Crisis Planning Background and Tools

Surge Planning Tools for Scarce Resource Situations

Resource Title Organizational Author or Journal Title Description
Patient Care Strategies for Scarce Resources Situations Minnesota Department of Health Emergency and Response Comprehensive toolkit for patient care management in scarce resource situations in summary cards.
Scarce Resource Management & Crisis Standards of Care Washington State Department of Health Comprehensive toolkit for patient care management in scarce resource situations.
Rapid Expert Consultation on Crisis Standards of Care for the COVID-19 Pandemic National Academies of Sciences, Engineering, and Medicine Briefly describes the guiding principles, key elements, and core messages which comprise Crisis Standards of Care decision-making at all levels.
Patient Surge in Disasters: A Hospital Tool Kit for Expanding Resources in Emergencies, ICU Capacity Expansion Kit NYC Department of Health and Mental Hygiene Office of Emergency Preparedness and Response Toolkit to help hospital administrators and emergency managers in preparing for and responding to unexpected increases in patient volume with focus on ICU planning.
Scaled Pandemic Preparedness: From Large Medical Center to Community Hospital What Do You Need to Do? Society for Critical Care Medicine Approximately 60 minute video providing guidance on surging planning during a pandemic for healthcare facilities.
COVID-19 Resources for Providers University of Nebraska Medical Center Protocol and policy examples for clinicians, healthcare administrators and emergency manager preparing for and responding to various issues on all levels presented during COVID pandemic.

Surge Strategy Protocols and Examples

Resource Title Organizational Author or Journal Title Description
COVID-19 Protocols Brigham and Women’s Hospital Comprehensive resource tool for clinicians caring for critically-ill COVID-19 patients.
UW Medicine COVID-19 University of Washington Medicine Protocol and policy examples for clinicians, healthcare administrators and emergency manager preparing for and responding to various issues on all levels presented during COVID pandemic.
Lifesaving Treatment and Clinical Operations Vikram Mukherjee, Bellevue Hospital Presentation from Bellevue Hospital on COVID experience as of March 30, 2020. Includes specific crisis strategies and describes cohorting scheme. Part of Prohect ECHO/ASPR/HHS Webinar Series.
COVID-19 Resources for Providers University of Nebraska Medical Center Protocol and policy examples for clinicians, healthcare administrators and emergency manager preparing for and responding to various issues on all levels presented during COVID pandemic.
Scaled Preparedness Webinar Society of Critical Care Medicine Approximately 60 minute video providing guidance on surging planning during a pandemic for healthcare facilities.

Crisis Planning Background Information

Resource Title Organizational Author or Journal Title Description
Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report National Academy of Medicine Outlines the general framework and broad process needed for developing crisis standards of care protocols for a healthcare system.
Surge Capacity Logistics: Care of the Critical Ill and Injured During Pandemics and Disaster CHEST: American College of Chest Physicians Discusses surge logistics with specific suggestions pertaining to requirements for equipment, supplies, pharmaceuticals, staff preparation, organization and mitigation as means to build capacity to deliver mass critical care.
Preparing Your ICU for Disaster Response Society of Critical Care Medicine Briefly describes the conventional, contingency and crisis frameworks hospitals can look for indicators and triggers to utilized during critical care surge planning.
Indicators and Triggers for Potential Movement to Crisis Care Society for Critical Care Medicine Toolkit designed to help critical care directors and hospital administrators to implement surge critical care services.
Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2 National Academy of Medicine Summary and application of the Crisis Standards of Care framework to the COVID-19 pandemic.

