Surge Capacity Logistics Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement
Surge Capacity Logistics Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement
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DOI：
10.1378/chest.14-0734
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发表时间：
2014-10-01
期刊：
影响因子：
9.6
通讯作者：
Christian, Michael D.
中科院分区：
文献类型：
--
作者：
Einav, Sharon;Hick, John L.;Christian, Michael D.
背景技术背景：成功管理流行病或灾难需要实施预先存在的计划，以尽量减少生命损失并保持控制。管理重症监护能力的预期激增需要从系统的角度进行战略规划，包括集中的重症监护能力和要求以及参与医院和区域规划的所有个人和组织。本文中的建议对所有参与大规模灾难或流行病的人都很重要，包括一线临床医生，医院管理人员以及公共卫生或政府官员。具体而言，本文重点介绍了激增物流，这些元素提供的能力，提供大规模critical care.METHODS：浪涌能力专题小组制定了23个关键问题集中在以下领域：系统问题;设备，用品，药品;人员配备;和信息学。进行了文献检索，以确定可以提出循证建议的研究。对结果进行了审查，以确定与主题的相关性，并由两名主题编辑对文章进行筛选，以将其置于前面提到的激增领域之一。大多数报告是小规模的，是观察性的，或者使用了有缺陷的模型;因此，建议所依据的证据水平很差，不允许制定循证建议。浪涌能力专题小组随后遵循美国胸科医师学会（CHEST）的指导方针监督委员会的方法，制定建议的基础上，专家意见，使用修改后的德尔菲process.RESULTS：本文提出了22条建议，有关浪涌能力大规模重症监护，包括设备，用品和药品的要求;工作人员的准备和组织;缓解压倒性的病人负荷的方法;可部署的重症监护服务的作用;和使用的运输资产，以支持激增respons.CONCLUSIONS：重症监护对灾难的反应依赖于仔细规划的工作人员和资源的增加，并涉及许多机构。最大限度地利用区域资源，包括人员，设备和用品，扩展重症监护能力。应建立区域联盟，以促进协议，概述业务计划，并协调医院的努力，以实现预定的目标。专业医生的监督是必要的，如果现场没有，可以通过远程咨询提供。由经验丰富的提供者进行分诊、反向分诊和服务降级可用于最小化ICU资源消耗。在基础设施暂时丧失或医院资源不堪重负时，应考虑部署重症监护服务。胸部2014; 146（4_增刊）：e17 S-e43 S
BACKGROUND: Successful management of a pandemic or disaster requires implementation of preexisting plans to minimize loss of life and maintain control. Managing the expected surges in intensive care capacity requires strategic planning from a systems perspective and includes focused intensive care abilities and requirements as well as all individuals and organizations involved in hospital and regional planning. The suggestions in this article are important for all involved in a large-scale disaster or pandemic, including front-line clinicians, hospital administrators, and public health or government officials. Specifically, this article focuses on surge logistics-those elements that provide the capability to deliver mass critical care.METHODS: The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify studies upon which evidence-based recommendations could be made. The results were reviewed for relevance to the topic, and the articles were screened by two topic editors for placement within one of the surge domains noted previously. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. The Surge Capacity topic panel subsequently followed the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestion based on expert opinion using a modified Delphi process.RESULTS: This article presents 22 suggestions pertaining to surge capacity mass critical care, including requirements for equipment, supplies, and pharmaceuticals; staff preparation and organization; methods of mitigating overwhelming patient loads; the role of deployable critical care services; and the use of transportation assets to support the surge response.CONCLUSIONS: Critical care response to a disaster relies on careful planning for staff and resource augmentation and involves many agencies. Maximizing the use of regional resources, including staff, equipment, and supplies, extends critical care capabilities. Regional coalitions should be established to facilitate agreements, outline operational plans, and coordinate hospital efforts to achieve predetermined goals. Specialized physician oversight is necessary and if not available on site, may be provided through remote consultation. Triage by experienced providers, reverse triage, and service deescalation may be used to minimize ICU resource consumption. During a temporary loss of infrastructure or overwhelmed hospital resources, deployable critical care services should be considered. CHEST 2014; 146 (4_Suppl): e17S-e43S