Resp Care
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This Journal conference was the first to be held with a live audience. After the final faculty presentation, and in lieu of a conference summary from the guest editors, the conference faculty had a discussion session that addressed written questions from the audience. The moderators, Lewis Rubinson and Rich Branson, reviewed the questions and addressed them either to specific conference faculty or to the entire conference faculty group. There were too many questions to address in the allotted time, so the moderators selected the questions they thought either most pertinent or most likely to be answerable.
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Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. ⋯ Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective.
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Mass-care events, such as pandemic influenza, could reach such devastating proportions that there will be the need to make difficult triage decisions that will ultimately result in the deaths or severe disability of patients in large numbers. The method by which we determine how triage of scarce health care resources will be performed must be clearly defined prior to a disaster event. ⋯ Development of triage policies in such an event should be developed in an open and transparent manner, be reasonable in design, include the views of the critical stakeholders, and be responsive to and provide a mechanism for accountability, with a clearly defined goal of the just triage of limited health care resources. Planning failure will result in increased deaths from poor triage processes and substantial mistrust of the health care system and its practitioners.
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Mechanical ventilation in a situation of mass casualty respiratory failure will require a substantial increase in the capacity for mechanical ventilation, to prevent unnecessary mortality. Concern over the difficulties of treating large numbers of patients with respiratory failure is exceeded only by our lack of experience on which to base decisions. This review evaluates the likely scenarios that could lead to mass casualty respiratory failure and the types of respiratory failure anticipated. ⋯ Matching the degree of respiratory impairment anticipated from the most likely mass casualty scenarios allows conclusions to be drawn regarding the performance characteristics of ventilators required for these situations. Little is known about the success of mechanical-ventilator stockpiling for mass casualty respiratory failure. Careful planning with an emphasis on matching ventilator performance to patient need and caregiver skill is critical to appropriate stockpile choices.
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Acquiring a resupply of critical medical assets following a national emergency will be crucial to saving lives. The Strategic National Stockpile is a national repository of various medications, vaccines, antidotes, and medical/surgical equipment that would be used to augment federal, state, and local public health agencies in the event of a terrorist attack or other public health emergency. ⋯ A state that requires these assets initiates a request for federal assistance through established guidelines. This paper provides an overview of the Strategic National Stockpile, the types of ventilators and ancillary equipment currently available, and the process for requesting these assets.