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

Area of Science:

• Emergency Medicine
• Public Health Policy
• Critical Care Systems

Background:

• Mechanical ventilator failure during pandemics or disasters can be fatal.
• Government agencies require robust preparedness and response plans for life-critical systems.
• Ensuring availability, reliability, and predictability of essential medical equipment is paramount.

Purpose of the Study:

• To evaluate state emergency preparedness plans regarding mechanical ventilator management for critically ill patients during mass casualty events.
• To identify deficiencies in current state-level disaster response plans for ventilator allocation.
• To propose a standardized ventilator triage system and guidelines for disaster settings.

Main Methods:

• Analysis of all 50 state emergency preparedness and response plans.
• Contacting public health authorities in each state for additional information.
• Development of the AGILITIES Score for ventilator triage.

Main Results:

• Only 17.6% of state plans included specific provisions for mechanical ventilation triage during pandemics.
• All reviewed state plans relied on the CDC's Flu Surge 2.0 spreadsheet for influenza planning.
• Significant deficiencies were identified in ventilator accountability, operational expertise, resource availability, and triage strategy.

Conclusions:

• The AGILITIES Score Ventilator Triage System and accompanying guidelines are proposed for uniform adoption by government agencies and hospitals.
• The system addresses critical factors: relative health, duration on mechanical ventilation, and resource utilization.
• The United States is inadequately prepared for large-scale ventilator demand during catastrophic events.