Resp Care
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Mass casualty and pandemic events pose a substantial challenge to the resources available in our current health care system. The ability to provide adequate oxygen therapy is one of the systems that could be out-stripped in certain conditions. Natural disasters can disrupt manufacturing or delivery, and pandemic events can increase consumption beyond the available supply. ⋯ Large-capacity oxygen concentrators and LOX systems may effectively provide support to alternative care sites or larger institutions. They may also be appropriate selections for governmental emergency-response scenarios. Careful consideration of the strengths and limitations of each of these options can reduce the impact of a mass casualty event.
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Mass casualty respiratory failure will lead to many challenges, not the least of which is safe and secure management of the victims' airways. These patients will be sicker than those typically managed in the operating room and will require more emergency management of their airways. ⋯ Planning for scenarios such as these will require consideration of personal protection for health care workers to minimize these risks. Understanding the risks involved and the airway techniques required for each possible scenario will be key to planning and preparation.
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Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. ⋯ Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective.
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This Journal conference was the first to be held with a live audience. After the final faculty presentation, and in lieu of a conference summary from the guest editors, the conference faculty had a discussion session that addressed written questions from the audience. The moderators, Lewis Rubinson and Rich Branson, reviewed the questions and addressed them either to specific conference faculty or to the entire conference faculty group. There were too many questions to address in the allotted time, so the moderators selected the questions they thought either most pertinent or most likely to be answerable.
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Mass-care events, such as pandemic influenza, could reach such devastating proportions that there will be the need to make difficult triage decisions that will ultimately result in the deaths or severe disability of patients in large numbers. The method by which we determine how triage of scarce health care resources will be performed must be clearly defined prior to a disaster event. ⋯ Development of triage policies in such an event should be developed in an open and transparent manner, be reasonable in design, include the views of the critical stakeholders, and be responsive to and provide a mechanism for accountability, with a clearly defined goal of the just triage of limited health care resources. Planning failure will result in increased deaths from poor triage processes and substantial mistrust of the health care system and its practitioners.