Geiling James, Burkle Frederick M, Amundson Dennis, Dominguez-Cherit Guillermo, Gomersall Charles D, Lim Matthew L, Luyckx Valerie, Sarani Babak, Uyeki Timothy M, West T Eoin, Christian Michael D, Devereaux Asha V, Dichter Jeffrey R, Kissoon Niranjan
Chest. 2014 Oct;146(4 Suppl):e156S-67S. doi: 10.1378/chest.14-0744.
Planning for mass critical care (MCC) in resource-poor or constrained settings has been largely ignored, despite their large populations that are prone to suffer disproportionately from natural disasters. Addressing MCC in these settings has the potential to help vast numbers of people and also to inform planning for better-resourced areas.
The Resource-Poor Settings panel developed five key question domains; defining the term resource poor and using the traditional phases of disaster (mitigation/preparedness/response/recovery), literature searches were conducted to identify evidence on which to answer the key questions in these areas. Given a lack of data upon which to develop evidence-based recommendations, expert-opinion suggestions were developed, and consensus was achieved using a modified Delphi process.
The five key questions were then separated as follows: definition, infrastructure and capacity building, resources, response, and reconstitution/recovery of host nation critical care capabilities and research. Addressing these questions led the panel to offer 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part 1, Infrastructure/Capacity in this article, and part 2, Response/Recovery/Research in the accompanying article.
Lack of, or presence of, rudimentary ICU resources and limited capacity to enhance services further challenge resource-poor and constrained settings. Hence, capacity building entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is needed to mount a surge response. Moreover, planning should include when to disengage and how the host nation can provide capacity beyond the mass casualty care event.
尽管资源匮乏或受限地区人口众多，极易在自然灾害中遭受重创，但针对这些地区的大规模重症护理（MCC）规划在很大程度上被忽视了。在这些地区解决大规模重症护理问题有可能帮助大量人口，也能为资源更丰富地区的规划提供参考。
资源匮乏地区小组确定了五个关键问题领域；通过界定资源匮乏的概念，并运用灾害的传统阶段（减灾/备灾/应对/恢复），进行文献检索以找出回答这些领域关键问题的证据。鉴于缺乏用以制定循证建议的数据，于是提出了专家意见建议，并采用改良的德尔菲法达成共识。
随后，这五个关键问题被分为以下几类：定义、基础设施与能力建设、资源、应对以及东道国重症护理能力与研究的重建/恢复。对这些问题的探讨使小组提出了33条建议。由于建议数量众多，结果被分为两个部分：本文的第1部分，基础设施/能力，以及随附文章的第2部分，应对/恢复/研究。
基本重症监护资源的匮乏或存在，以及进一步提升服务的有限能力，给资源匮乏和受限地区带来了更大挑战。因此，能力建设需要预防策略并加强初级卫生服务。需要其他国家和组织的援助来展开应急响应。此外，规划应包括何时撤离，以及东道国如何在大规模伤亡护理事件之后提供相关能力。