Space Surge Strategies

Sustained Mechanical Ventilation Outside of the ICU

Resource Title Organizational Author or Journal Title Description
Sustained Mechanical Ventilation Outside Traditional Intensive Care Units Society for Critical Care Medicine Comprehensive training on implementing ICU surge into alternative spaces, focusing on the needs of mechanically ventilated patients.
COVID-19 Town Hall Webinar: Video American Society of Anesthesiologists The first presentation is a technical and implementation guide for use of anesthesia ventilators for the provision of critical care, including brief explanations of physiology. For anesthesiologists.
Quick Reference Guide for Repurposing Anesthesia Machines as ICU Ventilators American Society of Anesthesiologists Quick reference for setting up an anesthesia machine as an ICU ventilator, initiating therapy, and a framework for monitoring.
COVID-19 Response Mindray North America Detailed technical resources on conversion of Mindray anesthesia products for use as ventilators.
ACS Statement on the Importance of Maintaining the Emergency Care System during the COVID-19 Pandemic American College of Surgeons Statement describing strategies maintain sufficient trauma capacity when operating room staff and spaces are diverted to the non-trauma care.

Negative Pressure Rooms

Resource Title Organizational Author or Journal Title Description
ICU Potential Negative Pressure Space Mount Sinai West Protocol for turning rooms with windows into negative pressure spaces.

Staff Surge Strategies

Just-in-Time Training Resources

Resource Title Organizational Author or Journal Title Description
General Critical Care
Critical Care for the Non-ICU Clinician Society of Critical Care Medicine Modules on multiple aspects of critical care, including specific modules on mechanical ventilation, for the education to healthcare professionals who may benefit from critical care training. Designed for non-ICU clinicians who may be tasked with caring for critically ill patients.
COVID Activated Emergency Scaling of Anesthesiology Responsibilities American Society of Anesthesiologists A library of quick training resources on all aspects of critical care for non-intensivist physicians and advanced practice practitioners who may be tasked with caring for critically ill patients as part of hospital surge during the COVID-19 pandemic. Developed by a Joint Committee of ASA, SOCCA, SCCM, and APSF.
Supporting Ethical Care and Responding to Moral Distress in a Public Health Emergency The Hastings Center This slide deck aims to quickly prepare hospital ethics committees (HECs) and clinical ethics consultation (CEC) services to 1) assess and shift their operations to reflect new tasks and work conditions, including resources scarcity, and 2) respond to changing ethical needs and concerns among clinicians caring for patients.
Critical Care for Non-Intensivists EMCrit: COVID-19 Blue Book A series of short, practical training videos on critical care topics.
COVID-19 ARDS and Proning: Learning in Real Time Lippincott Nursing Center ~20 min podcast with critical care nurses describing how COVID-19 patients with ARDS differ from the traditional ARDS patient. Also discuss prone positioning – what it means, how it works, and managing patients.
Essential Skills for Non-ICU Nurses American Nurses Foundation A series of free webinars on PPE, mechanical ventilation, ethics, self-care, and innovation for surge COVID-19 nursing staff in the ICU.
Mechanical Ventilation
Cross Training Respiratory Extenders for Medical Emergencies American Association for Respiratory Care Training video on the basics of mechanical ventilation and the use of ventilators stored in the Strategic National Stockpile. Designed for respiratory therapy extenders and others who will contribute to ventilator setup and change ventilator settings.
Strategic National Stockpile Ventilator Training Program American Association for Respiratory Care Repository of training resources on the technical aspects of setting up and changing settings on the ventilator models stored in the Strategic National Stockpile.
Basics of Mechanical Ventilation for the Clinician American College of Chest Physicians Basic training for front line clinicians on the physiology and practical aspects of respiratory management of ventilator patients in the ICU. Suitable for all members of the ICU team, from physicians to students and trainees.
Critical Respiratory Care Prep for Clinicians Returning to the ICU for COVID Support Boise State University Respiratory Care Program Education material for CRNAs, non-ICU physicians and non-ICU RRTs who will be assisting in the monitoring of patients receiving mechanical ventilatory support.
Mechanical Ventilation for non-ICU Clinicians Harvard EdX Free course from Harvard/MGH ER physician for licensed, no-ICU hospital clinicians.
Ventilación mecánica para no intensivistas Harvard EdX In Spanish. Free course from Harvard/MGH ER physician for licensed, no-ICU hospital clinicians.
Personal Protective Equipment
NETEC: Personal Protective Equipment for COVID-19: Resources National Emerging Special Pathogen Training and Education Center. Guidance for all ICU Team members on the donning and doffing of Personal Protective Equipment (PPE) for COVID-19 following the CDC guidelines: Standard, Contact, and Airborne Precaution.
COVID-19 Personal Protective Equipment: Donning University of Nebraska Medical Center Donning PPE step by step written guide with images from the University of Nebraska Medical Center.
Helmet Ventilation Provider Training The University of Chicago A video with slides that describes applications for helmet NIV in the COVID pandemic, assembly instruction, and the use of helmet with and without a ventilator.
COVID-19 Personal Protective Equipment: Doffing University of Nebraska Medical Center Doffing PPE step by step written guide with images from the University of Nebraska Medical Center.

