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Hospitalists key in organizing mass-emergency critical care

Emergency Management Alert, February 23, 2006

Reorganizing hospital function for
mass-emergency critical care

"Hospitalists need to bring their perspective to disaster planning...[It's] a perspective the rest of the hospital doesn't have."

So says Lewis Rubinson, MD, PhD, county health officer for the Deschutes County Health Department in Bend, OR, and an intensivist at Bend Memorial Clinic. Rubinson recently spoke to the editors of the HCPro newsletter, Hospitalist Program Management Guide (HPMG). The newsletter's focus is to help hospital financial administration manage information and measure hospital programs' quality and effectiveness.

As epidemiologists and health officials worldwide are carefully tracking flu cases to head off a potential deadly avian flu pandemic, the nation's hospitals must be prepared to modify the critical-care services they routinely provide in favor of offering "mass critical care" to the greatest possible number of patients, says Rubinson.

As a result, hospitalists-through their 24/7 presence in hospitals and their intimate knowledge about patient flow issues-could play a significant role in treating mass volumes of patients. At many facilities, hospitalists have not been included in epidemic or disaster preparedness planning for two primary reasons, according to Rubinson: Their specialty is new and inpatient populations are rarely the focus of disaster planning.

Historically, physicians and medical staff leaders from emergency medicine, mental health, radiology, and surgery departments have been the most active in planning for such events, he says.

Rubinson is one of 33 experts who comprise the Working Group on Emergency Mass Critical Care, which was organized by the Center for Biosecurity at the University of Pittsburgh Medical Center and the Society of Critical Care Medicine (SCCM), to give recommendations to hospital and clinical leaders on critical care services during bioterrorist attacks, epidemics, and other disasters. The group published its recommendations in the October 2005 issue of the SCCM's journal Critical Care Medicine. "Critical care surge capacity is the 'big white elephant' no one was talking about," Rubinson says.

Mark Ackermann, chief administrative officer at St. Vincent's Catholic Medical Center in New York, NY, and another member of the Working Group, agrees that the topic is one that has not been given adequate attention. He says that Americans must understand that in a pandemic-or in any disaster requiring mass critical care-patients will be prioritized based on age or severity of injury. "If they are beyond help, we will not be able to expend precious resources on treating these patients, other than making them comfortable." He adds that Israelis, for example, who are accustomed to living under the constant threat of terror and the resulting mass casualties, understand this, but that most Americans don't.

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