Disaster Medicine Training in Family Medicine: A Review of the Evidence

Este artículo presenta la revisión de las experiencias en apoyo a la formación de desastre en una variedad de escenarios. La evidencia publicada acerca de la mejora de los resultados educativos y orientada al paciente, arroja como resultado que la capacitación de desastres en general, o de determinadas modalidades educativas, es débil

Oxygen Supplies During a Mass Casualty Situation

Mass casualty and pandemic events pose a substantial challege to the resources available in our current health care system. The ability to provide adequate oxygen therapy is one of the systems that could be out-stripped in certain conditions. Natural disasters can disrupt manufacturing or delivery, and pandemic events can increase consumption beyond the available supply. Patients may require manual resuscitation, basic oxygen therapy, or positive-pressure ventilation during these scenarios. Available sources of oxygen include bulk liquid oxygen systems, compressed gas cylinders, portable liquid oxygen (LOX) systems, and oxygen concentrators. The last two are available in a variety of configurations, which include personal and home systems that are suitable for individual patients, and larger systems that can provide oxygen to multiple patients or entire institutions. Bulk oxygen system are robust and are probably sustainable during periods of high consumption, but are at risk if manufacturing or delivery is disrupted. Compressed gas cylinders offer support during temporary periods of need but are no a solution for extended periods of therapy. Personal oxygen concentrators and LOX systems are limited in their application during mass casualty scenarios. Large-capacity oxygen concentrators and LOX system may effectively provide support to alternative care sites or large institutions. They may also be appropriate selections for governmental emergency-response scenarios. Careful consideration of the strengths and limitations of each of these options can reduce the impact of a mass casualty event. (AU)

Modified Critical Care and Treatment Space Considerations for Mass Casualty Critical Illness and Injury

Mass critical care events are increasingly likely, yet the resource challenges to augment everyday, unrestricted critical care for a surge of disaster victims are insurmountable for nearly all communities. In light of these limitations, an expert panel defined a circumscribed set of key critical are interventions that they believed could be offered to many additinal people and yet would also continue to offer substantial life-sustaining benefits for nommribund critically ill and injured people. They proposed Emergency Mass Critical Care, wich is based in the set of key interventions and includes recommendations for necessary surge medical equipment, treatment space characteristics, and staffing competencies for mass critical care response. To date, Emergency Mass Critical Care is untested, and the real benefits of implementation remain uncertain. Nonetheless, Emergency Mass Critical Care currently remains the only comprehensive construct for mass critical care preparedness and response. This paper reviews current concepts to provide life-sustaining care for hundreds or thousands of people outside of traditional critical care sites.

Definitive Care for the Critically III During a Disaster: Medical Resources for Surge Capacity

Background: Mass numbers of critically ill disaster victims will stress the abilities of health-care system to maintain usual critical care servicies for all in need. To enhance the number of patients who can receive life-sustaining interventions, the Task Force on Mass Critical Care (hereafter termed the Task Force) has suggested a framework for providing limited, essential critical care, termed emergency mass critical care (EMCC). This article suggests medical equipment, concepts to expand treatment spaces, and staffing models for EMCC. Methods: Consensus suggestions for EMCC were derived form published clinical practice guidelines and medical resource utilization data for the everyday critical care conditions that are anticipated to predominate during mass critical care events. When necessary, expert opinion was used. Task force major suggestions: The Task Force makes the following suggestions (1) one mechanical ventilator that meets specific characteristics, as well as a set of consumable and durable medical equipment, should be provided for each EMCC patient; (2) should be provided in hospitals or similarly equipped structures; after ICUs, postanesthesia care units, and emergency depatments all reach capacity, hospital locations should be repurposed for EMCC in the following order: (A) step-down units and large procedure suites, (B) telemetrh units, and (C) hospital ward; and (3) hospitals can extend the provision of critical care using non-critical care personnel via deliberate model of delegation to match staff competencies with patient needs. Discussion: By using the Task Force suggestions for adequate supplies of medical equipment, appropiate treatment space, and trained staff, communities may better prepare to deliver augmented essential critical care in response to disasters. (AU)

Resuscitation medicine including the management of severe trauma

Resuscitation potentials have documented for everyday emergency medical services, multicasualty incident type disasters, and conventional wars. Resuscitation potentials in mass disasters, like major earthquakes, are highly suspect; for nuclear power plant accidents are unknown but must be prepared for; and for nuclear war are zero. Modelling studies are needed to evaluate the cost-effectiveness for resuscitative preparedness for major industrial disaster, earthquakes, volcanic explosions, floods, storms, major fires and other mass disasters. Resuscitation medicine, if applied with reason and compassion, by trying to achieve useful survival for as amny victims as possible, should be considered not only on the basis of numerical results, but also for its philosophical impact. Medicine in general and resuscitation medicine in particular represent an imposition of human values on thr species-orientayed random processes nature on earth (AU)