News and Highlights

August 2014

CHEST Releases Guide to Care of the Critically Ill and Injured During Pandemics and Disasters

Dr. Nathaniel Hupert Is Task Force Member and Co-Author of Report

The American College of Chest Physicians (CHEST) released Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement in the Online First section of the journal CHEST. It was developed by the Task Force for Mass Critical Care, comprising over 100 clinicians and experts from more than nine countries representing a broad variety and scope of clinical fields, who met in Chicago in 2012. It offers the latest evidence-informed suggestions on how to best prepare and manage the critically ill and injured during large-scale disasters and pandemics. The statement was released early as a response to the current Ebola outbreak in West Africa.

“The rigorously developed set of suggestions made by an unparalleled group of experts who comprise the CHEST Task Force for Mass Critical Care are intended to support bedside critical care providers, hospital administrators, public health officials, and government planners,” said Richard S. Irwin, MD, Master FCCP, Editor in Chief of the journal CHEST.

Matthew Press, MD, MSc

One of the task force members was Nathaniel Hupert, MD, MPH, Associate Professor of Healthcare Policy and Research at Weill Cornell Medical College and Senior Medical Advisor to the Biomedical Advanced Research and Development Authority (BARDA) of the Office of the Assistant Secretary for Preparedness and Response (ASPR), U.S. Department of Health and Human Services (DHHS). He is a co-author of the statement chapter titled “System Level Planning, Coordination, and Communication: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement.” The authors of this section developed and grouped suggestions for system-level planning according to certain thematic elements: 1) National government support of healthcare coalitions/Regional Health Authorities; 2) Teamwork within healthcare coalitions and Regional Health Authorities; 3) Systems level communication; 4) System level surge capacity and capability; 5) Pediatric patients and special populations; 6). Healthcare coalitions, Regional Health Authorities and networks: 7). Models of advanced regional care systems: and 8) The use of simulation for preparedness and planning. “Systems level planning is essential to provide care for large numbers of critically ill patients due to disaster or pandemic,” they write. “It also entails a departure from the routine, independent system and involves all levels from healthcare institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.”

The first version of the CHEST mass critical care consensus statement was released in 2008. Following publication, the recommendations were employed during the 2009 H1N1 influenza pandemic in Mexico City and following the earthquake in Haiti; they also helped with triage during Hurricane Sandy. The new statement updates and greatly expands the scope of disaster planning for large numbers of critically ill patients. It also integrates suggestions and considerations for the management of children impacted by large-scale events because they represent at least a quarter of most nations’ populations. The statement provides key suggestions on integration of hospitals with providers to expand bed capacity to maximally care for potentially large numbers of patients and to provide triage resources for patients under extreme shortages and also includes systems planning, business continuity, legal framework, provider education, and ethical considerations that facilitate the provision of this care. Suggestions are also provided for partnerships and improving capacity for disasters and pandemics in the developing world where resources are chronically depleted.


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