Critical care clinics
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Critical care clinics · Oct 2019
ReviewDisaster Ethics: Shifting Priorities in an Unstable and Dangerous Environment.
Emergency and critical care medicine are fraught with ethically challenging decision making for clinicians, patients, and families. Time and resource constraints, decisional-impaired patients, and emotionally overwhelmed family members make obtaining informed consent, discussing withholding or withdrawing of life-sustaining treatments, and respecting patient values and preferences difficult. When illness or trauma is secondary to disaster, ethical considerations increase and change based on number of casualties, type of disaster, and anticipated life cycle of the crisis. This article considers the ethical issues that arise when health providers are confronted with the challenges of caring for victims of disaster.
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Critical care clinics · Oct 2019
ReviewPrinciples and Practices of Establishing a Hospital-Based Ebola Treatment Unit.
Outbreaks of Ebola virus disease and high-risk transmissible infections are increasing and pose threats to health care workers and global health systems. Previous outbreaks offer lessons for health system preparedness and response, including establishment of hospital-based high-risk pathogen treatment units. Their creation demands early preparation and interprofessional coordination; infection prevention and control; case management training; prepositioning of supplies; conversion of existing structures to treatment units; and strengthening communication and research platforms. Hospital-based Ebola and high-risk pathogen treatment units may improve case detection, interrupt transmission, and improve staff safety and patient care.
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Critical care teams can face a dramatic surge in demand for ICU beds and organ support during a disaster. Through effective preparedness, teams can enable a more effective response and hasten recovery back to normal operations. ⋯ Broad stakeholder input from within and outside the critical care team is necessary to avoid gaps in planning. Evaluation of critical care disaster plans require frequent exercises, with a mechanism in place to ensure lessons learned effectively prompt improvements in the plan.
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Critical care clinics · Oct 2019
ReviewBattling Superstorm Sandy at Lenox Hill Hospital: When the Hospital Is Ground Zero.
In preparation for Superstorm Sandy, the emergency control center at Lenox Hill Hospital (LHH) was activated. Patients were evacuated safely to increase hospital capacity, including increased critical care beds, hospital equipment and supplies, including ventilators. ⋯ NYU medical staff was granted Disaster Emergency privileges, credentialed at LHH, and oriented to LHH. NYU residents and fellows were added by the Office of Graduate Medical Education.
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Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. ⋯ Most terrorist and criminal activities that create a mass-casualty situation are performed using the weapons most readily available, such as firearms or explosives. A consistent pattern, comparing terrorism with interpersonal violence, is the greater severity of impact on the victim.