title: Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL.
abstract: BACKGROUND
  Plausible disasters may yield hundreds or thousands of critically ill victims. However, most countries, including those with widely available critical care services, lack sufficient specialized staff, medical equipment, and ICU space to provide timely, usual critical care for a large influx of additional patients. Shifting critical care disaster preparedness efforts to augment limited, essential critical care (emergency mass critical care [EMCC]), rather than to marginally increase unrestricted, individual-focused critical care may provide many additional people with access to life-sustaining interventions. In 2007, in response to the increasing concern over a severe influenza pandemic, the Task Force on Mass Critical Care (hereafter called the Task Force) convened to suggest the essential critical care therapeutics and interventions for EMCC.
  EMCC should include the following: (1) mechanical ventilation, (2) IV fluid resuscitation, (3) vasopressor administration, (4) medication administration for specific disease states (eg, antimicrobials and antidotes), (5) sedation and analgesia, and (6) select practices to reduce adverse consequences of critical illness and critical care delivery. Also, all hospitals with ICUs should prepare to deliver EMCC for a daily critical care census at three times their usual ICU capacity for up to 10 days.
  
  
  CONCLUSIONS
  By using the Task Force suggestions for EMCC, communities may better prepare to deliver augmented critical care in response to disasters. In light of current mass critical care data limitations, the Task Force suggestions were developed to guide preparedness but are not intended as strict policy mandates. Additional research is required to evaluate EMCC and revise the strategy as warranted.
authors.affiliation: University of Washington, Harborview Medical Center, Campus Box 359762, 325 Ninth Ave, Seattle, WA 98104, USA. rubinson@u.washington.edu
authors.forename: Lewis
authors.initials: L
authors.lastname: Rubinson
authors.forename: John L
authors.initials: JL
authors.lastname: Hick
authors.forename: Dan G
authors.initials: DG
authors.lastname: Hanfling
authors.forename: Asha V
authors.initials: AV
authors.lastname: Devereaux
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dichter
authors.forename: Michael D
authors.initials: MD
authors.lastname: Christian
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.forename: Justine
authors.initials: J
authors.lastname: Medina
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: James A
authors.initials: JA
authors.lastname: Geiling
mesh_terms: D019985:Benchmarking; D003422:Critical Care / Q000458:organization & administration*; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D054527:Mass Casualty Incidents; D014481:United States