EXECUTIVE SUMMARY

Critical care often is overlooked in disaster planning. Risk managers should ensure this component is fully included.

  • Critical care must ramp up quickly in a disaster, the same as the emergency department.
  • Include critical care in full drills, not just tabletop exercises.
  • Liability risks are amplified when critical care is not adequately involved.

Critical care often is overlooked when planning for mass casualties and disasters, according to two researchers whose recent work suggests experts from that field should be included in such preparations.

During a disaster, the staffing for intensive care may need to increase quickly, says Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM, director of the Adult-Gerontology Acute Care Nurse Practitioner Program and assistant professor at Emory University. That means a disaster plan should include tactics for mobilizing staff and expanding access to critical care.

“That should not be done on the fly. The plan should include how to notify staff, where additional patients should be placed, how to obtain additional equipment,” she says. “A consistent approach is what we aim for, with job action sheets in each unit or department to guide people in the first few hours as far as who’s in charge and what their duties are, until you can get some more resources mobilized.”

Many hospitals do not have a good way to notify critical care staff of a disaster operation, says John J. Gallagher, DNP, RN, CCNS, CCRN-K, TCRN, RRT, FCCM, professor in the department of acute and tertiary care at the University of Pittsburgh School of Nursing. The focus usually is on the emergency department (ED) and the trauma bay, with disaster drills typically including hands-on examples there but leaving other departments, including critical care, to use tabletop exercises.

“With critical care and the ICU, it’s often just a phone call asking how many patients you can take, or telling you to make three beds and how are you going to do that. They don’t have to actually make three beds, so you don’t get a chance to encounter the real problems that can pop up,” he says. “That’s a problem because when it really goes down, people don’t know what to do.”

Gallagher and Adamski recently published a report on how to better include critical care considerations in disaster planning.1 Gallagher says risk managers should include critical care in the hazard vulnerability analysis, a typical component of disaster planning that identifies potential weak spots in infrastructure and other issues.

Critical care is a type of treatment rather than a physical department in the hospital, Adamski says. Disaster planning should include tactics for turning additional spaces into ICU space. Many hospitals learned these lessons from the COVID-19 pandemic.

“The biggest concern we saw was with staffing. Even when we expanded into additional spaces, there were a lot of staff who had to be trained to work in the ICU,” she says. “That is a huge problem for risk management if people are just thrown into these areas. A part of the planning should include tools and resources to get these people up to speed quickly.”

Critical care professionals also can be helpful with overall disaster planning because they are used to dealing with seriously ill, dying patients on a regular basis, Adamski says. Even ED professionals see many low-acuity patients, so they might not be as finely attuned to the needs of critical patients in high volume. Critical care professionals could reveal some blind spots in disaster planning.

Risk managers also should be concerned about critical care in a disaster situation because caregivers are not acting under typical conditions and expectations, Gallagher says. There can be a misconception that once a patient makes it through the ED during a disaster, the rest of that patient’s care is normal. It often is not.

“You’re operating at crisis levels. People are doing things they don’t normally do, we’re not documenting the way we normally would, and the standard of care goes out the window because you can’t maintain it,” he says. “There is going to be someone who comes around to Monday-morning quarterback and bring litigation because something didn’t happen. You have to be prepared for that and include critical care in those disaster drills so that you can adopt strategies that minimize the potential for problems.”

REFERENCE

  1. Gallagher JJ, Adamski J. Mass casualties and disaster implications for the critical care team. AACN Adv Crit Care 2021;32:76-88.

SOURCES

  • Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM, Adult-Gerontology Acute Care Nurse Practitioner Program Director and Assistant Professor, Emory University, Atlanta. Phone: (404) 727-4102. Email: jennifer.adamski@emory.edu.
  • John J. Gallagher, DNP, RN, CCNS, CCRN-K, TCRN, RRT, FCCM, Professor, Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh. Email: jjg135@pitt.edu.