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  • Print publication year: 2007
  • Online publication date: December 2009

10 - Critical care and biological disasters: lessons learned from SARS and pandemic influenza planning

    • By Michael D. Christian, Mount Sinai Hospital and University Health Network Toronto General Toronto Western, and Princess Margaret Hospital Room 18–206 600 University Avenue Toronto M5G 1X5 Ontario Canada, Thomas E. Stewart, Mount Sinai Hospital and University Health Network Toronto General Toronto Western, and Princess Margaret Hospital Room 18–206 600 University Avenue Toronto M5G 1X5 Ontario Canada, Stephen E. Lapinsky, Mount Sinai Hospital and University Health Network Toronto General Toronto Western, and Princess Margaret Hospital Room 18–206 600 University Avenue Toronto M5G 1X5 Ontario Canada
  • Edited by Jeremy Cashman, Michael Grounds
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511544521.011
  • pp 159-178

Summary

Day to day, critical care units in Western society provide highly resourced intense care to patients with complex medical problems or injuries. Typically a relatively small number of patients are managed by highly educated and specialised physicians (intensivists) in collaboration with a large team of health care workers (HCWs), skilled specifically in dealing with critically ill patients including: critical care nurses, respiratory therapists, nutritionists, physiotherapists, pharmacists and other allied HCWs. Critical care is comprised of three core components: intensive nursing care with a 1:1 or 1:2 nurse-to-patient ratio, the provision of life support measures, and invasive monitoring including devices such as arterial lines or pulmonary artery catheters. Life support in this context can include ventilatory support with positive pressure mechanical ventilation, circulatory support with medications to control/support blood pressure (e.g. dopamine) or mechanical support (e.g. intra-aortic balloon pump or temporary transvenous pacemaker), and renal replacement therapy.

Whilst the model of care described above is effective for day-to-day patient management, during a disaster, particularly biological disasters, this model of care is often not sustainable nor an efficient use of limited resources. The term biological disaster is used to refer to events such as infectious disease outbreaks (epidemics and pandemics) or bioterrorism attacks. This chapter will discuss issues related to providing critical care services during biological disasters including preparedness, organisational structure, communication, surge capacity, mass critical care, triage, infection control, and ethical challenges.

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