Definitive care for the critically ill during a disaster: A framework for allocation of scarce resources in mass critical care - From a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL

被引：118

作者：

Devereaux, Asha V. ^{[1
]}

Dichter, Jeffrey R. ^{[2
]}

Christian, Michael D. ^{[3
]}

Dubler, Nancy N. ^{[4
]}

Sandrock, Christian E. ^{[5
]}

Hick, John L. ^{[6
]}

Powell, Tia ^{[7
]}

Geiling, James A. ^{[8
,9
]}

Amundson, Dennis E. ^{[10
]}

Baudendistel, Tom E. ^{[11
]}

Braner, Dana A. ^{[12
]}

Klein, Mike A. ^{[7
]}

Berkowitz, Kenneth A. ^{[13
,14
]}

Curtis, J. Randall ^{[15
]}

Rubinson, Lewis ^{[16
]}

机构：

[1] Sharp Coronado Hosp, Coronado, CA USA

[2] Presbyterian Hosp, Albuquerque, NM USA

[3] Mt Sinai Hosp, Univ Hlth Network, Toronto, ON M5G 1X5, Canada

[4] Montefiore Med Ctr, New York, NY USA

[5] Univ Calif Davis, Davis, CA 95616 USA

[6] Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA

[7] New York State Task Force Life & Law, New York, NY USA

[8] White River Junct VA Med Ctr, Hanover, NH USA

[9] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Hanover, NH 03756 USA

[10] USN, Med Ctr, San Diego, CA 92152 USA

[11] Calif Pacific Med Ctr, Geraldine Brush Canc Res Inst, San Francisco, CA 94115 USA

[12] Oregon Hlth & Sci Ctr, Portland, OR USA

[13] VHA Natl Ctr Eth Hlth Care, New York, NY USA

[14] NYU, Sch Med, New York, NY USA

[15] Harborview Med Ctr, Seattle, WA USA

[16] Univ Washington, Seattle, WA 98195 USA

来源：

CHEST | 2008年 / 133卷 / 05期

关键词：

critical care; disaster; ethics; health-care rationing; health-care worker; palliative medicine; posttraumatic stress; triage;

D O I：

10.1378/chest.07-2693

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Anticipated circumstances during the next severe influenza pandemic highlight the insufficiency of staff and equipment to meet the needs of all critically ill victims. It is plausible that an entire country could face simultaneous limitations, resulting in severe shortages of critical care resources to the point where patients could no longer receive all of the care that would,usually be required and expected. There may even be such resource shortfalls that some patients would not be able to access even the most basic of life-sustaining interventions. Rationing of critical care in this circumstance would be difficult, yet may be unavoidable. Without planning, the provision of care would assuredly be chaotic, inequitable, and unfair. The Task Force for Mass Critical Care Working Group met in Chicago in January 2007 to proactively suggest guidance for allocating scarce critical care resources. Task Force suggestions: In order to allocate critical care resources when systems are overwhelmed, the Task Force for Mass Critical Care Working Group suggests the following: (1) an equitable triage process utilizing the Sequential Organ Failure Assessment scoring system; (2) the concept of triage by a senior clinician(s) without direct clinical obligation, and a support system to implement and manage the triage process; (3) legal and ethical constructs underpinning the allocation of scarce resources; and (4) a mechanism for rapid revision of the triage process as further disaster experiences, research, planning, and modeling come to light.

引用

页码：51S / 66S

页数：16

共 56 条

[1]

[Anonymous], 2007, NERDC year basic education curriculum (Basic technology) for JS, P1

[2] Reliability and accuracy of sequential organ failure assessment (SOFA) scoring [J].