Study highlights need to integrate critical care-specific needs into disaster response planning

Natural disasters, terrorism attacks, mass shootings and the COVID-19 pandemic have highlighted the importance of disaster response planning throughout the healthcare system.

Disaster drills often focus on the immediate aftermath of an incident, such as managing the initial triage and patient surge in the emergency department and testing the hospital incident command system. However, a disaster also may require critical care capacity to expand in a rapid and sustained fashion.

"Mass Casualties and Disaster Implications for the Critical Care Team" details various considerations to integrate critical care-specific needs into disaster response planning, including the ability to expand capacity for intensive care unit (ICU) beds, the number of trained personnel, supplies and equipment. The article is published in AACN Advanced Critical Care.

Co-authors John Gallagher, DNP, RN, CCNS, CCRN-K, TCRN, RRT, FCCM, and Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM, have responded to multiple mass casualty incidents during their nursing careers and helped numerous organizations develop disaster response plans.

A professor at the University of Pittsburgh School of Nursing, Gallagher has nearly 30 years of experience in trauma nursing. Adamski is an assistant professor and director of the adult-gerontology acute care nurse practitioner program at Emory University, Atlanta. She is also a critical care nurse practitioner on the critical care flight team for the Cleveland Clinic. They both serve on the national board of directors for the American Association of Critical-Care Nurses (AACN), which publishes the journal.

Hospitals need to have an ICU-specific disaster plan as part of their larger facility plan, due to the unique requiremens for expansion of ICU space, staffing, supplies and equipment. It's crucial that ICU providers anticipate challenges before an actual disaster."

John Gallagher, Study Co-Author and Professor, University of Pittsburgh School of Nursing

"Disaster planning can take a general all-hazard approach or one that focuses on a specific hazard that the facility may be at higher risk for, due to its location and other factors," Adamski said. "Thinking through the ramifications of an incident, preparing for worst-case scenarios and practicing the response can literally save lives when a disaster happens."

When disaster surge conditions increase pressure on healthcare operations, facilities move from conventional to contingency or crisis-level standards to meet the needs for their patients.

Predisaster planning includes taking inventory of available space to expand ICU space, with the possibility that other areas within the hospital may need to become ICUs. When internal space is at capacity, external or remote ICU expansion and field hospitals may be needed.

Staffing considerations include the use of creative, tiered staffing models and just-in-time education for clinicians and support staff to quickly multiply the number of capable personnel under surge conditions.

In addition to space and personnel, facilities must identify supply and equipment needs and vulnerabilities. These include personal protective , redundant oxygen, ventilators, point-of-care ultrasound and emergency blood components. Some common critical care medications may be in short supply due to increased demand, while others, such as chemical weapon and nerve agent antidotes, may be needed only during specific types of disasters.

The article also addresses transfer and transport considerations that should be included with disaster plans, as well as anticipating the potential needs of special populations in the community.

The article is one of several published in the spring 2021 issue of the journal that provide updates in key areas of trauma patient care to assist advanced practice nurses and others in treating injured patients. Other articles in the symposia focus on:

• Traumatic brain injury
• Hemostatic strategies in trauma
• Critical care considerations for damage control in trauma patients
• Pain control in trauma patients, including minimizing opioid use