Biomedical Engineering Reference
In-Depth Information
•
Equipment and supplies that will be rationed
and used in ways consistent with achieving the
ultimate goal of saving the most lives
(e.g.,
disposable supplies may be reused).
in mass casualty events. Guidelines should take
into account and be scaleable to the size, nature,
and speed of the event, so that they can guide the
following decisions:
•
How to ensure and protect an adequate supply
of trained providers and support staff.
•
How to triage patients into groups by the nature
of their condition, probability of success of
interventions/treatment, and consideration of
resources available.
•
How to maintain infection control and a safe
care environment.
•
How to use and reuse common supplies and
equipment, such as gloves, gowns, and masks.
•
How to allocate scarce clinical resources of a
general nature, such as beds, surgery capability,
and laboratory and other diagnostic services.
•
How to allocate scarce and highly special-
ized clinical resources, such as decontamination
units, isolation units, ventilators, burn beds, and
intensive and critical care units.
•
How to treat specific conditions, including how
to make best use of available pharmaceuticals.
•
How to protect health care providers and
support staff and their families.
•
How to modify documentation standards to
ensure enough information to support care and
obtain reimbursement without posing an undue
administrative burden.
•
How to manage excessive fatalities.
As illustrated in these scenarios, the occurrence
of a mass-casualty event will require significant
changes in the way in which health and medical
care is delivered under extraordinary circum-
stances. The panel of experts was quite clear in
its view that if the health care system is to be
successful in saving as many lives as possible,
planning, education, and training efforts should be
focused on the development and implementation
of appropriate altered standards of care in response
to a mass-casualty event. A framework and set of
principles to guide work in this area were devel-
oped by the panel and are presented in the next
chapter.
•
Not enough trained staff
. Staff will be scared
to leave home and/or may find it difficult to
travel to work. Burnout from stress and long
hours will occur, and replacement staff will be
needed. Some scarce and valuable equipment,
such as ventilators, may not be used without
staff available who are trained to operate them.
•
Delays in hospital care due to backlogs of
patients
. Patients will be waiting for scarce
resources, such as operating rooms, radiological
suites, and laboratories.
•
Providers that may need to make treatment
decisions based on clinical judgement
. For
example, if laboratory resources for testing or
radiology resources for x-rays are exhausted,
treatment based on physical exam, history, and
clinical judgement will occur.
•
The psychological impact of the event on
providers
. Short- and long-term stress manage-
ment measures (e.g., Critical Incident Stress
Management
programs)
are
essential
for
providers and their families.
•
Current documentation standards that will be
impossible to maintain
. Providers may not have
time to obtain informed consent or have access
to the usual support systems to fully document
the care provided, especially if the health care
setting is damaged by the event.
•
Backlog in processing fatalities
. It may not be
possible to accommodate cultural sensitivities
and attitudes toward death and handling bodies.
Numbers of fatalities may make it difficult to
find and notify next of kin quickly. Burial and
cremation services may be overwhelmed. Stan-
dards for completeness and timeliness of death
certificates may need to be lifted temporarily.
Based on a review of the health and medical care
issues presented by these two scenarios, the panel
of experts identified a need for more guidelines
to ensure a systematic approach to decisionmaking
