title: System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.
abstract: BACKGROUND
  System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials.
  
  
  METHODS
  The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process.
  
  
  RESULTS
  Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning.
  
  
  CONCLUSIONS
  System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dichter
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kanter
authors.forename: David
authors.initials: D
authors.lastname: Dries
authors.forename: Valerie
authors.initials: V
authors.lastname: Luyckx
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Lim
authors.forename: John
authors.initials: J
authors.lastname: Wilgis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Anderson
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Hupert
authors.forename: Ryan
authors.initials: R
authors.lastname: Mutter
authors.forename: Asha V
authors.initials: AV
authors.lastname: Devereaux
authors.forename: Michael D
authors.initials: MD
authors.lastname: Christian
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
mesh_terms: D032921:Consensus; D003422:Critical Care / Q000458:organization & administration; D016638:Critical Illness / Q000628:therapy*; D004190:Disasters; D004632:Emergency Medical Services / Q000458:organization & administration*; D006288:Health Planning Organizations / Q000458:organization & administration*; D006801:Humans; D058873:Pandemics; D014947:Wounds and Injuries / Q000628:therapy*