Nursing Staff Considerations

Resource Title Organizational Author or Journal Title Description
Surge Priority Planning COVID-19: Critical Care Staffing and Nursing Considerations CHEST: American College of Chest Physicians Guidance for hospital administrators, nursing leaders, and bedside nursing personnel on nursing leadership and administrative considerations, strategies for optimizing staffing resources, and maintaining staff safety and resilience.
CRNAs Asked to Assume Critical Care Responsibilities During the COVID-19 Pandemic: Position Statement American Association of Nurse Anesthetists Statement by the AANA on roles that can be played by Certified Registered Nurse Anesthetists in hospital surge scenarios. Contains several practical links for CRNAs as they assume roles outside of their traditional scope.

Staffing Complement and General Strategy

Resource Title Organizational Author or Journal Title Description
COVID-19: Elective Case Triage Guidelines for Surgical Care American College of Surgeons Overarching principles and detailed guidance by specialty on what constitutes an “elective” surgery that should be postponed in surge situations.
U.S. ICU Resource Availability for COVID-19 Society of Critical Care Medicine Estimates of national resource availability. Describes a tiered staffing model for crisis surge scenarios with a high demand for mechanical ventilation.
Project XTREME: Model for Health Professionals’ Cross-Training for Mass Casualty Respiratory Needs Agency for Healthcare Research and Quality; U.S. Department of Health and Human Services Provides an example of a tiered staffing model for crisis surge scenarios with a high demand for mechanical ventilation, specific to surge of respiratory therapists.
The Value of Team-Based Management in a Virus Outbreak Medscape Lessons learned in team management useful for non-traditional and tiered staff critical care teams, including strategies for effective communication and interprofessional collaboration.
ASA COVID-19 Town Hall April 2 American Society of Anesthesiologists Town Hall Discussion (slides and video) featuring Mount Sinai and Long Island strategies for communication and allocation of staff in non-traditional surge critical care teams.

Supply Surge Strategies

Continuous Renal Replacement Therapy

Resource Title Organizational Author or Journal Title Description
Coronavirus Epidemic and Extracorporeal Therapies in Intensive Care: si vis pacem para bellum Blood Purification Call to action to develop and advance extracorporeal therapies, including CRRT. Reviews literature and suggests technical strategies for hemodialysis and hemofiltration.
COVID-19 and the Inpatient Dialysis Unit Clinical Journal of American Society of Nephrology A discussion on how during a crisis, such as the COVID-19 pandemic, inpatient dialysis units can spread resources (Dialysis supplies, Human Resources, Dialysis methods) to be able to treat as many patients as possible.
Acute Kidney Injury and COVID-19 European Society of Intensive Care Medicine (ESICM) ~70 minute video from ESCIM, second half describes surge strategies for renal replacement therapy.
Emory Health Center RRT Surge Plan American Society of Nephrology/Emory Health Center Emory Health Center’s tiered surge plan for conservation of staff and supplies for RRT in COVID-19. Presented in American Society of Nephrology’s webinar on April 21, 2020.
Acute PD for AKI Important Considerations Cleveland Clinic A set of slides that reviews acute peritoneal dialysis for acute kidney injury and important considerations for acute PD implementation.
Tidal PD Indications and Prescription Cleveland Clinic A set of slides that reviews tidal peritoneal dialysis and why it is used as well as how tidal peritoneal dialysis is prescribed.

