Care of the Critically ill and Injured During Pandemics and Disasters: Materials and Methods
The Business and Continuity of Operations panel followed the American College of Chest Physicians (CHEST) Guidelines Oversight Committee’s methodology to develop suggestions, based on a consensus development process (see “Methodology” article by Ornelas et al in this consensus statement). The Business and Continuity of Operations panel developed 13 key questions. (See e-Appendix 1 for key questions list, corresponding search terms and results, and data tables if sufficient evidence found). A systematic literature review was then performed for relevant articles and documents, reports, and gray literature reported since 2007 to 2012; English language papers were included, and non-English language papers were excluded. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. We suggest highest priority critical care supplies and medications needed for routine day-to-day care, and crucial in mass casualty events, for which no substitutions are available be identified (eg, ventilator circuits, N95 masks, insulin, etc). Once identified, dual sourcing should be used for routine purchasing of these key supplies and medications to reduce the impact of a supply chain disruption. natural breast enhancement pill
We suggest available alternatives for routinely used critical care supplies and medications (eg, sedatives, vasopressors, antimicrobials, etc) be identified in routine practice and pre-event planning to anticipate solutions to supply chain disruptions.
We suggest health-care systems use integrated electronic systems to track purchase, storage, and use of medical supplies.
We suggest these systems be used to identify equipment, supplies, and medications that are in short supply and for which increased routine inventory levels would be needed to adequately address both day-to-day and mass casualty event planning.
We suggest modified use protocols, which restrict routine use of affected medications and supplies and encourage use of alternatives, be implemented at the earliest opportunity when impending medication and medical supply shortages are identified, and for which adequate resupply may not be available in a timely manner.
We suggest health-care facilities, health systems, and health-care coalitions encourage, comply with, and support ongoing governmental and non-governmental organizational efforts to reduce global medical supply chain vulnerabilities.