Care of the Critically ill and Injured During Pandemics and Disasters
Business and Continuity of Operations in a disaster is a broad area; therefore, the task force chose to focus on medication/medical supply shortages and continuity of information technology (IT) operations, as they are both key issues affecting critical care patients identified by several of the topic groups (see “Evacuation of the ICU” article by King et al, “Surge Capacity Principles” article by Hick et al, “Surge Capacity Logistics” article by Einav et al, ’’System Level Planning, Coordination, and Communication” article by Dichter et al, and “Triage” article by Christian et al in this consensus statement) as enablers.
Industrial globalization, including manufacturing of medications and medical supplies, has helped to increase production and reduce costs, allowing for the wide availability of products throughout the world. However, as production now depends on the integration of increasingly interdependent global networks of raw materials, manufacturing, packaging, and distribution, globalization has also contributed to increased vulnerability of the medical supply chain to disruptions caused by natural and man-made events. As such, there are steps health-care institutions should take to help prepare and account for potential medical supply chain disruptions, especially shortages of key critical care medications and supplies, regardless of the location of the disruption.Equally important, an intact IT information infrastructure is essential for any hospital or health system in providing patient care and financial accounting for services rendered, among other functions. Only 57% of hospitals have the ability to bring clinical systems back online within 24 h after complete loss of their primary data center. If there is damage to off-site centers or cloud-based storage systems, recovery time will most certainly be longer. In a catastrophic disaster, such as the Haiti earthquake, effective clinical systems were instituted and functioning quickly using local networks, portable devices, and currently available software. As part of IT disaster preparedness, hospitals and health systems should have the means to reestablish local networks with functioning information systems quickly and have plans for management of long-term IT storage if a disaster is prolonged.
The suggestions in this chapter are important for all of those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, and public health or government officials. Although it is important for all providers to be familiar with all aspects of business continuity, Table 1 provides an overview of the suggestions of most interest to each of the groups above.
Table 1 – List of Suggestions, With Recommended Category of Health-care Professionals for Which Each Set of Suggestions Is Intended
SuggestionNumber | Primary Target Audience | ||
Clinicians | HospitalAdministrators | Public Health and Government | |
1 | + | + | |
2 | + | + | |
3 | + | + | |
4 | + | + | |
5 | + | + | |
6 | + | + | |
7 | + | ||
8 | + | ||
9 | + | ||
10 | + | + | |
11 | + | + | |
12 | + | + | |
13 | + | + | |
14 | + | + | |
15 | + | ||
16 | + | ||
17 | + | ||
18 | + |