Epistemic_Statements  

CORD-19:3cf7bf4d0a1cbe9a6fa635ddbeb3e20c9728cc2f JSONTXT 11 Projects

Annnotations TAB TSV DIC JSON TextAE

Id Subject Object Predicate Lexical cue
T1 0-207 Epistemic_statement denotes Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations* From a Task Force for Mass Critical Care Summit 9S 14S Definitive Care for the Critically Ill During a Disaster
T2 218-369 Epistemic_statement denotes In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care.
T3 370-580 Epistemic_statement denotes However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response.
T4 581-833 Epistemic_statement denotes This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles.
T5 834-1049 Epistemic_statement denotes Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions.
T6 1305-1329 Epistemic_statement denotes (CHEST 2008; 133:8S-17S)
T7 1331-1528 Epistemic_statement denotes M ass casualty events occur frequently worldwide 1 ; fortunately, the majority of these do not generate overwhelming numbers of critically ill or injured victims requiring definitive critical care.
T8 1669-1820 Epistemic_statement denotes [3] [4] [5] [6] [7] [8] [9] In 2004, an analysis 10 of US critical care disaster response identified major limitations to respond to serious epidemics.
T9 1821-1977 Epistemic_statement denotes In light of the increasing consternation about a potential influenza pandemic, 11, 12 an updated review of critical care response capabilities is warranted.
T10 2084-2253 Epistemic_statement denotes 13 A number of efforts are underway to meet this need, but detailed guidance regarding how to provide critical care for large volumes of patients remains underdeveloped.
T11 2368-2539 Epistemic_statement denotes The Task Force steering committee members (listed in the Appendix) were fairly certain that current critical care surge capacity for disasters had a number of limitations.
T12 2540-2717 Epistemic_statement denotes However, the specific strengths and weaknesses of critical care response capabilities must be delineated to best inform development of novel strategies to augment critical care.
T13 3269-3413 Epistemic_statement denotes 16 -18 Disaster plans have assumed that critical care resources will be available when needed, 5 and generally this assumption has been correct.
T14 3414-3636 Epistemic_statement denotes However, with the anticipation of large volumes of critically ill patients in future disasters, some believe that hospital capacity, and in particular critical care capability, will be a major limiting factor for survival.
T15 3637-3764 Epistemic_statement denotes 15, 19 Numerous authorities have forecast scenarios that will result in large numbers of critically ill and injured casualties.
T16 3984-4169 Epistemic_statement denotes If such events occur, the demand on critical care resources will be multiple orders of magnitude greater than previous emergencies experienced in the past half century in North America.
T17 4170-4379 Epistemic_statement denotes The experience with the severe acute respiratory syndrome in Toronto, although not a mass casualty event, stands as example where critical care can prevent deaths even for a disease lacking specific treatment.
T18 4380-4512 Epistemic_statement denotes In the absence of critical care, the case fatality rate in Toronto would have been more than triple (20%) the observed rate of 6.5%.
T19 4513-4596 Epistemic_statement denotes 20 This lesson may have profound import were a serious influenza pandemic to occur.
T20 4597-4748 Epistemic_statement denotes Further, the effectiveness of community mitigation as well as the utility and availability of antivirals to forestall serious illness remain uncertain.
T21 4749-4874 Epistemic_statement denotes 21, 22 Many people, particularly high-risk groups, may have critical illness 23 and without critical care will assuredly die.
T22 4875-5105 Epistemic_statement denotes If critical illness directly or indirectly resulting from influenza is not uniformly fatal with essential critical care services, then availability of life-sustaining interventions may have a profound impact on community survival.
T23 5183-5402 Epistemic_statement denotes Illness developing after exposures to chemicals, 25 infection with serious pathogens, and exposure to radiologic materials are all likely to result in life-threatening clinical conditions, such as severe sepsis or ARDS.
T24 5740-5991 Epistemic_statement denotes [33] [34] [35] [36] [37] [38] Unlike the duration of surge demands on emergency departments (EDs) in mass casualty incidents, which are often measured in units of minutes or hours, the critical care response may need to be sustained for days to weeks.
T25 6280-6483 Epistemic_statement denotes 39 Similarly, following the 2005 London bombings, the major incident lasted in the ED lasted 3 h and 14 min, yet the average length of stay for the critically injured was 12.4 days (range, 6 to 22 days).
T26 6484-6682 Epistemic_statement denotes 16, 40 Complications seen in the critically ill or injured, such as ARDS, prolong recovery times in ICU 16, [41] [42] [43] and should be anticipated in planning for future mass critical care events.
T27 7080-7263 Epistemic_statement denotes Although a rather simplistic conceptual approach, one can confidently state that a system that fails to meet any one of these requirements will not be able to cope with a large surge.
