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Mechanical Ventilation in Nontraditional Settings 589

Reliability and Safety. The ventilator used at home should be highly dependable and
The ventilator used at should require infrequent or no maintenance by nonmedical personnel such as the
home should be highly de-
pendable and should require family members and home care assistants. Each ventilator should have safety fea-
infrequent or no maintenance
by nonmedical personnel such tures such as high pressure, low pressure, and ventilator failure alarms. These fea-
as the family members and tures must not be too complicated for those working with the patient and ventilator.
home care assistants.
Simplicity and Portability. The operation and maintenance of home care ventilators
should be direct and simple. Dials and alarms on the ventilator that are illogical
and hard to understand are likely to confuse the users. The ventilator circuits and
supplies should be disposable or simple to clean and disinfect if they are reusable.
Ventilators that are small, compact, and portable will provide the most flexibil-
ity when the patient wants to move around the home. Ventilators with built-in
rechargeable battery packs are also very versatile in the event of brief power failure.
The patient may also take advantage of this portability feature to make physician
office visits or brief shopping trips.
In summary, a successful HMV program demands proper patient selection, careful
planning, detailed home instruction, and a programmatic follow-up by the health
care team. The team approach is probably the most critical element of successful
ventilator care in the home. The health care professionals, and especially the family
members, must be able to make a long-term commitment in caring for the mechani-
cally ventilated patient at home.

MECHANICAL VENTILATION IN MASS
CASUALTY INCIDENTS

Mass casualty refers to a large number of severely injured or deaths that exceeds a
mass casualty: A large number
of severely injured or deaths that timely response from regional support centers. Mechanical ventilation is a necessity
exceeds a timely response from in the management of victims of mass casualty, as they often suffer from head and
regional support centers.
chest trauma, ARDS, and ventilatory failure.

Causes of Mass Casualty

Mass casualty incidents may be due to natural or man-made events. Natural events
Mass casualty incidents such as Tsunamis, earthquakes, and pandemics have caused mass casualty incidents
may be due to natural (e.g.,
earthquakes, pandemics) with high mortalities.
or man-made events (e.g., Man-made events that can cause mass casualty include war, terrorism, acts of civil
terrorism, wars).
disobedience, bomb explosions, and exposure to radiologic and chemical agents
(e.g., Bhopal, India, 1984).
These events have caused millions of casualties; many of the victims died from
conditions leading to ventilatory failure.

Natural and Man-Made Causes. Throughout history, natural disasters have caused
many casualties. The Indian Ocean tsunami on December 26, 2004, caused up
to 225,000 deaths (MMWR, 2005), and 127,000 people were listed as missing
(CNN, 2005). In the Haiti earthquake on January 12, 2010, the Haiti government

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