Planning for a Resource Shortfall

During disasters and other crises, the scarcity of resources facing emergency physicians can escalate rapidly. The luxury of taking a structured, proactive approach is rarely afforded to emergency physicians in disaster situations. Understanding how to prioritize actions and triage decisions is critical. Unfortunately, consideration is often not given to how decision making or resource use should be modified to allow for the greatest good for the greatest number of patients. “We need to have a mindset in which we are prepared to make ethically appropriate, relevant, best-informed triage decisions when faced with a disaster situation,” says John L. Hick, MD. Analyzing the Spectrum of Emergency Care Dr. Hick was lead author of a review on allocating scarce resources in disasters that was published in Annals of Emergency Medicine. He says that care in the ED occurs across a spectrum, from conventional care to contingency care (Figure 1). “Contingency care involves providing usual care, but also adapting the staffing, supplies, or environment slightly from conventional care practices. Institutions that are better prepared can delay transition to crisis care longer than those that are not as prepared. In crisis care, the medical care provided changes to reflect resource limitations. Decisions about how to prioritize resources to benefit the most people have to be made.” Six key strategies have been established in published literature to help ED providers when anticipating or faced with a resource shortfall: 1. Prepare: Stockpiling some reasonably inexpensive items, like morphine, can make a big difference when faced with any kind of mass casualty situation. 2. Substitute: Many medications, such as antibiotics that cover the same basic spectrums,...