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Intensive Care Unit Microcosm Within Disaster Medical Response

This complimentary chapter from Fundamental Disaster Management aims to: explain the concept of all-hazard preparedness as it relates to critical care disaster response, describe how hazard-vulnerability analysis can lead to effective contingency planning for a given problem, identify the standard elements of an incident command system and how they inform critical care delivery, compare and contrast internal and external communications processes employed during disaster response, discuss how an individual hospital’s response plan integrates with the larger community disaster response plan.

During a large-scale mass casualty incident (MCI), the resources of local responding hospitals can be rapidly overwhelmed by the number of disaster victims who present for evaluation and treatment. Critical care resources must function well despite whatever injuries or illness affect the local populace during various natural and human-generated catastrophes. In a disaster setting, critical care medicine must continue to deliver resource-intensive, high-quality service at a time when, paradoxically, resources dwindle and demand escalates.

Preparing a response for unforeseen disasters is known as all-hazard preparedness. The Joint Commission has developed a set of standards for all-hazard preparedness in acute care hospitals. These standards address 4 disaster phases: mitigation, preparedness, response, and recovery. Because MCIs are impossible to predict, hospitals are obliged to have circumspect plans for dealing with each disaster phase, including the disaster’s time, scope, type, and location. Some events, like the release of a nerve agent, demand a prompt response, and treatment cannot be delayed until outside assistance arrives. Hospitals should plan to be self-sufficient until support from governmental, community, and service organizations can be mobilized. ICU staff must understand how their efforts integrate with institutional, community, and governmental responses. The ICU staff should actively plan strategies to optimize the ICS, internal and external communications, surge capacity, and evacuation to ensure that they can provide high-quality care for incoming victims while continuing the care of current patients.

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