Chapter 2. Surge capacity and infrastructure considerations for mass critical care

• Published in: Intensive care medicine Vol. 36; no. Suppl 1; pp. 11 - 20
• Main Authors: Hick, John L., Christian, Michael D., Sprung, Charles L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2010; Springer; Springer Nature B.V
• Subjects: Analysis; Anesthesiology; Collaboration; Contingency planning; Critical care; Critical Care Medicine; Emergency medical care; Emergency Medicine; Emergency preparedness; Employee development; Health care; Hospitals; Influenza; Infrastructure; Infrastructure (Economics); Intensive; Intensive care; Management by objectives; Mass casualty incidents; Medical care; Medicine; Medicine & Public Health; Nursing; Pain Medicine; Pandemics; Pediatrics; Pneumology/Respiratory System; Political aspects; Quality management; Ventilators; Recommendations; Standard operating procedures; Influenza epidemic; Pandemic; Disaster; Surge capacity; Hospital; H1N1; Intensive care unit
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1761-4

Purpose To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations. Methods Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations. Results Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards. Conclusions Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.