Mechanical Ventilation in Mass Casualty Scenarios

Mechanical Ventilation in Mass Casualty ScenariosHospitals have long responded to acute multiple-casualty events, which lead to short-lived chaos followed by a more organized medical response and rapid health-system recovery.There has been increasing recognition, though, that events can occur that require a prolonged response for many critically ill patients.These disasters will require a well-coordinated regional and extra-regional medical response, and in-patient surge capacity will be much more needed than for past events.At the same time, the past decades have seen a contraction in United States hospital beds, shrinking hospital operating margins, just-in-time purchasing, and staff shortages, which now seriously limit in-patient surge capacity.Disasters leading to mass casualty respiratory failure (MCRF), such as a severe influenza pandemic, will undoubtedly tax hospital, local, regional and possibly even national critical care capacity.MCRF represents a scenario where insufficient numbers of intensive care unit beds and ventilators might result in deaths from normally survivable illness.In an MCRF response, respiratory therapists (RTs) will play an important role in ventilator management, the appropriate utilization of equipment, and the coordination of staffing and care.Just as importantly, RTs must participate in pre-event planning for MCRF and, in particular, decisions related to treatment space, medical equipment, staffing, and personal protection for MCRF response.The role of the RT in MCRF is, of course, as part of the health care team, working in concert with intensivists, critical care nurses, pharmacists, other critical care professionals, and hospital administrators.This conference on mass casualty care was organized in an attempt to summarize the current state of mechanical ventilation for mass casualty scenarios.The co-chairs wanted this conference to highlight current best efforts related to key critical care surge capacity elements.The presentations on potential threats focused on crucial situational features relevant to MCRF that must be considered to adequately respond to such disasters.The conference was fortunate to have included a host of experts from a variety of backgrounds, all of whom have previously contributed to the literature in mass casualty care.The task of framing the issue was aptly handled by Christian Sandrock, who described the challenge of febrile respiratory illness, and Pete Muskat, who described chemical agents capable of causing an MCRF.