ICU Management & Practice, ICU Volume 9 - Issue 3 - Autumn 2009

Disaster: Are you prepared?

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DISASTER: A heading that covers a myriad of problems, reactions, plans that have failed to come to fruition, sometimes natural, uncontrollable- other times purposeful and deliberate. Whether it be a natural eventhurricane, earthquake, flood or wild fire; an accidentplane crash, bridge collapse, ferry capsizing; or an intentional act- bomb explosion, arson, mass shooting, biological warfare, the result and the manner of response should and must remain the same. Responders must act quickly, in an organised and well-planned fashion in an attempt to utilise resources and ultimately save the lives of as many as possible in what may well become a mass casualty situation.

ARE YOU PREPARED? Even carefully laid plans made by emergency departments and intensive care units or those based on national or international guidelines can sometimes fail to suffice in the heart of a mass casualty event. As recent events have shown, governments and federal agencies are not always in control of the actual implementation of these plans, and it often falls to those in the front-lines: on the scene, in the ER / trauma bay and ICU. In this issue of ICU Management, we attempt to delve into issues of planning at a hospital level and touch on a number of techniques used in emergency rooms, trauma centres and intensive care units around the world.

In this issue, paramedics Mike Clumpner and Jim Mobley discuss front-line planning for a range of disasters and remind us of recent events and lessons learned. Prof. Weiss brings his experiences from a level one trauma centre in Israel to an article on the importance of process control in mass casualty events. Professors Amir Khorram-Manesh and Martin Wahl from Sweden discuss disaster preparedness given the current ongoing challenges (economic and resourcebased) in our hospitals, and management of a pandemic in our ICUs, respectively. In the management section, Prof. Örtenwall pushes further on the topic, by delving into the value of surge capacity in a cost-effective healthcare system.

Within the Matrix, you will find a number of enlightening articles - from the conclusion of Dr. Malbrain's article on the polycompartment syndrome to Mary Kay Bader's detailed description of the positive results of utilising nurse-directed protocols in the ICU. We are also pleased to bring you the first in a three-part series on early mobilisation of critically ill patients. In this article, Radha Korupolu and her team from Johns Hopkins will discuss patient screening and safety issues.

We feature Mexico in our Country Focus this issue - a somewhat timely choice given the cover story of this issue and the country's recent management of the outbreak of the H1N1 virus. In addition to the usual overview of healthcare and intensive care in his country, Prof. Vazquez de Anda has kindly agreed to share his first hand experiences with the influenza epidemic in his country.

It has been oft said "To fail to plan is to plan to fail", and undoubtedly in these uncertain times of both global economic strife and political unease, we in the healthcare realm must assuredly make plans for events which are in most cases unpredictable and unexpected.

DISASTER: A heading that covers a myriad of problems, reactions, plans that have failed to come to fruition, sometimes natural, uncontrollable- other time

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