T28 7850-8238 Epistemic_statement denotes Proposals to train hundreds of volunteers to provide manual ventilation to patients during a pandemic are naïve and fraught with serious logistical and scientific shortfalls, such as the lack of staff or volunteers during bioevents as well as the risk of secondary transmission to the caregivers who must remain at the bedside and the adverse consequences of prolonged manual ventilation.
T29 8801-9021 Epistemic_statement denotes If several local hospitals require additional ventilators, rental supplies may be insufficient to meet need, as it is common for vendors to contract to provide the same finite pool of ventilators to several institutions.
T30 9216-9362 Epistemic_statement denotes Based on these data, at least 10,000 full-feature ventilators are likely available across the United States at any time for use during a disaster.
T31 9363-9495 Epistemic_statement denotes This predicted available national mechanical ventilator quantity may at first seem reassuring, but it also has potential to mislead.
T32 9593-9779 Epistemic_statement denotes Thousands of ventilators may be available at hospitals nationwide, yet an affected community requiring just hundreds of additional devices may not be able to get them in a timely manner.
T33 9780-10004 Epistemic_statement denotes Also, published and unpublished models of varying sophistication portend there will still be a large gap between the total number of ventilators required during the peak of a serious influenza pandemic and available devices.
T34 10596-10946 Epistemic_statement denotes For some events, these devices, together with staff augmentation strategies, may allow for many additional patients to survive (see "Definitive Care for the Critically Ill During a Disaster: A Framework for Optimizing Critical Care Surge Capacity" and "Definitive Care for the Critically Ill During a Disaster: Medical Resources for Surge Capacity").
T35 10947-11313 Epistemic_statement denotes For more catastrophic events, these additional ventilators may be beneficial but still insufficient to serve all in need; in such cases, scarce mechanical ventilators will need to be allocated to those patients who are prioritized (see "Definitive Care for the Critically Ill During a Disaster: A Framework for Allocation of Scarce Resources in Mass Critical Care").
T36 11526-11724 Epistemic_statement denotes 55 Of the typically "consumable" medical supplies required for the provision of critical care some may have the potential for limited disinfection and reuse in a disaster when no alternative exists.
T37 11832-11939 Epistemic_statement denotes However, oxygen remains a critical consumable resource which has a limited supply and distribution network.
T38 12001-12068 Epistemic_statement denotes If this source runs low, oxygen must be trucked in from a supplier.
T39 12069-12210 Epistemic_statement denotes The number of suppliers of medical grade oxygen in North America is limited as are the number of tanker trucks available to transport oxygen.
T40 12211-12404 Epistemic_statement denotes Portable oxygen supplies for use during an infrastructure failure or in 12S off-site critical care facilities are very limited, inefficient and not included in the strategic national stockpile.
T41 12937-13023 Epistemic_statement denotes In the past, staff shortages have not typically been a major problem during disasters.
T42 13024-13152 Epistemic_statement denotes 62 However, a report 7 revealed that staffing can be a problem, with staff absenteeism during a disaster ranging from 10 to 60%.
T43 13153-13403 Epistemic_statement denotes The authors 7 described disasters that were prolonged, were of a type rare for the community, or impacted the personal lives of employees (ie, school closures, day-care closures, or elder-care issues) were associated with higher rates of absenteeism.
T44 13479-13616 Epistemic_statement denotes 63, 64 In bioevents, staff may fail to report for duty for a variety of reasons, including fear of infection or infecting their families.
T45 13617-13895 Epistemic_statement denotes [63] [64] [65] [66] Although volunteers often converge on disaster-stricken communities, 67,68 rarely do these volunteers possess the skills necessary to provide critical care; and even if they do, rapidly verifying credentials during a disaster can be logistically challenging.
T46 14079-14324 Epistemic_statement denotes 3, 4, 69 A study 70 of other physician groups report that preparedness for bioterrorism or public health emergencies are particular areas of weakness, and deficiencies in training to respond to mass casualty events are not limited to physicians.
T47 14325-14453 Epistemic_statement denotes Hospital administrators, who are often called on to lead the response in a health-care facility, also lack appropriate training.
T48 14638-14808 Epistemic_statement denotes As a result, there are limited areas in which critical care can be provided on a routine basis outside of current critical care areas (ICU, postanesthesia care unit, ED).
T49 15122-15245 Epistemic_statement denotes 50 Demands on critical care resources are expected to increase in both the United States and Canada as the populations age.
T50 15246-15424 Epistemic_statement denotes 75 On a day-to-day basis, additional capacity can be created in the critical care system by expanding critical care to areas of the hospital such as the postanesthesia care unit.
T51 15425-15517 Epistemic_statement denotes However, this expansion is still limited by the issues of stuff and staff discussed earlier.
