Category Archives: Critically ill

Special Populations: Areas for Research

No data directly prove that transitioning to a crisis standard of care is the preferred method for preserving limited resources for special needs populations. Several publications discuss the general issues surrounding the use of crisis standards of care when resources are limited, but these discussions do not directly address outcomes, such as morbidity or mortality.
An example of implementation of a crisis standard of care occurred on the US Naval Ship Comfort during the aftermath of the Haitian earthquake on January 12, 2010. Having the only dialysis capability for the country after the earthquake, the influx of patients with renal failure and crush injuries stretched the dialysis capabilities onboard the 1,000-bed hospital ship. This prompted a dialyzer reuse protocol. Patient-designated dialysis filters were cleaned between treatments and reused for each patient. Priority was given to those with oliguric renal failure. Hyperkalemia was treated with bicarbonate-based IV fluids, oral binding agents, IV calcium, insulin, and glucose. Dual-lumen catheters were not available; therefore, separate central venous cannulae were used. There did not appear to be any long-term sequelae of this approach. It would be advantageous to have professional societies and stakeholders in the care of the special populations outlined in this article develop crisis standard of care guidelines based on the Institute of Medicine’s tenets. More info
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Special Populations: Therapeutic Considerations

Special Populations: Therapeutic ConsiderationsWe suggest local, regional, and national critical care pharmacists and resources be identified during disaster preparedness. We suggest access to critical care or specialist pharmacists and resources include consideration for special populations such as those with burns, cirrhosis, organ transplant, and need for dialysis.
We suggest pharmacists, especially those with critical care and specialty training, be an integral part of any mass critical care disaster team.
Local Pharmacist Disaster Response Teams have been developed along with integration of National Pharmacy Response Teams as part of the US Department of Health and Human Services National Disaster Medical System response teams. The American Society of Health-System Pharmacists has committed to help maintain emergency preparedness and just-in-time care, including maintenance of an electronic communications network of hospital pharmacy department directors that can be used to transmit urgent information related to emergency preparedness.

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Special Populations: Planning for Access to Regionalized Services for Special Populations

We suggest identification of regionalized centers and establishment of communication be included in mass critical care planning.
We suggest regional specialized centers have mass disaster plans in place that include easily accessible, multidimensional, round-the-clock expertise available for consultation by local providers during mass critical care events.
Some special populations of mass critical care may require early transfer to specialized centers to maximize outcomes so should be identified early.
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Special Populations: Special Population Planning

Special Populations: Special Population PlanningWe suggest critical care disaster planning include special populations.
Special populations suffered higher morbidity and mortality during recent disasters and have led governmental and nongovernmental organizations to include this group in disaster planning. For example, during Hurricane Katrina, 75% of all deaths occurred among elderly people, who comprised only 15% of the affected population. Forty-four percent of > 600 patients on chronic dialysis missed at least one session, and 17% missed three or more sessions with a concomitant increase in hospitalization postdisaster.
We suggest professional societies, advocacy groups, governmental, and nongovernmental organizations be consulted when planning special population disaster preparedness and just-in-time care.
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Special Populations: Defining Special Populations for Mass Critical Care

We suggest the definition of special populations for mass critical care be those patients that may be at increased risk for morbidity and mortality outside a fully functional critical care environment or those patients that present unique challenges to providers when a full complement of supportive services is not available. We include the chronically ill and technologically dependent as the fragility of their baseline health puts them at significant risk for progression to a higher level of medical need.
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Special Populations

Special PopulationsFifty-four million people with disabilities live in the United States, a group that is disproportionately vulnerable to disasters. In addition, many individuals have chronic health problems that are worsened by disaster conditions, particularly if they require supplemental oxygen, renal support, and mobility aids; are paralyzed; or are obese. These special populations are ill-defined, and planning for them is believed to be inadequate across a wide range of activities, pointing to a need for information to bolster disaster preparedness. Many issues that are potential barriers to care during a disaster have been identified. fully
Apart from a shortage of intensive care beds and qualified ICU personnel, patients who require a high nursing-to-patient ratio, advanced technologic interventions, or extra supportive care may cause additional strain on the capability of the ICU to continue to provide care to existing patients as well as incoming patients. The suggestions in this article are important for all who care for special populations both before and after a disaster or pandemic occurs, including front-line clinicians, hospital administrators, and public health or government officials. Although it is important for all providers to be familiar with the potential implications for a disaster or pandemic on special populations, Table 1 provides an overview of the suggestions of most interest to each group.
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