Neuromuscular Blockade Agents and Sedation

Resource Title Organizational Author or Journal Title Description
Tracheotomy Recommendations During the COVID-19 Pandemic American Academy of Otolaryngology-Head and Neck Surgery Provides recommendations regarding tracheotomy with focus on minimization of risk, viral exposure, and personal protective equipment (PPE) depletion.
Percutaneous Tracheotomy Protocol in COVID19 Positive Intubated Patients New York University Hospitals Selection criteria and procedure for percutaneous tracheostomy in a COVID setting.
CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management Oral Oncology Protocol for open tracheostomy in a COVID setting.

Palliative Care

Resource Title Organizational Author or Journal Title Description
CAPC COVID-19 Response Resources Center to Advance Palliative Care Open source toolkit that provides palliative care teams tools, protocols, resources, and guidance specifically tailored to COVID-19.

Personal Protective Equipment

Resource Title Organizational Author or Journal Title Description
Strategies to Optimize the Supply of PPE and Equipment Center for Disease Control and Prevention Provides guidance for optimizing PPE when such supplies are stressed, running low, or absent.
Personal Protective Equipment (PPE) Burn Rate Calculator Center for Disease Control and Prevention Provides a spreadsheet-based model to help healthcare facilities can utilize in order to plan and optimize the use of PPE.
Strategies for the Conservation of Respiratory PPE New York City Department of Health and Mental Hygiene. Provides a brief overview of strategies for hospitals and clinicians for the reuse and extended use of PPE.
N95 Decontamination
N95 Filtering Facepiece Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse University of Nebraska Medical Center Provides detailed information manual explaining the procedure to surface decontaminate and reuse N95 FFRs.
Cautionary Fact Sheet for COVID19 N95 Decontamination and Reuse N95DECON Quick reference guide for promising and unpromising methods for N95 Decontamination.
COVID N95 Decontamination and Reuse: Heat and Humidity N95DECON Quick reference guide for on the key considerations and risks of using heat and humidity method for N95 Decontamination.
COVID N95 Decontamination and Reuse: UV-C N95DECON Quick reference guide for on the key considerations and risks of using UV-C radiation method for N95 Decontamination.
COVID N95 Decontamination and Reuse: Hydrogen Peroxide Vapor and Hydrogen Peroxide Gas Plasma N95DECON Quick reference guide for on the key considerations and risks of hydrogen peroxide vapor and hydrogen peroxide gas plasma method for N95 Decontamination.
Decontamination and Reuse of Filtering Facepiece Respirators Centers for Disease Control and Prevention Summary of research conducted on N95 decontamination recommendations within crisis standards of care.

Scarce Resource Allocation

Resource Title Organizational Author or Journal Title Description
Fair Allocation of Scarce Medical Resources in the Time of COVID-19 New England Journal of Medicine Resource assessment and ethical overview of allocating scarce health resources during the COVID-19 pandemic.
Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2 The National Academy of Medicine Summary and application of the Crisis Standard of care framework to COVID-19. Specifically, the authors note that “Sequential Organ Failure Assessment scores have limited prognostic value in viral-induced lung injury compared to sepsis so they should be used as contributory data and not to exclude a patient from resources.”
A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic JAMA Network Brief overview of ethical considerations for the facility level allocation of critical care resources in the event that a public health emergency creates demand for critical care resources (e.g., ventilators, critical care beds) that outstrips the supply. Supplement contains detailed practical strategies for implementation.
Ethical Framework for Health Care Institutions and Guidelines for Institutional Ethics Services Responding to the Coronavirus Pandemic The Hastings Center This document aims to help structure ongoing discussion of significant, foreseeable ethical concerns arising under contingency levels of care and potentially crisis standards of care.

