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Will Your Institution Be Ready if Disaster Strikes?

Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement released

By: Dr. Jeffrey R. Dichter

9/11 and Hurricane Katrina exposed the vulnerabilities in our health-care system’s ability to respond to a mass disaster. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002  provided both financial assistance and focus in helping our health-care system move toward effectively providing care to potentially large numbers of patients and/or casualties. In 2008, the publication of the CHEST consensus statement, Definitive Care for the Critically Ill During a Disaster, represented a landmark contribution to uniform disaster preparedness by providing foundational principles of disaster planning for large numbers of critically ill patients.

However, there have been many devastating global disasters including two major tsunamis in Indonesia and Japan and numerous earthquakes (notably in Haiti, affecting thousands of people in vulnerable settings). We have seen significant illnesses due to the pandemic, H1N1, and now the recent outbreak of Ebola that is crippling some African health-care systems. The 2014 Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement updates and greatly expands the scope of disaster planning for large numbers of critically ill patients with over 300 suggestions for disaster preparedness. The core disaster topics of hospital surge capacity, triage, and ethics have been updated. In addition, this publication addresses for the first time other important issues, including ICU evacuation; system level planning, the disaster needs of special populations, business and continuity of operations; legal principles; provider engagement and education; and a strong focus on disaster planning for resource-poor areas.

Experts from throughout the world met in Chicago in 2012 to address the important questions to be addressed. Though there is only a limited amount of randomized controlled data available in disasters, this consensus statement used a scientific process developed by CHEST to obtain the highest quality consensus suggestions from many of the world’s foremost experts on caring for critically ill patients in a disaster. 

There is no question that this document is an authoritative resource, which will greatly advance disaster planning both in the United States and internationally. Recent disasters, such as Hurricane Sandy (which affected New York City in 2012) and the Boston Marathon bombing in 2013, have again demonstrated why disaster planning for large numbers of critically ill patients is so important and timely. 

The 2014 Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement is intended primarily for clinicians and hospital administrators responsible for disaster preparedness planning and providing care in a disaster but also addresses key issues of importance to government officials at local, state, and national levels.

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Dr. Jeffrey R. Dichter has been involved in disaster medicine for more than a decade. He served as an executive committee member for the 2014 Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement, in addition to the 2008 publication Definitive Care for the Critically Ill During a Disaster. He has also co-authored other disaster medicine publications.

Dr. Dichter is an intensivist trained in internal medicine and critical care medicine. His current position is medical director for intensive care at Unity Hospital, a part of the Allina Health system in Minneapolis, Minnesota. His professional expertise also includes development of inpatient clinical programs, including critical care and hospitalist practices. He has served in many leadership positions, including being a past president of the Society of Hospital Medicine.