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56 PART 1: An Overview of the Approach to and Organization of Critical Care

pulmonary disease: can we meet the requirements of an aging
population? JAMA. 2000;284(21):2762-2770. At 10 am on August 27, a handful of patients are referred from the college’s
• Colpaert K, Claus B, Somers A, Vandewoude K, Robays H, Health Clinic to your hospital’s emergency department (ED), with fever,
cough, sore throat, and muscle aches months before the normal start of the
Decruyenaere J. Impact of computerized physician order entry on influenza season. A few are presenting with exacerbations of their asthma.
medication prescription errors in the intensive care unit: a con- By evening the ED is overflowing with patients presenting with typical flu-
trolled cross-sectional trial. Crit Care. 2006;10(1):R21. like symptoms. A handful of patients in acute respiratory distress are arriving
• Herasevich V, Pickering BW, Dong Y, Peters SG, Gajic O. by ambulance. The EMT says that this is the sixth case and third hospital to
Informatics infrastructure for syndrome surveillance, decision which he has transported such a patient today.
support, reporting, and modeling of critical illness. Mayo Clin The pattern recurs and worsens the following day. Half of the ED patients
Proc. 2010;85(3):247-254. are experiencing what appears to be primary viral pneumonia and those
• Kahn JM, Cicero BD, Wallace DJ, Iwashyna TJ. Adoption of ICU admitted the previous day are developing multiorgan failure. Many are
telemedicine in the United States. Crit Care Med. 2014;42(2):362-368. transferred to the intensive care unit (ICU) and require mechanical ventila-
• Lilly CM, Cody S, Zhao H, et al. Hospital mortality, length of stay, tion. Meanwhile, patients have overflowed from the ED into the hallways as
and preventable complications among critically ill patients before they await diagnosis, treatment, and final disposition.
and after tele-ICU reengineering of critical care processes. JAMA. Three days into this event, all of the nearby hospitals are reporting an
2011;305(21):2175-2183. influx of patients with similar symptoms. Their EDs are overcrowded, every
inpatient bed is filled, and the night shift—already sparse—is short staffed
• Puri N, Puri V, Dellinger RP. History of technology in the intensive because some health care workers (HCWs) are afraid to come to work due to
care unit. Crit Care Clin. 2009;25(1):185-200, ix. the mysterious infectious outbreak being reported on the television news.
• Sittig DF, Ash JS, Zhang J, Osheroff JA, Shabot MM. Lessons
from “unexpected increased mortality after implementation of a
commercially sold computerized physician order entry system.”
Pediatrics. 2006;118(2):797-801. KEY POINTS
• Thomas EJ, Lucke JF, Wueste L, Weavind L, Patel B. Association
of telemedicine for remote monitoring of intensive care patients • Critical care providers must be aware of challenges for the ICU,
with mortality, complications, and length of stay. JAMA. hospital, and community in disaster preparation and response. Failure
2009;302(24):2671-2678. to fully understand and appreciate the applicable concepts of disaster
medicine will impede the provision of optimal critical patient care in
• Walsh SH. The clinician’s perspective on electronic health records and a disaster.
how they can affect patient care. BMJ. 2004;328(7449):1184-1187. • Hazard Vulnerability Analysis is a tool to aid in hospital and ICU
• Wong DH, Gallegos Y, Weinger MB, Clack S, Slagle J, Anderson emergency planning in terms of likelihood and risk to demand
CT. Changes in intensive care unit nurse task activity after installa- ratios for hospital services. Given these likely events, hospitals and
tion of a third-generation intensive care unit information system. ICUs must then develop and test Emergency Operations Plans.
Crit Care Med. 2003;31(10):2488-2494. • Preparing and exercising plans challenge hospitals and ICUs that
• Zhou L, Soran CS, Jenter CA, et al. The relationship between elec- already suffer from fiscal and time constraints for high risk, but
tronic health record use and quality of care over time. J Am Med low probability events. However, a variety of funding sources,
Inform Assoc. 2009;16(4):457-464. exercise development resources, and modeling applications exist
to aid in medical surge planning relevant to critical care.
• Incidents such as intentional explosions and disease outbreaks will
REFERENCES likely have a direct, though vastly different, impact upon demand
for hospital-based critical care resources. Acute traumatic events
Complete references available online at www.mhprofessional.com/hall
tend to surge demand for surgical services with short ICU stays,
whereas pandemic flu, for instance, will more likely isolate its
effects in the ICU for a prolonged period of time.

CHAPTER Preparedness for • The “stuff,” “staff,” and “space” paradigm provides three key meth-
ods to surge critical care resources during a disaster response.
9 Catastrophe * Streamlining and simplifying inventory to meet common critical
care issues such as respiratory failure and shock, cross-training
James Geiling staff who have critical care providers overseeing a tiered team, and
Michael Rea finally expanding the ICU into other areas of convenience inside a
hospital, together provides an effective response strategy.
Robert Gougelet
• Understanding the process of hospital and community emergency
planning lends to greater scarce critical care resource management
SETTING THE STAGE in actual catastrophe. An ICU does not, nor can it, manage a surge
of patients in isolation.
You work in a small city that has several nearby colleges. Many students and
faculty come from around the globe, including Southeast Asia where yet another
flu strain seems to be developing. Early reports indicate the severity of the illness
and affected population to be potentially greater than that of nH1N1 in 2009. INTRODUCTION AND BACKGROUND

Critical care providers must be prepared to handle mass casualties
*Disclaimer: The views expressed in this chapter are those of the author’s and do resulting from all types of natural and man-made disasters. Hurricanes,
not necessarily reflect official policy of the Department of Veterans Affairs or the floods, other weather-related incidents, wildfires, and earthquakes
US Government. occur both seasonally and sporadically in various parts of the world.

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