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      Assessing the Capacity of the US Health Care System to Use Additional Mechanical Ventilators During a Large-Scale Public Health Emergency

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          Abstract

          Objective

          A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use.

          Methods

          We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level.

          Results

          Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning.

          Conclusions

          The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems’ capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need. ( Disaster Med Public Health Preparedness. 2015;9:634–641)

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          Most cited references11

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          Health care workers' ability and willingness to report to duty during catastrophic disasters.

          Catastrophic disasters create surge capacity needs for health care systems. This is especially true in the urban setting because the high population density and reliance on complex urban infrastructures (e.g., mass transit systems and high rise buildings) could adversely affect the ability to meet surge capacity needs. To better understand responsiveness in this setting, we conducted a survey of health care workers (HCWs) (N =6,428) from 47 health care facilities in New York City and the surrounding metropolitan region to determine their ability and willingness to report to work during various catastrophic events. A range of facility types and sizes were represented in the sample. Results indicate that HCWs were most able to report to work for a mass casualty incident (MCI) (83%), environmental disaster (81%), and chemical event (71%) and least able to report during a smallpox epidemic (69%), radiological event (64%), sudden acute respiratory distress syndrome (SARS) outbreak (64%), or severe snow storm (49%). In terms of willingness, HCWs were most willing to report during a snow storm (80%), MCI (86%), and environmental disaster (84%) and least willing during a SARS outbreak (48%), radiological event (57%), smallpox epidemic (61%), and chemical event (68%). Barriers to ability included transportation problems, child care, eldercare, and pet care obligations. Barriers to willingness included fear and concern for family and self and personal health problems. The findings were consistent for all types of facilities. Importantly, many of the barriers identified are amenable to interventions.
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            ICU occupancy and mechanical ventilator use in the United States.

            Detailed data on occupancy and use of mechanical ventilators in U. S. ICU over time and across unit types are lacking. We sought to describe the hourly bed occupancy and use of ventilators in U.S. ICUs to improve future planning of both the routine and disaster provision of intensive care.
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              Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care.

              The Working Group on Emergency Mass Critical Care was convened by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Society of Critical Care Medicine to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack resulting in hundreds or thousands of critically ill patients. In these conditions, traditional hospital and clinical care standards in general, and critical care standards in particular, likely could no longer be maintained, and clinical guidelines for U.S. hospitals facing these situations have not been developed. The Working Group offers recommendations for this situation.
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                Author and article information

                Journal
                Disaster Med Public Health Prep
                Disaster Med Public Health Prep
                DMP
                Disaster Medicine and Public Health Preparedness
                Cambridge University Press (New York, USA )
                1935-7893
                1938-744X
                09 October 2015
                December 2015
                : 9
                : 6
                : 634-641
                Affiliations
                [1 ] Food and Drug Administration, Silver Spring, Maryland
                [2 ] Department of Health and Human Services, Assistant Secretary for Preparedness and Response, Washington, DC
                [3 ] Centers for Disease Control and Prevention , Atlanta, Georgia
                [4 ] IEM Inc, Morrisville, North Carolina
                [5 ] Pardee Rand Graduate School , Santa Monica, California.
                Author notes
                Correspondence and reprint requests to Adebola Ajao, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993 (e-mail: adebola.ajao@ 123456fda.hhs.gov ).
                Article
                S1935789315001056 00105
                10.1017/dmp.2015.105
                4636910
                26450633
                15437d69-4905-42fe-a5ce-a9aa7f587e81
                © Society for Disaster Medicine and Public Health, Inc. 2015

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means subject to acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Page count
                Figures: 1, Tables: 3, Pages: 8
                Categories
                Original Research

                pandemic,public health emergency,surge capacity,mechanical ventilators,model

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