Within an effective command and control system to coordinate regional response, surge capacity in critical care depends on three crucial elements: (1) “stuff,” medical equipment and supplies; (2) “staff,” appropriately trained health professionals to competently care for critically ill and injured patients; and (3) “space,” the physical location suitable for safe provision of critical care. Although a rather simplistic conceptual approach, one can confidently state that a system that fails to meet any one of these requirements will not be able to cope with a large surge. Medical response to disasters, including the critical care response, is dependent on a number of non-clinical medical institution services (eg, logistics and procurement, environmental services, food services) and external services (eg, transportation, consistent functional utilities, commerce infrastructure). For expediency, this article will focus on critical care-specific capabilities.
Mechanical ventilators are unique to the critical care environment, and they are essential equipment for the management of respiratory failure. There are no realistic substitutes for ventilators. Proposals to train hundreds of volunteers to provide manual ventilation to patients during a pandemic are naive and fraught with serious logistical and scientific shortfalls, such as the lack of staff or volunteers during bioevents as well as the risk of secondary transmission to the caregivers who must remain at the bedside and the adverse consequences of prolonged manual ventilation.