CHEST Guidelines-Evacuation-of-the-ICU

Evacuation-of-the-ICU_chest
Pdf Summary
The document is a CHEST Consensus Statement, focusing on the evacuation of Intensive Care Units (ICUs) during pandemics or disasters. It is authored by several experts and highlights the lack of training for critical care providers in performing safe ICU evacuations, even though there is a significant risk of harm during such events. The committee developed a series of expert opinion-based suggestions through a modified Delphi process after finding no high-quality studies to create evidence-based recommendations.

Key points include:

1. <strong>Evacuation Recommendations</strong>: A structured approach with 13 suggestions is proposed, emphasizing planning, preparation, and communication. This includes mutual-aid agreements between hospitals for redistributing critically ill patients and arrangements with transport agencies. 

2. <strong>Evacuation Timeline</strong>: A timeline is outlined for ICU evacuations, comprising three stages—no immediate threat, evacuation threat, and evacuation implementation. It’s vital for a Critical Care Team Leader (CCTL) to be designated through the Hospital Incident Command System to oversee evacuations.

3. <strong>Planning and Preparation</strong>: Preparation involves developing and regularly simulating emergency plans, considering staffing needs for evacuation, and preparing for critical care transport. A vertical evacuation plan using stairs may also be necessary for some critical patients.

4. <strong>Transportation and Equipment</strong>: The document proposes identifying specific transport resources for different patient categories and drills involving transport agencies. It suggests storing adequate ventilators suitable for use during emergencies that require flexible power and medical gas specifications.

5. <strong>Patient Prioritization and Logistics</strong>: Details on organizing the evacuation orderly, assessing which patients to transport first based on available time and resources, and ensuring patient data management with electronic and paper systems for tracking patients during evacuations. 

6. <strong>International Coordination</strong>: In events overwhelming local resources, national and international systems like the US National Disaster Medical System should be engaged.

Overall, the document argues for strategic, well-coordinated efforts and responsibility on the part of critical care providers to participate actively in safe evacuations, ensuring continuity of care during disasters.
Keywords
ICU evacuation
pandemics
disasters
critical care
Delphi process
transport agencies
mutual-aid agreements
evacuation planning
patient prioritization
emergency simulations