Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL.
BACKGROUND
Anticipated circumstances during the next severe influenza pandemic highlight the insufficiency of staff and equipment to meet the needs of all critically ill victims. It is plausible that an entire country could face simultaneous limitations, resulting in severe shortages of critical care resources to the point where patients could no longer receive all of the care that would usually be required and expected. There may even be such resource shortfalls that some patients would not be able to access even the most basic of life-sustaining interventions. Rationing of critical care in this circumstance would be difficult, yet may be unavoidable. Without planning, the provision of care would assuredly be chaotic, inequitable, and unfair. The Task Force for Mass Critical Care Working Group met in Chicago in January 2007 to proactively suggest guidance for allocating scarce critical care resources.
In order to allocate critical care resources when systems are overwhelmed, the Task Force for Mass Critical Care Working Group suggests the following: (1) an equitable triage process utilizing the Sequential Organ Failure Assessment scoring system; (2) the concept of triage by a senior clinician(s) without direct clinical obligation, and a support system to implement and manage the triage process; (3) legal and ethical constructs underpinning the allocation of scarce resources; and (4) a mechanism for rapid revision of the triage process as further disaster experiences, research, planning, and modeling come to light.
Devereaux
Asha V
AV
Sharp Coronado Hospital, San Diego, CA, USA. ADevereaux@pol.net
Dichter
Jeffrey R
JR
Christian
Michael D
MD
Dubler
Nancy N
NN
Sandrock
Christian E
CE
Hick
John L
JL
Powell
Tia
T
Geiling
James A
JA
Amundson
Dennis E
DE
Baudendistel
Tom E
TE
Braner
Dana A
DA
Klein
Mike A
MA
Berkowitz
Kenneth A
KA
Curtis
J Randall
JR
Rubinson
Lewis
L
D003422:Critical Care / Q000458:organization & administration*; D015276:Health Care Rationing / Q000458:organization & administration*; D006295:Health Resources / Q000458:organization & administration*; D006801:Humans; D054527:Mass Casualty Incidents; D014218:Triage / Q000458:organization & administration*