Mechanical ventilation in disaster situations: a new paradigm using the AGILITIES Score System

Area of Science:

• Emergency Medicine
• Public Health Policy
• Critical Care

Background:

• Failure of life-critical systems like mechanical ventilators during pandemics or disasters can be fatal.
• Government agencies require robust preparedness and response plans for system availability, reliability, and predictability.

Purpose of the Study:

• To evaluate state emergency preparedness plans regarding mechanical ventilation for critically ill patients during mass casualty events.
• To develop and propose guidelines for ventilator triage and management in disaster scenarios.

Main Methods:

• Analysis of all 50 state emergency preparedness and response plans for mechanical ventilation strategies.
• Contacting public health authorities in each state for additional information.

Main Results:

• Only 17.6% of state plans included specific provisions for mechanical ventilation triage during a pandemic.
• All state plans utilized the CDC's Flu Surge 2.0 spreadsheet for influenza planning estimates.
• The authors developed the AGILITIES Score and guidelines for ventilator triage in catastrophic events.

Conclusions:

• The AGILITIES Score Ventilator Triage System and guidelines are presented for uniform adoption by government agencies and hospitals.
• The system considers patient health, duration on ventilation, and resource use.
• The US is inadequately prepared for mass ventilator needs, facing deficiencies in accountability, staffing, resource availability, and triage strategy.