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A quick primer for setting up and maintaining surgical intensive care in an austere environment: Practical tips from volunteers in a mass disaster

Randeep S. Jawa, MD, Jagtar S. Heir, DO, David Cancelada, MD, David H. Young, MD, David W. Mercer, MD

Abstract


The provision of critical care in any environment is resource intensive. However, the provision of critical care in an austere environment/mass disaster zone is particularly challenging.While providers are well trained for care in a modern intensive care unit, they may be underprepared for resource-poor environments where there are limited or unfamiliar equipment and fewer support personnel. Based primarily on our experiences at a field hospital in Haiti, we created a short guide to critical care in a mass disaster in an austere environment. This guide will be useful to the team of physicians, nurses, respiratory care, logistics, and other support personnel who volunteer in future critical care relief efforts in limited resource settings.

Keywords


intensive care, austere, disaster, oxygen, mechanical ventilation

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References


CDC: Post-earthquake injuries treated at a field hospital—Haiti, 2010.Weekly, January 7. Morbidity and Mortality Weekly Report. 2011; 59(51): 1673-1677.Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5951a1.htm. Accessed February 4, 2011.

Ginzburg E, O’Neill WW, Goldschmidt-Clermont PJ, et al.: Rapid medical relief—Project Medishare and the Haitian earthquake. N Engl J Med. 2010; 362: e31.

Dulski TM, Basavaraju SV, Hotz GA, et al.: Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January-May 2010. Am J Disaster Med. 2011; 6(5): 275-284.

Kacmarek RM: Delivery systems for long-term oxygen therapy. Respir Care. 2000; 45(1): 84-92.

Barillo DJ, Renz E, Broger K, et al.: An emergency medical bag set for long-range aeromedical transportation. Am J Disaster Med. 2008; 3(2): 79-86.

Rice DH, Kotti G, Beninati W: Clinical review: Critical care transport and austere critical care. Crit Care. 2008; 12(2): 207.

Hick JL, Rubinson L, O’Laughlin DT, et al.: Clinical review: Allocating ventilators during large-scale disasters—Problems, planning, and process. Crit Care. 2007; 11(3): 217.

Mareiniss DP, Levy F, Regan L: ICU triage: The potential legal liability of withdrawing ICU care during a catastrophic event. Am J Disaster Med. 2011; 6(6): 329-338.

Sperry JL, Minei JP, Frankel HL, et al.: Early use of vasopressors after injury: Caution before constriction. J Trauma. 2008; 64(1): 9-14.

Kopp JB, Ball LK, Cohen A, et al.: Kidney patient care in disasters: Emergency planning for patients and dialysis facilities. Clin J Am Soc Nephrol. 2007; 2(4): 825-838.

Vanholder R, Borniche D, Claus S, et al.: When the earth trembles in the Americas: The experience of Haiti and Chile 2010. Nephron Clin Pract. 2011; 117(3): c184-c197.

Kost GJ, Sakaguchi A, Curtis C, et al.: Enhancing crisis standards of care using innovative point-of-care testing. Am J Disaster Med. 2011; 6(6): 351-368.

Grathwohl KW, Venticinque SG.: Organizational characteristics of the austere intensive care unit: The evolution of military trauma and critical care medicine; applications for civilian medical care systems. Crit Care Med. 2008; 36(7 Suppl): S275-S283.

Halpern P, Rosen B, Carasso S, et al.: Intensive care in a field hospital in an urban disaster area: Lessons from the August 1999 earthquake in Turkey. Crit Care Med. 2003; 31(5): 1410-1414.

Etienne M, Powell C, Amundson D: Healthcare ethics: The experience after the Haitian earthquake. Am J Disaster Med. 2010; 5: 141-147.

Rosborough S: A tale of two responses: Haiti earthquake highlights the need for training in international disaster response. Disaster Med Public Health Prep. 2010; 4(1): 21-23.

Farfel A, Assa A, Amir I, et al.: Haiti earthquake 2010: A field hospital pediatric perspective. Eur J Pediatr. 2011; 170(4): 519-525.

Madei WF, Klieser HP: Intensive care medicine in the German Field Hospital during the implementation force mission in Trogir, Croatia. Mil Med. 2000; 165(6): 445-448.

Kreiss Y, Merin O, Peleg K, et al.: Early disaster response in Haiti: The Israeli field hospital experience. Ann Intern Med. 2010; 153(1): 45-48.

Merin O, Ash N, Levy G, et al.: The Israeli field hospital in Haiti—Ethical dilemmas in early disaster response. N Engl J Med. 2010; 362(11): e38.




DOI: https://doi.org/10.5055/ajdm.2012.0097

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