factors when weighing if a patient should receive critical care: daily Sequential Organ Failure Assessment (SOFA) scores and the patient’s chronic
