ICU Response to a Pandemic

OVERVIEW

• A pandemic is a global outbreak of an infectious disease
• This page uses influenza virus as an example
• Other examples include coronaviruses such as SARS

ICU RESPONSE SUMMARY

• Activate ICU/Hospital pandemic plan, if available
• Liaison / pandemic planning with other departments within the hospital, ambulance services, ICUs of other hospitals and state department of health
• Surveillance and early detection of influenza patients
• Increase ICU bed capacity
• Increase ICU healthcare staffing levels
• Anticipated need for ICU equipment – identify where additional equipment can be resourced (ED, OR etc.)
• Infection control measures to reduce the spread to other patients and ICU staff
• Provision of antiviral prophylaxis / virus vaccine (if becomes available) for the staff
• Establish real-time communication link with laboratory and healthcare administration

ICU STAFFING AND BED CAPACITY

Increased ICU bed capacity:

• Opening additional beds in existing non-commissioned physical critical care bed spaces
• Defer elective surgery requiring post-operative ICU/HDU care
• Progressively convert HDU beds to Intensive Care
• Identify potential additional capacity for ICU ventilated beds in alternative clinical areas such as recovery, CCU, peri-operative units and respiratory units
• Discharge of suitable patients to other ward areas (with appropriate upgrade in medical/nursing support)
• Maximise the use of non-ventilatory strategies in care of ICU patients freeing up devices and equipment for patients for whom mechanical ventilation is essential
• Facilitate end-of-life discussions and decisions in those appropriate ICU patients assessed as not reaching a meaningful recovery
• Increase threshold for referral of patients for ICU from other hospitals
• Consider using available private hospital ICU capacity

Increased staffing:

• Increase nursing staff shift length (e.g. 8 to 12 hour shifts)
• Expansion of nursing capacity by increasing casual, agency or bank staff support
• Cancellation of leave for medical and nursing staff
• Provision of anti-viral prophylaxis and virus vaccine (if becomes available) to staff to reduce staff absenteeism due to sickness
• Train staff from other non-ICU monitored areas to provide intensive care
• Secondment of additional medical staff from elective duties (e.g. anaesthesia)
• Change in nurse:patient ratio to provide intensive care
• Allocation of pregnant / immuno-compromised staff to” non-flu” patients
• Train staff in the use of PPE

References and Links

LITFL

• CCC — SARS, MERS and the Coronaviruses
• CCC — Influenza

Journal articles

• Gomersall CD, Loo S, Joynt GM, Taylor BL. Pandemic preparedness. Curr Opin Crit Care. 2007 Dec;13(6):742-7. Review. PubMed PMID: 17975401.
• Harrigan PW, Webb SA, Seppelt IM, O’Leary M, Totaro R, Patterson D, Davies AR, Streat S. The practical experience of managing the H1N1 2009 influenza pandemic in Australian and New Zealand intensive care units. Crit Care Resusc. 2010 Jun;12(2):121-30. PubMed PMID: 20513221. [Free Full Text]
• Horvath JS, McKinnon M, Roberts L. The Australian response: pandemic influenza preparedness. Med J Aust. 2006 Nov 20;185(10 Suppl):S35-8. Review. PubMed PMID: 17115949. [Free Full Text]
• Morens DM, Taubenberger JK, Harvey HA, Memoli MJ. The 1918 influenza pandemic: lessons for 2009 and the future. Crit Care Med. 2010 Apr;38(4 Suppl):e10-20. doi: 10.1097/CCM.0b013e3181ceb25b. Review. PubMed PMID: 20048675; PubMed Central PMCID: PMC3180813.
• Sprung CL, et al; European Society of Intensive Care Medicine Task Force for Intensive Care Unit Triage during an Influenza Epidemic or Mass Disaster. Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Intensive Care Med. 2010 Mar;36(3):428-43. doi: 10.1007/s00134-010-1759-y. Epub 2010 Feb 5. Review. PubMed PMID: 20135090.

FOAM and web resources

• WHO — Pandemic influenza preparedness and response (2009) [pdf]