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
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
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DOI：
10.1378/chest.07-2693
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发表时间：
2008-05-01
期刊：
影响因子：
9.6
通讯作者：
Rubinson, Lewis
中科院分区：
文献类型：
--
作者：
Devereaux, Asha V.;Dichter, Jeffrey R.;Rubinson, Lewis
背景：下一次严重流感大流行期间的预期情况突出表明，工作人员和设备不足，无法满足所有危重患者的需要。看似合理的是，整个国家可能同时面临限制，导致重症监护资源严重短缺，以至于患者不再能够获得通常需要和期望的所有护理。甚至可能出现如此严重的资源短缺，以至于一些患者甚至无法获得最基本的维持生命的干预措施。在这种情况下，配给危重护理将是困难的，但可能是不可避免的。如果没有规划，护理服务的提供肯定是混乱、不公平和不公平的。大规模危重护理工作组于2007年1月在芝加哥召开会议，积极提出分配稀缺危重护理资源的指导意见。工作组建议：为了在系统不堪重负时分配危重护理资源，工作组建议：(1)利用序贯器官衰竭评估评分系统建立公平的分诊流程；(2)由没有直接临床义务的资深临床医生(S)进行分流的概念，以及实施和管理分流流程的支持系统；(3)支持稀缺资源分配的法律和伦理构建；以及(4)随着进一步的灾难经验、研究、规划和建模的出现，快速修订分类过程的机制。
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.Task Force suggestions: 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.