T52 15518-15779 Epistemic_statement denotes Therefore, even though the bed spaces may be available to use for critical care, if the hospital rents its ventilators and has no more on site, the ability to expand critical care remains limited unless specific advanced planning and preparation are undertaken.
T53 15780-16129 Epistemic_statement denotes Finally, although it is possible to convert off-site locations 17, 53 (ie, hotels, gymnasiums, sports fields) into medical treatment facilities, the ability to convert such areas to critical care facilities on a large scale is curtailed because of the functional requirements and logistical challenges, such as large-volume portable oxygen supplies.
T54 16130-16330 Epistemic_statement denotes While unlimited stockpiles of medical equipment could mitigate the shortfall of critical care resources during a disaster, this is not a realistic solution in part because of the costs of stockpiling.
T55 16528-16701 Epistemic_statement denotes This cost does not take into account the cost of the financing to purchase the stockpile or the potential returns from alternative investments those funds could be used for.
T56 16923-17021 Epistemic_statement denotes Thus the cost is substantial, imposing significant fiscal limitations on the ability to stockpile.
T57 17022-17141 Epistemic_statement denotes Therefore, a balance must be struck between service provision today and preparation for potential events of the future.
T58 17200-17363 Epistemic_statement denotes One option most health-care facilities consider when they are overwhelmed is to seek help from outside, either by transferring patients out or having help sent in.
T59 17364-17625 Epistemic_statement denotes 14 Generally, if a health-care facility elects to transport a patient to another hospital for ongoing treatment because it does not have the ability or resources to manage that patient, it is the responsibility of the sending facility to arrange transportation.
T60 17626-17750 Epistemic_statement denotes However, this is often difficult to do during a disaster when ambulances are occupied with the ongoing prehospital response.
T61 17751-17946 Epistemic_statement denotes Moreover, most areas will not have a sufficient number of dedicated critical care transport teams to evacuate large numbers of critically ill; thus, regular critical care staff would be required.
T62 17947-18163 Epistemic_statement denotes This would take critical care staff away from the hospital during transport and would be an inefficient use of valuable staff (ie, 2:1 or 3:1 registered nurse/respiratory technician/ medical doctor-to-patient ratio).
T63 18471-18961 Epistemic_statement denotes 76 Although the Department of Defense is capable of transporting critically ill patients, 5,77 its ability to do so is has been estimated at 81 patients in 54 h. Civilian ground, aeromedical rotor-wing, and fixed-wing assets may assist, if not dedicated to the on-scene major incident response, but the total number of aircraft in the United States is limited (eg, 800 civilian rotor-wing aircraft), 78 and all are designed for the transport of one to two critically ill patients at a time.
T64 18962-19198 Epistemic_statement denotes This limited capacity certainly is not sufficient to move large surges of critically ill patients; nor is it likely that these transport assets from outside regions will be available during the first 12 to 24 h of a mass casualty event.
T65 19401-19501 Epistemic_statement denotes Depending on the situation, assistance can come from the local, regional/ state, or national levels.
T66 19626-19829 Epistemic_statement denotes 53 This type of an arrangement can be very useful in the event of small surge situations, but is not helpful in the type of mass casualty scenario where all hospitals in a local area will be overwhelmed.
T67 19941-20153 Epistemic_statement denotes 79 The NDMS was created to address civilian disasters and military contingencies in which there might be a large number of casualties that cannot be accommodated by the Departments of Defense or Veterans Affairs.
T68 20489-20691 Epistemic_statement denotes 80 However, there are significant concerns that the system is not equipped to respond to an event involving large numbers of critically ill patients, particularly a biological event, such as a pandemic.
T69 20855-21250 Epistemic_statement denotes While it may be possible to piece together a team or two of available volunteers from a distant unaffected area to respond to a geographically isolated event, it will be a significant challenge to find enough available DMAT members to meet the needs of many communities during a widespread event, such as an influenza pandemic or simultaneous terrorist attacks in major cities across the nation.
T70 21251-21348 Epistemic_statement denotes For disasters in which DMATs are available, another limitation is their critical care capability.
T71 21866-21938 Epistemic_statement denotes Because of logistic issues, deployment typically may take hours to days.
T72 22028-22201 Epistemic_statement denotes 27 However, unlike many less acutely injured patients in past disasters, critically ill patients are unlikely to survive without care while awaiting the arrival of the team.
T73 22202-22384 Epistemic_statement denotes Although great strides have been made to prepare the health-care system to respond to disaster, these plans fall short for mass casualty events with a large number of critically ill.
T74 22561-22770 Epistemic_statement denotes Were a mass casualty critical care event to occur tomorrow, many people with clinical conditions that are survivable under usual health-care system conditions might have to forgo life-sustaining interventions.