Airway Management During a Mass Casualty Event

Mass casualty respiratory failure will lead to many challenges, not the least of which is safe and secure management of the victims ariways. These patients will be sicker than those typically managed in the operating room and will requiere more emergency management fo their ariways. Mass casualty incidents involving biological or chemical agents will pose the addittional risk of exposure to pathogen. During the severe acute respiratory syndrome epidemic in Toronto, airway manipulation was clearly identified as the procedure most associated with risk to health care workers. Planning for scenarios such as these will require consideration of personal protection for health care workers to minimize these risks. Understanting the risk involved and the airway techniques required for each possible scenario will be key to planning and preparation. (AU)

Ethical Issues in Resource Triage

Mass-care events, such as pandemic influenza, could reach such devasting proportions that there will be the need to make difficult triage decisions that will ultimately result in the deaths or severe disability of patients in large numbers. The method by wich we determine how triage of scarce health care resources will be performed must be clearly defined prior to a disaster event. This paper will discuss several of the ethical principles that must be weighed in developing a mass-care triage plan, as well as steps to facilite its implementation. Development of triage policies in such an event should be developed in an open and transparent manner, be reasonable in design, include the views of the critial stakeholders, and be responsive to and provide a mechanism for accountability, with a clearly defined goal of the just triage of limited health care resources. Planning failure will result in increased deaths from poor triage processes and substantial mistrust of the health care system and ist practitioners. (AU)

Mechanical Ventilation in Mass Casualty Scenarios: Augmenting Staff: Project XTREME

Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacactions. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective. (AU)