Mass critical care: pediatric considerations in extending and rationing care in public health emergencies

Area of Science:

• Pediatric critical care
• Public health preparedness
• Disaster medicine

Background:

• Public health emergencies (PHEs) pose unique challenges for pediatric critical care.
• Existing hospital resources often fall short of estimated pediatric needs during PHEs.
• Mass critical care (MCC) principles require adaptation for pediatric populations.

Purpose of the Study:

• To apply and adapt Mass Critical Care (MCC) concepts for pediatric populations during Public Health Emergencies (PHEs).
• To identify critical resource gaps and propose solutions for pediatric mass critical care.
• To inform policy regarding pediatric critical care resource allocation and outcome goals in PHEs.

Main Methods:

• Review and adaptation of existing Mass Critical Care (MCC) guidelines for pediatric application.
• Analysis of pediatric-specific resource needs and potential equipment limitations (e.g., ventilators).
• Evaluation of validated pediatric mortality prediction scores (e.g., Pediatric Index of Mortality 2) for rationing.

Main Results:

• MCC can improve population outcomes in PHEs by prioritizing life-saving interventions.
• Significant gaps exist in pediatric critical care resources compared to adult needs.
• Age-appropriate equipment is essential, and adult equipment poses limitations for infants.
• The Pediatric Index of Mortality 2 score is suitable for rationing interventions to maximize survival.

Conclusions:

• Adapting MCC principles is vital for optimizing pediatric outcomes during PHEs.
• Strategic planning, resource management, and specialized pediatric expertise are necessary for effective pediatric MCC.
• Policymakers must establish clear population outcome goals, balancing lives saved with life-years saved.