Cupp O Shawn, Predmore Brad G
Department of Logistics and Resource Operations, US Army Command and General at Staff College, Fort Leavenworth, Kansas, USA.
Am J Disaster Med. 2011 Jul-Aug;6(4):243-54. doi: 10.5055/ajdm.2011.0063.
The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). The first step in this planning process is the development of specific triage requirements during an influenza pandemic. The second step is identification of logistical resources required during such a pandemic, which are then analyzed within the proposed logistics science and art model for planning purposes. Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients.
本文讨论了医疗服务提供者面临的复杂性和挑战，以及他们为提供基本物资以满足流感大流行后勤需求所做的努力。供应链、规划以及应对不可避免的短缺的替代方案是与这种紧急大规模重症护理情况相关的一些考虑因素。本文详细讨论了此类事件的规划过程和支持措施，并借鉴了文献中的若干建议以及近期大规模伤亡事件（MCI）的经验。该规划过程的第一步是制定流感大流行期间的具体分诊要求。第二步是确定此类大流行期间所需的后勤资源，然后在为规划目的而提出的物流科学与艺术模型中对这些资源进行分析。该模型中突出的资源包括劳动力的分配和使用、床位、重症监护病房资产、呼吸机、个人防护设备和氧气。第三步是使用该模型详细讨论可能的变通方法、合适的替代品和资源分配。本文还审视了在大规模伤亡事件背景下围绕姑息治疗的伦理问题，以及不可避免地决定这些关键资产对姑息治疗患者进行配给和优先分配的因素。
