Matzo Marianne, Wilkinson Anne, Lynn Joanne, Gatto Maria, Phillips Sally
Sooner Palliative Care Institute, University of Oklahoma, Oklahoma City, 73117, USA.
Biosecur Bioterror. 2009 Jun;7(2):199-210. doi: 10.1089/bsp.2009.0017.
Catastrophic mass casualty events, such as pandemic flu outbreaks or large-scale terrorism-related events, could yield thousands of victims whose needs would overwhelm local and regional healthcare systems, personnel, and resources. Such conditions will require deploying scarce resources in a manner that is different from the more common single-event disaster. This article introduces the topic of palliative care during a mass casualty event and reviews the major findings for a federally funded planning guide that examined palliative care issues associated with providing medical care under circumstances where resources are scarce. We focus on the role of palliative care in the support of individuals not expected to survive and offer recommendations of specific actions for a coordinated disaster response plan. Semistructured telephone discussions with disaster management experts and a group meeting of experts identified issues, roles, responsibilities, procedures, and resources that offer the benefits of integrating palliative care into disaster planning and response. The investigations identified 5 domains of concern, along with guidance: (1) the role of palliative care in a mass casualty event with resulting scarce resources; (2) the triage and ensuing treatment decisions for those "likely to die"; (3) the critical palliative care services to provide, along with the personnel and settings; (4) the pragmatic plans needed for ensuring training, supplies, and organizational or jurisdictional arrangements; and (5) unusual issues affecting palliative care under mass casualty event scenarios. Palliative care minimizes the suffering of those who die, ensures comfort, addresses their needs, and may also free up resources to optimize survival of others. Planning to provide palliative care during mass casualty events should be part of the current state and local disaster planning/training guidelines, protocols, and activities.
灾难性大规模伤亡事件，如大流行性流感爆发或与恐怖主义相关的大规模事件，可能导致数千名受害者，其需求将使当地和地区的医疗系统、人员和资源不堪重负。这种情况将需要以不同于更常见的单事件灾难的方式部署稀缺资源。本文介绍了大规模伤亡事件中的姑息治疗主题，并回顾了一份由联邦资助的规划指南的主要发现，该指南研究了在资源稀缺情况下提供医疗护理时与姑息治疗相关的问题。我们关注姑息治疗在支持预计无法存活的个体方面的作用，并为协调的灾难应对计划提供具体行动建议。与灾难管理专家进行的半结构化电话讨论以及一次专家小组会议确定了将姑息治疗纳入灾难规划和应对的益处的问题、角色、责任、程序和资源。调查确定了5个关注领域以及指导意见：（1）在资源稀缺的大规模伤亡事件中姑息治疗的作用；（2）对那些“可能死亡”者的分诊及后续治疗决策；（3）需要提供的关键姑息治疗服务以及人员和场所；（4）确保培训、物资供应以及组织或管辖安排所需的务实计划；（5）大规模伤亡事件场景下影响姑息治疗的特殊问题。姑息治疗可将死者的痛苦降至最低，确保舒适，满足他们的需求，还可能释放资源以优化其他人的生存几率。在大规模伤亡事件期间提供姑息治疗的规划应成为当前州和地方灾难规划/培训指南、协议及活动的一部分。
