Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident
Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident
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DOI：
10.15585/mmwr.rr6404a1
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发表时间：
2015-12-04
影响因子：
33.7
通讯作者：
Meaney-Delman, Dana
中科院分区：
文献类型：
--
作者：
Bower, William A.;Hendricks, Katherine;Meaney-Delman, Dana
2014年，疾控中心发布了最新的炭疽预防和治疗指南(Hendricks Ka，Wright ME，Shadomy SV等人)。疾病控制和预防中心关于预防和治疗成人炭疽病的专家小组会议。2014年紧急感染疾病；20[2]可在http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article.htm).上查看这些指南为在传统医疗环境中诊断和治疗自然发生的或与生物恐怖主义有关的炭疽病患者提供了建议的最佳做法。炭疽芽孢杆菌孢子在人口稠密地区的气雾化释放可能会造成大规模伤亡事件。为了为这种可能性做准备，美国。政府储备了用于炭疽预防和治疗的设备和治疗药物(称为医学对策[MCM])。然而，以前公开提供的临床建议没有涉及在炭疽病大规模伤亡事件中使用MCM或临床管理的问题，当患者数量可能超过卫生保健基础设施提供传统护理标准的能力时，MCM的供应可能不足以满足所需的需求。为了弥补这一差距，2013年，疾控中心对炭疽病的科学文献进行了一系列系统的审查，以确定证据，以帮助临床医生和公共卫生当局制定指南，指导静脉注射抗菌剂和抗毒素的使用，炭疽脑膜炎的诊断，以及在大规模伤亡事件中常见的炭疽特有并发症的处理。在2013年8月至2014年3月举行的一系列工作组会议上，这些审查的证据被提交给拥有炭疽、重症护理和灾难医学专业知识的专业人士。2014年3月，举行了一次会议，102名主题专家在会上讨论了证据，并将现有最佳做法指南调整为临床使用框架，以明智、有效和合理地使用储存的中成药在大规模伤亡事件中治疗炭疽病，本报告对此进行了描述。本报告阐述了以医院为基础的急性护理的要素，特别是抗毒素和静脉注射抗菌剂的使用，以及在大规模伤亡事件中常见的炭疽特有并发症的诊断和处理。本报告中的建议只有在满足了从常规护理向应急或危机护理标准转变的预定触发因素后才应实施，例如当病例的数量可能导致静脉内抗菌剂、抗毒素、危重护理资源(例如胸管和胸腔引流系统)或诊断能力即将短缺时。本指南不涉及初级？)、分诊决定、炭疽暴露后预防、医院病床或劳动力激增能力，或分配MCM的后勤。临床医生、医院管理人员、州和地方卫生官员以及规划者可以使用这些建议来帮助制定危机预案，以确保国家为炭疽大规模伤亡事件做好准备。
In 2014, CDC published updated guidelines for the prevention and treatment of anthrax (Hendricks KA, Wright ME, Shadomy SV et al. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20[2] Available at http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article.htm). These guidelines provided recommended best practices for the diagnosis and treatment of persons with naturally occurring or bioterrorism-related anthrax in conventional medical settings. An aerosolized release of Bacillus anthracis spores over densely populated areas could become a mass-casualty incident. To prepare for this possibility, the US. government has stockpiled equipment and therapeutics (known as medical countermeasures [MCMs]) for anthrax prevention and treatment. However, previously developed publicly available clinical recommendations have not addressed the use of MCMs or clinical management during an anthrax mass-casualty incident, when the number of patients is likely to exceed the ability of the health care infrastructure to provide conventional standards of care and supplies of MCMs might be inadequate to meet the demand required. To address this gap, in 2013, CDC conducted a series of systematic reviews of the scientific literature on anthrax to identify evidence that could help clinicians and public health authorities set guidelines for intravenous antimicrobial and antitoxin use, diagnosis of anthrax meningitis, and management of common anthrax-specific complications in the setting of a mass-casualty incident. Evidence from these reviews was presented to professionals with expertise in anthrax, critical care, and disaster medicine during a series of workgroup meetings that were held from August 2013 through March 2014. In March 2014, a meeting was held at which 102 subject matter experts discussed the evidence and adapted the existing best practices guidance to a clinical use framework for the judicious, efficient, and rational use of stockpiled MCMs for the treatment of anthrax during a mass-casualty incident, which is described in this report. This report addresses elements of hospital-based acute care, specifically antitoxins and intravenous antimicrobial use, and the diagnosis and management of common anthrax-specific complications during a mass-casualty incident. The recommendations in this report should be implemented only after predefined triggers have been met for shifting from conventional to contingency or crisis standards of care, such as when the magnitude of cases might lead to impending shortages of intravenous antimicrobials, antitoxins, critical care resources (e.g., chest tubes and chest drainage systems), or diagnostic capability. This guidance does not address prima?), triage decisions, anthrax postexposure prophylaxis, hospital bed or workforce surge capacity, or the logistics of dispensing MCMs. Clinicians, hospital administrators, state and local health officials, and planners can use these recommendations to assist in the development of crisis protocols that will ensure national preparedness for an anthrax mass-casualty incident.