Ventilators

Resource Title Organizational Author or Journal Title Description
Bilevel Ventilation
Bilevel Ventilation Theory and Application American Association for Respiratory Care ~54-minute video providing an overview of the theory of Bilevel modes of ventilation with discussion of application. This is an advanced lecture that assumes familiarity with basic mechanical ventilation and pressure control modes.
Repurposing bi-level ventilators for use with intubated patients while minimizing risk to health care works during insufficient supply of conventional ventilation for patients with COVID-19 Mount Sinai Protocol to convert a Resmed S9 Bilevel ventilator for use in intubated patients in COVID-19 setting. (Methods/tools function on other models of BiPAP-ST ventilators.)
Emergency Protocol for using Philips Respironics V60 ventilator with Pressure Control Ventilation (PCV) Option as a Pressure-Controlled Ventilator Using a Conventional Bipap Circuit Northwell Health Systems Protocol to use a Philips Respironics V60 believel ventilator on intubated patients in COVID-19 setting.
Update on Converting BiPAP machines into Ventilators Mount Sinai Detailed instructional guidelines and training video for repurposing bilevel ventilators for invasive ventilation in COVID-19. Part of a larger resource library on research and innovation in the Mount Sinai Hospital System.
MSH/NYSDOH BiPaP Webinar Mount Sinai Health ~60 min. webinar – first half addresses a Bilevel invasive ventilation strategy for COVID-19 that is applicable to multiple BiPAP machine models.
Repurposed Home BiPAP Training Video Mount Sinai Health ~10 minute instructional video teaching how to repurpose home BiPAP machine in COVID-19.
Delayed Intubation
ICU Management of the COVID-19 Patient – April 15, 2020 Webinar GNYHA ~90 Webinar; first third comprehensively describes an approach to delayed intubation used in NYC. The rest of the webinar addresses steroid usage and anticoagulation.
Ventilator Sharing
Joint Statement on Multiple Patients Per Ventilator Society of Critical Care Medicine A joint statement made by several organizations which recommends that clinicians do not attempt to ventilate more than one patient with a single ventilator while any clinically proven, safe, and reliable therapy remains available. This joint statement includes background and reasons for the recommendation.
MSH/NYSDOH BiPaP Webinar Mount Sinai Health ~60 min. webinar – second half address ventilator sharing between two patients.
FEMA Ventilator Sharing Protocol FEMA/SCCM Washington DC COVID-19 National Task Force method of implementation for ventilator sharing.
NYP Ventilator Sharing Protocols and Video Columbia University College of Physicians & Surgeons New York-Presbyterian Hospital NYP website that contains the current (updated) ventilator sharing protocol from NYP-Columbia and a related video that is used for training
Strategic National Stockpile Ventilators
Strategic National Stockpile Ventilator Features New York City Department of Health and Mental Hygiene Quick reference guide for hospitals on information about ventilators that may be distributed from the Strategic National Stockpile.
Experimental Studies on Performance of Ventilator Stored in the Strategic National Stockpile Journal of Emergency Management Provides information about the long-term storage of ventilators that have regular maintenance, and their ability to perform reliably during a public health emergency.
Strategic National Stockpile Ventilator Training Program American Association for Respiratory Care Repository of training resources on the technical aspects of setting up and changing settings on the ventilator models stored in the Strategic National Stockpile.
Regulatory Information
Enforcement Policy for Ventilators and Accessories and Other Respiratory Devices During the Coronavirus Disease 2019 COVID-19 Public Health Emergency US Food and Drug Administration Provides FDA guidance on expanding the availability of devices that facilitate respiration, including ventilators, anesthesia gas machines, and other respiratory devices, and their accessories, to support patients during the COVID-19 pandemic.
Ventilator Supply Mitigation Strategies: Letter to Healthcare Providers US Food and Drug Administration Provides recommendations for healthcare providers and facilities, based on the issued guidance, regarding the use of devices with patients who develop respiratory compromise from COVID-19 or other respiratory disorders.