Summary of suggestions from the Task Force for Mass Critical Care Summit, January 26-27, 2007

This Supplement on the management of mass critical care for ill patients represents the consensus opinion of a multidisciplinary panel convened under the umbrella of the Critical Care Collaborative Initiative. Expert recommendations on this subject are needed. Most countries have insufficient critical care staff, medical equipment, and ICU space to provide timely, usual critical care to a surge of critically ill victims. If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survival under usual health-care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing. As a result, US and Canadian authorities^1,2 have called for the development of comprehensive plans for managing mass casualty events, particularly for the provision of critical care. This Supplement includes the following: (1) a review of current US and Canadian baseline critical care preparedness and response capabilities and limitations, (2) a suggested framework for critical care surge capacity, (3) suggestions for minimum resources ICUs will need for mass critical care, and (4) a suggested framework for allocation of scarce critical care resources when critical care surge capacity remains insufficient to meet need. This Supplement is intended to aid clinicians and disaster planners in providing a coordinated and uniform response to mass critical care. Mass casualty events occur frequently worldwide.³ Fortunately, the vast majority of these do not generate overwhelming numbers of critically ill victims. Attention to mass critical care, however, has been stimulated by the severe acute respiratory syndrome epidemic of 2002-2003,^4,5 recent natural disasters, concern for intentional catastrophes, and the looming threat of a serious influenza pandemic.^1,6-11 To guide preparedness for such events, the Task Force for Mass Critical Care (hereafter referred to as the Task Force) was convened. It comprised 37 experts from fields including bioethics, critical care, disaster preparedness and response, emergency medical services, emergency medicine, infectious diseases, hospital medicine, law, military medicine, nursing, pharmacy, respiratory care, and local, state, and federal government planning and response. Several members of the Critical Care Collaborative (http://www.chestnet.org/institutes/cci/ccc.php) initiated the project and assembled a steering committee for project development and administration. Members of this steering committee included representatives from the organizational members of the Critical Care Collaborative as well as several unaffiliated North American disaster experts. This steering committee then selected members of the broader Task Force on the basis of their expertise and experience.