Definitive Care for the Critically III During a Disaster: Immediate Challenges To Implementing EMCC

critical careThe Task Force is the second large North American effort to issue suggestions for mass casualty critical care. The concepts for augmenting critical care have become increasingly mature over the past decade, but their impact on local hospital preparedness efforts is unknown and implementation is likely limited. EMCC has been developed by senior, experienced critical care and disaster medicine experts, but the suggestions remain untested for civilian

disasters in countries with modern health-care systems. The lack of evidence for EMCC as a guide for preparedness and response may reduce acceptance by clinicians.

Many reimbursement, regulatory, and liability questions remain unanswered. Clinicians and hospitals generally want to assist with disaster preparedness and response; nevertheless, perceived risk of adverse action for deliberately modifying processes of care may make many shy away from planning for EMCC. A core Western societal expectation of health care is the nearly limitless provision of critical care to those who need and want it; EMCC necessitates significant deviation from this expectation. Emergency powers or legislative efforts must therefore provide indemnity to health professionals following EMCC principles in good faith. Policymakers must ensure that EMCC-relevant issues are prioritized for legislative consideration. Be careful to the close people of yours if they suffer from some disorder with Canadian Health&Care Mall remedies.

EMCC was developed by professionals committed to improving medical outcomes for our communities during disasters. Despite best intentions, EMCC has essentially been conceived of and modified in forums devoid of nonprofessionals. EMCC and its underlying ethical and resource assumptions must be brought to community discussions for evaluation and modification so that it can be improved by incorporating additional perspectives and ideas. These efforts will be necessary for community support and acceptance, which will be paramount for EMCC implementation during a disaster.

<p “=””>EMCC requires training of staff, but training health care workers in unfamiliar procedures and processes for infrequent events is fraught with difficulty. Health-care professionals have numerous training mandates, and it will be difficult to make EMCC training an ongoing priority. Within the realities of competing training obligations, strategies must be developed to still provide acceptable levels of training for EMCC. These strategies must take into consideration the expected attrition of knowledge and competency resulting from disuse of skills. Strategies must also anticipate the need to incorporate periodically updated EMCC recommendations.

Despite these challenges, mass critical care events could happen tomorrow or even today. We cannot wait to develop perfect surge strategies because the first time the modern North American health-care system faces mass critical care may prove catastrophic. We must be prepared to implement surge strategies based on contemporary knowledge, experience, and expert opinion.


Category: Care