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Mechanical Ventilation in Nontraditional Settings 595

ventilators in the stockpile (Wilgis, 2008). At the state level, each state has plans to
distribute the SNS medicines and medical supplies to local communities as quickly
as possible (CDC, 2010).
Since the beginning of the stockpile program for mechanical ventilators, the
The LP-10 (discontinued LP-10 and Uni-Vent Eagle 754 had been the two ventilators designated by the
in November of 2006) and
Uni-Vent Eagle 754 are being federal government for mass casualty incidents (Malatino, 2008). The LP-10 (dis-
replaced with the LTV 1200 continued in November of 2006) and Uni-Vent Eagle 754 are being replaced with
(CareFusion) and Newport
HT50 portable ventilators. the LTV 1200 (CareFusion) and Newport HT50 portable ventilators. Readers may
refer to the manufacturer websites to obtain the respective technical specifications
and operating manuals. Other than the ventilators in the federal SNS program,
there are other portable ventilators that may be suitable for use in mass casualty
incidents (e.g., EPV 100, Allied Healthcare Products, Inc.).

Exclusion Criteria for Mechanical Ventilation

The number of ventilators in the Strategic National Stockpile is clearly insufficient
for the projected number of people needing mechanical ventilation in a major mass
casualty incidence (AARC, 2006; HHS, 2005). Exclusion criteria for ventilator ac-
cess have been developed to prioritize the allocation of a limited number of ventila-
tors in the event of a mass casualty incident.
The NYS DOH exclusion
criteria are based on objective For example, the New York State Department of Health (NYS DOH) outlined
clinical conditions and do not
rely on ethical or quality-of- the exclusion criteria for ventilator access (NYS DOH, 2007). The exclusion criteria
life issues. Individuals meet- are based on objective clinical conditions and do not rely on ethical or quality-of-
ing these exclusion criteria
would not be placed on a life issues. They focus on a person’s history of cardiac arrest, presence of metastatic
ventilator should the number malignancy, severe burn, and organ failure (Table 18-5). Individuals meeting these
of ventilators fail to meet the
surge in demand. exclusion criteria would not be placed on a ventilator should the number of ventila-
tors fail to meet the surge in demand.

TABLE 18-5 Exclusion Criteria for Ventilator Access (NYS DOH)

1. Cardiac arrest: unwitnessed arrest, recurrent arrest, arrest unresponsive to standard
measures, trauma-related arrest
2. Metastatic malignancy with poor prognosis

3. Severe burn: body surface area .40%, severe inhalation injury

4. End-stage organ failure:
Cardiac: NY Heart Association class III or IV
Pulmonary: severe chronic lung disease with FEV , 25%
1
Hepatic: MELD (model of end-stage liver disease) score .20
Renal: dialysis-dependent
Neurologic: severe, irreversible neurologic event/condition with high expected mortality

Reference NYS DOH (2007).
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