Devereaux Asha V, Tosh Pritish K, Hick John L, Hanfling Dan, Geiling James, Reed Mary Jane, Uyeki Timothy M, Shah Umair A, Fagbuyi Daniel B, Skippen Peter, Dichter Jeffrey R, Kissoon Niranjan, Christian Michael D, Upperman Jeffrey S
Chest. 2014 Oct;146(4 Suppl):e118S-33S. doi: 10.1378/chest.14-0740.
Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials.
A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process.
Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care.
The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.
重症监护病房（ICU）临床医生参与灾难准备工作受到时间限制和制度障碍的影响，且往往在灾难发生期间才进行。我们回顾了2007年至2013年4月的现有文献，以及关于大流行或灾难期间重症监护临床医生参与和教育的专家意见，并提出将ICU临床医生纳入规划和应对工作的建议。本文中的建议对所有参与应对有多名重症或受伤患者的大流行或大规模灾难的人员都很重要，包括一线临床医生、医院管理人员以及公共卫生或政府官员。
按照美国胸科医师学会（CHEST）共识声明制定方法进行了系统的文献综述并提出建议。我们评估了自2007年以来报道的文章、文件、报告和灰色文献。在对文献进行专家指导的分类和审查后，确定了关键优先领域和问题。未找到足够高质量的研究来做出基于证据的建议。因此，专家小组采用改良的德尔菲法提出了基于专家意见的建议。
根据基于文献的共识意见制定了23条建议。这些建议按以下主题要素分组：（1）态势感知，（2）临床医生的角色和职责，（3）教育，以及（4）社区参与。这四个要素共同构成了ICU临床医生有效参与大规模重症监护的基础。
要使ICU临床团队在应对大流行或灾难导致的大量重症患者时实现最佳参与，需要背离医院常规的独立运作系统。有效的应对需要强大的信息系统；临床医生、医院和政府组织之间的协调；相关利益攸关方在事件发生前的参与；以及重症监护临床医生教育和培训的标准化核心能力。
