CHEST Consensus Statement: Care of the Critically Ill and Injured During Pandemics and Disasters

The American College of Chest Physicians released an expert consensus statement, Care of the Critically Ill and Injured During Pandemics and Disasters
while the global health-care community cares for patients with the Ebola virus.Three of the authors discussed this important statement with

Asha V. Devereaux, MD, MPH Sharp Hospital, Coronado, CAAsha V. Devereaux, MD, MPH
Sharp Hospital
Coronado, CA

Jeffrey R. Dichter, MD Allina Health, Minneapolis, MN, and Aurora Health, Milwaukee, WIJeffrey R. Dichter, MD
Allina Health, Minneapolis, MN
and Aurora Health, Milwaukee, WI


Niranjan Kissoon, MBBS, FRCP(C) BC Children's Hospital and Sunny Hill Health Centre University of British Columbia, Vancouver, CanadaNiranjan Kissoon, MBBS, FRCP(C)
BC Children’s Hospital and Sunny Hill Health Centre
University of British Columbia, Vancouver, Canada

Medical Research: What are the main ethical concerns and criteria for evaluating
who may be eligible for treatment during a pandemic or disaster?

Dr. Asha Devereaux: The main ethical concerns regarding eligibility for treatment during a pandemic will be access to limited or scarce resources. Who should get treatment and who decides will be some significant questions whenever there is a scarcity of healthcare resources. Transparency and the fairness of the ethical framework for decision-making will need to be made public and updated based upon the changing dynamics of resources and disease process.

Dr. Niranjan Kissoon: There is work to be done in this area and engagement of citizens, government, medical community, ethicists and legal experts in the process is important.

Medical Research: Do you recommend a template or guideline for training the triage team in each community or hospital system?

Dr. Asha Devereaux: Absolutely. Using triage scenarios that are based upon real-world situations that will likely impact a community/hospital system are better than using a ‘never-event’ to simulate triage. The consensus statement specifically addresses the training of triage officers and recommends who should fulfill these roles.

Medical Research: Do you anticipate an accreditation or certification process (ie Magnet program) to acknowledge a system’s emergency preparedness?

Dr. Asha Devereaux: The Joint Commission currently attempts to assess a system’s preparedness; however, many resources are limited and previous attempts (like NDLS accreditation) have not been uniformly accepted. If a system is prepared, then the disaster event becomes an expected aspect of every-day business and then will become a routine part of accreditation.

Dr. Jeffrey Dichter: Going forward, healthcare organizations will be most prepared by building disaster plans on a foundation of routine daily processes, that can be quickly scaled up in a disaster. A good example are daily medication shortages faced by virtually all healthcare organizations, the routine strategies they use to adapt to them, and implementing these same strategies in a larger way in a disaster.

Medical Research: How much funding do you think is required (perhaps on a per capita or population basis) to establish and maintain preparedness?  How should that funding be obtained and sustained?

Dr. Jeffrey Dichter: Government engagement in disaster planning should focus on 3 sets of priorities:

  • Providing healthcare organizations financial assistance for disaster planning,
  • Economic incentives when feasible, and
  • Requirements or mandates when appropriate.The specific funding or financial incentives will vary by country or community, but for disaster planning to be most successful, governments must be engaged in disaster planning processes.


Michael D. Christian, MD, MSc, FCCP, FRCP(C); Asha V. Devereaux, MD, MPH, FCCP; Jeffrey R. Dichter, MD; Lewis Rubinson, MD, PhD; Niranjan Kissoon, MBBS, FRCP(C), FAAP, FCCM, FACPE on behalf of the Task Force for Mass Critical Care

Last Updated on October 28, 2014 by Marie Benz MD FAAD