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Highly Accessed Review

Clinical review: Allocating ventilators during large-scale disasters – problems, planning, and process

John L Hick12*, Lewis Rubinson3, Daniel T O'Laughlin14 and J Christopher Farmer5

Author Affiliations

1 University of Minnesota Medical School, Minneapolis, MN, USA

2 Emergency Medicine MC 825, Hennepin County Medical Center, 701 Park Ave. S., Minneapolis, MN 55415, USA

3 Disaster Medicine Director, Public Health-Seattle & King County, 999 3rd Avenue, Suite 1200, Seattle, WA 98104, USA

4 Abbott Northwestern Hospital, 2925 Chicago Ave. S. Emergency Medicine, Minneapolis, MN 55407, USA

5 Mayo Clinic School of Graduate Medical Education. Division of Critical Care Medicine, Mayo Clinic, Rochester, MN USA 55905, USA

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Critical Care 2007, 11:217  doi:10.1186/cc5929

Published: 19 June 2007

Abstract

Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly as possible. If inadequate resources are available despite optimal incident management, a process that is evidence-based and as objective as possible should be used to allocate ventilators. The process and decision tools should be codified pre-event by the local and regional healthcare entities, public health agencies, and the community. A proposed decision tool uses predictive scoring systems, disease-specific prognostic factors, response to current mechanical ventilation, duration of current and expected therapies, and underlying disease states to guide decisions about which patients will receive mechanical ventilation. Although research in the specifics of the decision tools remains nascent, critical care physicians are urged to work with their health care facilities, public health agencies, and communities to ensure that a just and clinically sound systematic approach to these situations is in place prior to their occurrence.