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.
Regionalization of specialized care is increasing as designated trauma centers, pediatric hospitals, and burn centers are becoming more commonplace. Regionalization to specialized centers decreases costs, alleviates the need for local stockpiling of specialized supplies, concentrates expertise, and may decrease morbidity and mortality. However, the ability of the regional center to accept mass critical care special populations may be limited because many of these centers run at near capacity normally. For example, burns require specific expertise within the first few days to have the best outcome. The approximate 1,800 burn beds in the United States run at 95% capacity. Understanding this limitation has led specialty centers to develop regional burn disaster plans that accommodate transfers and are a resource for just-in-time care. Use of websites and mobile phone applications of guidelines has also been suggested and developed worldwide. BurnMed (developed by The Johns Hopkins University) and MBC Burn Care (developed by the Euro-Mediterranean Council for Burns and Fire Disasters) are two examples of mobile applications for burn care. We suggest triage and resource allocation of special populations adhere to the same resource allocation strategy and process as the general population.
Societal norms, whether by moral, ethical standards or legislation, mandate that individuals be treated equally and not influenced by disability, race, gender, perceived value to society, age, creed, culture, or resource. In mass critical care, triage and resource allocation should be based on triage guidelines for the general population as outlined in the “Triage” article by Christian et al and “Ethical Considerations” article by Daugherty Biddison et al in this consensus statement.