Mass Critical Care Surge Response During COVID-19

After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require mo...

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Published in:	Chest Vol. 161; no. 2; pp. 429 - 447
Main Authors:	Dichter, Jeffrey R., Devereaux, Asha V., Sprung, Charles L., Mukherjee, Vikramjit, Persoff, Jason, Baum, Karyn D., Ornoff, Douglas, Uppal, Amit, Hossain, Tanzib, Henry, Kiersten N., Ghazipura, Marya, Bowden, Kasey R., Feldman, Henry J., Hamele, Mitchell T., Burry, Lisa D., Martland, Anne Marie O., Huffines, Meredith, Tosh, Pritish K., Downar, James, Hick, John L., Christian, Michael D., Maves, Ryan C., Al-Awadhi, Anwar, Alptunaer, Timur, Baldisseri, Marie, Barfield, Wanda, Benditt, Joshua, Bowden, Kasey, Branson, Richard, Christian, Michael, Dominguez-Cherit, Guillermo, Dries, David, Einav, Sharon, Etienne, Mill, Evans, Laura, Geiling, James, Gist, Ramon, Griffin, Kelly, Halpern, Neil, Henry, Kiersten, Hertelendy, Attila, Hick, John, Hupert, Nathaniel, Ingbar, David, Kadri, Sameer S., Kesler, Sarah, King, Mary A., Kissoon, Niranjan, Koenig, Kristi, Lamana, Joseph, Leif, Lindsay, Levy, Deborah, Livinsky, Alicia, Martin, Christie, Martland, Anne Marie, Mitchell, Steven, Narasimhan, Mangala, Niven, Alexander, Ochoa, Juan, Ornoff, Doug, Parrish, J. Scott, Powell, Tia, Reed, M.J., Rodriguez, Dario, Seda, Gilbert, Singh, Jaspal, Solar, Julie, Toner, Eric, Von-Maszewski, Marian
Format:	Journal Article
Language:	English
Published:	Elsevier Inc 01-02-2022
Subjects:	contingency conventional COVID-19 crisis levels critical clinical prioritization incident command system load-balancing mass critical care staffing surge telemedicine tiered staffing telemedicine critical clinical prioritization mass critical care load-balancing surge crisis levels staffing COVID-19 incident command system CCP conventional PD tiered staffing contingency TFMCC HCW
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Summary:	After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world. A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality. TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs. A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19. [Display omitted]
ISSN:	0012-3692 1931-3543
DOI:	10.1016/j.chest.2021.08.072