Steinlage Arnold J, Steinlage Corinne B, Curell Angela M
School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Mil Med. 2023 May 16;188(5-6):132-137. doi: 10.1093/milmed/usac434.
The rationing of medical resources became a common practice during the SARS-CoV-2 (COVID-19) pandemic. To cope with overwhelming patient numbers, hospitals were forced to adopt "crisis standards of care" (CSC) guidelines, which allow physicians to navigate the task of rationing health care resources in both an effective and ethically sound manner. The Military Health System currently has clinical guidelines for mass casualty incident (MCI) triage but lacks deployed Role 3 intensive care unit (ICU) CSC guidelines. In future peer and near-peer conflicts, this gap may prove detrimental when thousands of casualties following a single battle create a continuous and prolonged mass casualty event. The challenges of providing critical care in a battlefield hospital during a large conflict are unique and numerous, but lessons from COVID-19 ICUs such as transitioning to a utilitarian ethic, clear definitions, decision points, and decision authorities, as well as the establishment of clinical practice guidelines formulated from evidence-based protocols, can better prepare the U.S. expeditionary medical force for future conflicts. A battlefield CSC will allow military critical care physicians and nurses to manage overwhelmed ICUs and make better triage decisions, allowing them to provide a higher quality of care to the collective. In this commentary, we explore the need for Wartime CSC in the battlefield Role 3 ICU and the tools and methods used by civilian and military institutions to create and enact CSCs throughout the COVID-19 pandemic.
在严重急性呼吸综合征冠状病毒2（新冠病毒）大流行期间，医疗资源的配给成为一种常见做法。为应对患者数量过多的情况，医院被迫采用“危机护理标准”（CSC）指南，该指南使医生能够以有效且符合道德规范的方式应对医疗资源配给任务。军事卫生系统目前有针对大规模伤亡事件（MCI）分诊的临床指南，但缺乏部署在战地的三级重症监护病房（ICU）的CSC指南。在未来的同等及近似同等冲突中，当一场战斗造成数千人伤亡从而形成持续且长时间的大规模伤亡事件时，这一差距可能会产生不利影响。在大型冲突期间，在战地医院提供重症护理面临着独特且众多的挑战，但新冠病毒ICU的经验教训，如转向功利主义伦理、明确的定义、决策点和决策权威，以及制定基于循证方案的临床实践指南，能够让美国远征医疗队更好地为未来冲突做好准备。战地CSC将使军事重症护理医生和护士能够管理不堪重负的ICU并做出更好的分诊决策，从而为集体提供更高质量的护理。在这篇评论中，我们探讨了战地三级ICU中战时CSC的必要性，以及民用和军事机构在整个新冠病毒大流行期间创建和实施CSC所使用的工具和方法。
