title: Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
abstract: OBJECTIVE
  To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations.
  
  
  METHODS
  Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations.
  
  
  RESULTS
  Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards.
  
  
  CONCLUSIONS
  Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Hick
authors.forename: Michael D
authors.initials: MD
authors.lastname: Christian
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
mesh_terms: D003422:Critical Care / Q000458:organization & administration / Q000592:standards; D004189:Disaster Planning / Q000379:methods* / Q000458:organization & administration; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D004865:Equipment and Supplies, Hospital / Q000592:standards / Q000600:supply & distribution; D006742:Hospital Bed Capacity; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy* / Q000821:virology; D007318:Inservice Training / Q000379:methods; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D054527:Mass Casualty Incidents; D020380:Needs Assessment / Q000458:organization & administration / Q000592:standards; D010564:Personnel, Hospital / Q000193:education / Q000592:standards / Q000600:supply & distribution; D055872:Surge Capacity / Q000458:organization & administration; D000078329:Workforce