Evacuation of the ICU

King, Mary A.; Niven, Alexander S.; Beninati, William; Fang, Ray; Einav, Sharon; Rubinson, Lewis; Kissoon, Niranjan; Christian, Michael D.; Grissom, Colin K.

doi:10.1378/chest.14-0735

Cited by 39 publications

(14 citation statements)

References 66 publications

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“…While HMH’s response to the COVID-19 pandemic quickly paved the way for the full integration of the vICU with all its ICUs, more work is needed to improve preparedness for and resilience in future pandemics. In particular, frequent drills [ 12 ] and simulation training [ 13 ] have shown promise in preparing ICU staff for rare but high-consequence pandemic events. These efforts can focus on identifying necessary adjustments to staffing, layout, processes, and new use cases for vICU technology.…”

Section: Discussionmentioning

confidence: 99%

Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

Dhala¹,

Sasangohar²,

Kash³

et al. 2020

J Med Internet Res

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Background The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

Dhala¹,

Sasangohar²,

Kash³

et al. 2020

J Med Internet Res

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“…Recognizing that extreme emergencies, such as hurricanes and floods, might overwhelm a health-care facility’s ability to safely continue to care for patients, evacuation planning should be integrated into MCC emergency planning (see the “Evacuation of the ICU” article by King et al 30 in this consensus statement). 14,17,31,32 Hospitals are highly dependent on external infrastructure (eg, electricity, water, and communications) for basic functionality and patient safety, and backup systems have proven to be less than foolproof.…”

Section: Resultsmentioning

confidence: 99%

“…For example, in the aftermath of Hurricane Katrina (2005), approximately 45 patients are estimated to have died at a single hospital after hospital generators failed and patients were not evacuated to safety early enough. 6,33 Yet, evacuating medically complicated and fragile patients is complex and potentially dangerous to patients (see the “Evacuation of the ICU” article by King et al 30 in this consensus statement). 5 Contrasting the precautionary evacuations of hospitals in New York City before Hurricane Irene (2011) with the intraevent evacuations 1 year later during Hurricane Sandy (2012) demonstrates that a controlled, preplanned, collaborative evacuation may be safer than waiting to determine what to do in the midst of a disaster.…”

Section: Resultsmentioning

confidence: 99%

“…19 Consensus suggestions regarding details of evacuation of critically ill patients can be found (see the “Evacuation of the ICU” article by King et al 30 in this consensus statement). The failure of hospitals and jurisdictions to develop, implement, and coordinate adequate hospital evacuation plans can have serious legal, economic, and public health implications, including civil liability, sanctions, loss of accreditation, funding loss, access to care limitations, and stress on regional health-care systems.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Legal Preparedness

Courtney¹,

Hodge

Toner

et al. 2014

Chest

Self Cite

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BACKGROUND Significant legal challenges arise when health-care resources become scarce and population-based approaches to care are implemented during severe disasters and pandemics. Recent emergencies highlight the serious legal, economic, and health impacts that can be associated with responding in austere conditions and the critical importance of comprehensive, collaborative health response system planning. This article discusses legal suggestions developed by the American College of Chest Physicians (CHEST) Task Force for Mass Critical Care to support planning and response efforts for mass casualty incidents involving critically ill or injured patients. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS Following the CHEST Guidelines Oversight Committee’s methodology, the Legal Panel developed 35 key questions for which specific literature searches were then conducted. The literature in this field is not suitable to provide support for evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process resulting in seven final suggestions. RESULTS Acceptance is widespread for the health-care community’s duty to appropriately plan for and respond to severe disasters and pandemics. Hospitals, public health entities, and clinicians have an obligation to develop comprehensive, vetted plans for mass casualty incidents involving critically ill or injured patients. Such plans should address processes for evacuation and limited appeals and reviews of care decisions. To legitimize responses, deter independent actions, and trigger liability protections, mass critical care (MCC) plans should be formally activated when facilities and practitioners shift to providing MCC. Adherence to official MCC plans should contribute to protecting hospitals and practitioners who act in good faith from liability. Finally, to address anticipated staffing shortages during severe and prolonged disasters and pandemics, governments should develop approaches to formally expand the availability of qualified health-care workers, such as through using official foreign medical teams. CONCLUSIONS As a fundamental element of health-care and public health emergency planning and preparedness, the law underlies critical aspects of disaster and pandemic responses. Effective responses require comprehensive advance planning efforts that include assessments of complex legal issues and authorities. Recent disasters have shown that although law is a critical response tool, it can also be used to hold health-care stakeholders who fail to appropriately plan for or respond to disasters and pandemics accountable for resulting patient or staff harm. Claims of liability from harms allegedly suffered during disasters and pandemics cannot be avoided altogether. However, appropriate planning and l...

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“…The concept of crowd simulation was already studied in different forms [ 69 , 70 , 71 ]. While there are multiple models to simulate the evacuation of people during hazards, such as wildfires [ 72 , 73 ], earthquakes [ 74 ], and tsunamis [ 75 ], very little research can be found that directly addresses this issue during a pandemic or epidemic [ 76 ]. Therefore, developing such multi-hazard evacuation models is a missing link towards overall community resilience.…”

Section: Multi-hazard Evacuation Modelsmentioning

confidence: 99%

Living in a Multi-Risk Chaotic Condition: Pandemic, Natural Hazards and Complex Emergencies

Hariri-Ardebili

2020

IJERPH

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Humans are living in an uncertain world, with daily risks confronting them from various low to high hazard events, and the COVID-19 pandemic has created its own set of unique risks. Not only has it caused a significant number of fatalities, but in combination with other hazard sources, it may pose a considerably higher multi-risk. In this paper, three hazardous events are studied through the lens of a concurring pandemic. Several low-probability high-risk scenarios are developed by the combination of a pandemic situation with a natural hazard (e.g., earthquakes or floods) or a complex emergency situation (e.g., mass protests or military movements). The hybrid impacts of these multi-hazard situations are then qualitatively studied on the healthcare systems, and their functionality loss. The paper also discusses the impact of pandemic’s (long-term) temporal effects on the type and recovery duration from these adverse events. Finally, the concept of escape from a hazard, evacuation, sheltering and their potential conflict during a pandemic and a natural hazard is briefly reviewed. The findings show the cascading effects of these multi-hazard scenarios, which are unseen nearly in all risk legislation. This paper is an attempt to urge funding agencies to provide additional grants for multi-hazard risk research.

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Evacuation of the ICU

Cited by 39 publications

References 66 publications

Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

Legal Preparedness

Living in a Multi-Risk Chaotic Condition: Pandemic, Natural Hazards and Complex Emergencies

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