Five articles from the Task Force for Mass Critical Care address difficult issues around patient triage and resource allocation that may need to be implemented during an influenza pandemic. The articles address the following topics: 1) current capabilities and limitations for providing care for the critically ill during a disaster; 2) a framework for allocation of scarce resources in mass critical care; 3) medical resources for surge capacity during a disaster; 4) a framework for optimizing crucial care surge capacity; and 5) a summary of suggestions from the Task Force. The articles' primary focus is on provision of emergency mass critical care (EMCC), which requires a transition from patient-focused critical care to a population-oriented approach. The population-oriented approach is intended to provide the best outcomes for the largest number of critical care patients.
Each article focuses on a different, yet interrelated, set of issues, scenarios, and recommendations. "Summary of Suggestions from the Task Force for Mass Critical Care Summit" and "Current Capacities and Limitations" provide an overview of recommendations and a context under which these guidelines were developed. "A Framework for Optimizing Critical Care Surge Capacity" stresses the point that each hospital with an Intensive Care Unit should plan and prepare to provide EMCC in coordination with regional hospital planning. It also provides a tiered approach to creating critical care surge capacity. The tiers consider the risk of adverse events for patients if the tier is not sufficient, the risk of adverse events if the tier is sufficient, and the hospital emergency response obligations before increasing to the next tier.
"Medical Resources for Surge Capacity" addresses medical equipment needs (e.g., ventilators, positive pressure ventilation equipment, and medications); concepts to expand treatment spaces; and staffing models for EMCC. "A Framework for Allocation of Scarce Resources in Mass Critical Care" describes a uniform approach to triaging patients during a shortage of scarce resources. The triage approach is based on objective and quantifiable criteria and utilizes the Sequential Organ Failure Assessment (SOFA) scoring system.
One reviewer stated that, when taken together, the articles provide an invaluable resource to local and regional hospital planning for a mass care incident.