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Augmenting Critical Care Capacity During a Disaster

This complimentary chapter from Fundamental Disaster Management aims to: identify the 4 components of surge capacity, explain how surge capacity relates to intensive care unit (ICU) readiness for a mass casualty incident, discuss the challenges inherent in maintaining high surge capacity in the ICU, explain how ICU surge capacity fits within the larger framework of disaster medical response.

In a medical context, the term surge capacity refers to a healthcare delivery system’s ability to rapidly accommodate an increased demand for services under extenuating circumstances. The 3 most commonly identified components of surge capacity are staff, stuff (equipment, supplies, and pharmaceuticals), and space (room to accommodate patients, providers, and equipment). A fourth, usually problematic, component is structure (delineation of management infrastructure). How a modern intensive care unit might respond to a major catastrophic event is informed by how it deals with everyday stressors.

In a 2007 survey of hospital leaders, the American Hospital Association found that 30% of hospitals cited a lack of staffed critical care beds as the key reason for ambulance diversions. With ICU occupancy rates holding stable at 65% and the number of acute care hospitals providing critical care medicine declining by 13.7% between 1985 and 2000, surge capacity planning is paramount. This is not a US issue alone. In 2006 Ontario, Canada, reported 1,057 of 1,789 critical care beds could accommodate patients requiring mechanical ventilation, with occupancy rates approaching 90% (4). The surge capacity of a given intensive care unit is likely to incorporate external resources as a crisis evolves because the increased demand is quantitative, temporal, and clinical based upon the nature of the catastrophe. Under these circumstances, operational efficiency derives from collective resource management. A circumspect conceptualization of surge capacity therefore places the intensive care unit, as defined by the 4 “s” components cited earlier, within a broader context of disaster response (government agencies, service organizations, etc).

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