Resource-poor settings: Response, recovery, and research: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

James Geiling, Frederick M. Burkle, T. Eoin West, Timothy M. Uyeki, Dennis Amundson, Guillermo Dominguez-Cherit, Charles D. Gomersall, Matthew L. Lim, Valerie Luyckx, Babak Sarani, Michael D. Christian, Asha V. Devereaux, Jeffrey R. Dichter, Niranjan Kissoon, Task Force for Mass Critical Care

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

BACKGROUND: Planning for mass critical care in resource-poor and constrained settings has been largely ignored, despite large, densely crowded populations who are prone to suffer disproportionately from natural disasters. As a result, disaster response has been suboptimal and in many instances hampered by lack of planning, education and training, information, and communication. METHODS: The Resource-Poor Settings panel developed five key question domains; defining the term resource poor and using the traditional phases of the disaster cycle (mitigation/ preparedness/response/recovery). Literature searches were conducted to identify evidence to answer the key questions in these areas. Given a lack of data on which to develop evidence based recommendations, expert-opinion suggestions were developed, and consensus was achieved using a modified Delphi process. RESULTS: The five key questions were as follows: definition, capacity building and mitigation, what resources can we bring to bear to assist/surge, response, and reconstitution and recovery of host nation critical care capabilities. Addressing these led the panel to off er 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part I, Infrastructure/Capacity in the accompanying article, and part II, Response/Recovery/ Research in this article. CONCLUSIONS: A lack of rudimentary ICU resources and capacity to enhance services plagues resource-poor or constrained settings. Capacity building therefore entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is oft en needed to mount a surge response. Moreover, the disengagement of these responding groups and host country recovery require active planning. Future improvements in all phases require active research activities.

Original languageEnglish (US)
Pages (from-to)e168S-e177S
JournalCHEST
Volume146
DOIs
StatePublished - Oct 1 2014

Bibliographical note

Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts: Dr West receives research funding from the National Institutes of Health, the Wellcome Trust, the Doris Duke Charitable Foundation, the Defense Threat Reducation Agency, the Firland Foundation, and the Henry M. Jackson Foundation. The remaining authors report that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding Information:
FUNDING/SUPPORT: This publication was supported by the Cooperative Agreement Number 1U90TP00591-01 from the Centers of Disease Control and Prevention, and through a research sub award agreement through the Department of Health and Human Services grant Number 1 - HFPEP070013-01-00 from the Office of Preparedness of Emergency Operations. In addition, this publication was supported by a grant from the University of California–Davis.

Publisher Copyright:
© 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS.

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