title: Special populations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.
abstract: BACKGROUND
  Past disasters have highlighted the need to prepare for subsets of critically ill, medically fragile patients. These special patient populations require focused disaster planning that will address their medical needs throughout the event to prevent clinical deterioration. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients, including frontline clinicians, hospital administrators, and public health or government officials.
  
  
  METHODS
  Key questions regarding the care of critically ill or injured special populations during disasters or pandemics were identified, and a systematic literature review (1985-2013) was performed. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. The panel did not include pediatrics as a separate special population because pediatrics issues are embedded in each consensus document.
  
  
  RESULTS
  Fourteen suggestions were formulated regarding the care of critically ill and injured patients from special populations during pandemics and disasters. The suggestions cover the following areas: defining special populations for mass critical care, special population planning, planning for access to regionalized service for special populations, triage and resource allocation of special populations, therapeutic considerations, and crisis standards of care for special populations.
  
  
  CONCLUSIONS
  Chronically ill, technologically dependent, and complex critically ill patients present a unique challenge to preparing and implementing mass critical care. There are, however, unique opportunities to engage patients, primary physicians, advocacy groups, and professional organizations to lessen the impact of disaster on these special populations.
authors.forename: David
authors.initials: D
authors.lastname: Dries
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Reed
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.forename: Michael D
authors.initials: MD
authors.lastname: Christian
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dichter
authors.forename: Asha V
authors.initials: AV
authors.lastname: Devereaux
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D002648:Child; D032921:Consensus; D003422:Critical Care / Q000458:organization & administration; D016638:Critical Illness / Q000628:therapy*; D004190:Disasters; D004632:Emergency Medical Services; D006801:Humans; D058873:Pandemics; D014218:Triage / Q000379:methods* / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000628:therapy*