Hospital Crisis Response Requires Critical Care Readiness

Staffing, space, and supplies should be considered to integrate critical care-specific needs into disaster response planning, article says.

Disaster drills focus on the immediate aftermath of catastrophes—natural disasters, mass shootings, terrorism attacks—by 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," an article in the new issue of AACN Advanced Critical Care, explains how to integrate critical care-specific needs into sustained response planning, including expanding capacity for intensive care unit (ICU) beds, supplies and equipment, and the number of trained personnel.

"Hospitals need to have an ICU-specific disaster plan as part of their larger facility plan, due to the unique requirements for expansion of ICU space, staffing, supplies, and equipment," co-author John Gallagher, DNP, RN, CCNS, CCRN-K, TCRN, RRT, FCCM, says in a press release. "It's crucial that ICU providers anticipate challenges before an actual disaster."

Gallagher, a professor at the University of Pittsburgh School of Nursing, has responded to multiple mass casualty incidents in his nearly 30 years as a trauma nurse.

"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," says co-author Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM. "Thinking through the ramifications of an incident, preparing for worst-case scenarios, and practicing the response can literally save lives when a disaster happens."

Adamski, an assistant professor and director of the adult-gerontology acute care nurse practitioner program at Emory University's Nell Hodgson Woodruff School of Nursing, Atlanta, and a critical care nurse practitioner on the Cleveland Clinic critical care flight team, also has responded to mass casualty incidents. She also serves with Gallagher on the national board of directors for the American Association of Critical Care Nurses (AACN), which publishes the journal.

Predisaster planning includes inventorying space to expand ICU as needed. When ICU is full, external or remote ICU expansion and field hospitals may be needed, the article says.

Staffing considerations, particularly in sustained conditions, include the use of creative, tiered staffing models and just-in-time education for clinicians and support staff to quickly increase the number of capable personnel, the authors say.

"A tiered approach allows critical care providers to oversee a larger number of noncritical care providers who then provide direct care to the patients," they write. "In this model, an intensivist may oversee up to 4 nonintensivist providers, who, in turn, work with advanced practice providers experienced in critical care to treat a maximum of 24 critically ill patients."

Besides space and personnel, health systems and hospitals must identify supply and equipment needs and vulnerabilities. These include personal protective equipment (PPE), ventilators, redundant oxygen, point-of-care ultrasound, and emergency blood components.

They also must plan for transfer and transport considerations, the article says, as well as anticipating the potential needs of special populations within the community.