key: cord-0882182-fd1o0kl3
authors: Proulx, Jasmine; Russell, Katherine; Gallant, Julien; Krmpotic, Kristina
title: Provision of critical care in austere conditions: staff, supplies and space
date: 2021-06-18
journal: Intensive Care Med
DOI: 10.1007/s00134-021-06456-5
sha: 777ee502c8844717d0b19d8cba91d03dc2e749e5
doc_id: 882182
cord_uid: fd1o0kl3

nan

conditions. Capacity for respiratory isolation and climate control were highlighted. Equipoise was noted between adherence to the detail-oriented quality routines of established critical care units and inevitable modifications. No studies of actual events reported the need to make triage decisions related to limitations of therapy, but no scenarios were as devastating as the COVID-19 pandemic. Proudfoot et al. do not describe whether NHL adhered to routine protocols, or if compromises were (understandably) necessary with the significant strain on resources.

When local resources are overwhelmed following a natural disaster or mass casualty event, preparedness for evacuation and patient diversion may be adequate [3] . Local epidemics may be supported sufficiently by surge capacity planning for staff, supplies, and space, with contingency response (100% above baseline) similarly relying on regional collaboration [3, 4] . However, the COVID-19 pandemic has taught us that these strategies are insufficient when healthcare infrastructure is compromised on a wider scale. Surge crisis response (200% above baseline) requires mobilization of national and sometimes international aid [3, 4] . The worldwide nature of this disaster has resulted in an inability to access these resources. Even in well-prepared areas, maximal surge capacity has been exceeded due to high case rates and the prolonged nature of the pandemic. This has resulted in provision of critical care under austere conditions, including field hospitals staffed by non-critical care trained healthcare providers, and resource allocation necessitating reverse triage. There is much to be learned from studying the rapid mobilization of resources and provision of critical care in austere environments such as NHL and those identified by our review. In the future, we can be better prepared for global pandemic response.

Rapid establishment of a COVID-19 critical care unit in a convention Centre: the Nightingale Hospital London experience

What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine

Introduction and executive summary: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Surge capacity logistics: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

We thank librarian Jackie Phinney for assistance in developing the search strategy and reviewing the manuscript.

The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s00134-021-06456-5. Author contributions JP and KK designed the study. JP developed the search strategy. JP, KR, and JG screened articles and extracted data. All authors contributed to the interpretation of data. JP and KK drafted the manuscript. All authors critically reviewed the manuscript and approved the final version.

No specific funding was provided for this study.

The authors declare that they have no conflicts of interest.

This study did not require ethics approval.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Accepted: 7 June 2021