As we have seen, ramped-up production of ventilators
is also occurring to help address the shortage caused by
COVID-19. As well, in late March, the Pentagon announced
it will spend $84.4 million to purchase 8,000 ventilators from
four vendors, with the first deliveries slated to happen in May.
As Koonin, et al. (2020) observe, “During a severe
pandemic, especially one causing respiratory illness, many
people may require mechanical ventilation. Depending on the
extent of the outbreak, there may be insufficient capacity to
provide ventilator support to all of those in need.”
The researchers suggest that, as part of the overall strategy
to assist state and local planners to allocate stockpiled venti-
lators to healthcare facilities during a pandemic, accounting
for critical factors in facilities’ ability to make use of additional
ventilators is key. They explain, “As a part of pandemic
preparedness, public health officials should identify healthcare
facilities in their jurisdiction that currently care for critically
ill patients on mechanical ventilation to determine existing
inventory of these devices and facilities’ ability to absorb
additional ventilators. Facilities must have sufficient staff,
space, equipment and supplies to utilize allocated ventilators
adequately. At the time of an event, jurisdictions will need to
verify and update information on facilities’ capacity prior to
making allocation decisions. Allocation of scarce life-saving
resources during a pandemic should consider ethical principles
to inform state and local plans for allocation of ventilators. In
addition to ethical principles, decisions should be informed
by assessment of need, determination of facilities’ ability to
use additional ventilators, and facilities’ capacity to ensure
access to ventilators for vulnerable populations (e.g., rural,
inner city, and uninsured and underinsured individuals) or
high-risk populations that may be more susceptible to illness.”
Experts have debated the adequacy of the current number
of ventilators available in a pandemic scenario.
“Although the current supply of approximately 62,000
ventilators in U.S. acute-care hospitals would likely be
adequate to support patient care needs during a pandemic
with mild to moderate severity (similar to the 2009 H1N1
pandemic), a pandemic with greater severity would probably
result in many more patients requiring ventilatory support,”
says Koonin, et al. (2020). “In this severe scenario, there will
likely be insufficient capacity to ventilate all those who need
this treatment.”
They continue, “Assuming that ventilators would be
effective in reducing morbidity and mortality during a future
severe pandemic, researchers estimate that approximately
35,000 to 60,500 additional ventilators will be needed.
To support this need, scientists estimate that with robust
planning, if US hospitals could increase space and the
number of trained and qualified staff to care for ventilated
patients during a pandemic, approximately 26,200 to 52,400
additional patients could be ventilated at the peak of a
pandemic. Another study of more than 4,400 hospitals found
a significant increase in the number of adult intensive care
beds between 2009 and 2011, but this growth was seen
mostly in large urban teaching facilities, rather than in rural
areas or smaller, less-resourced hospitals, which often serve
residents with little or no other access to care. In addition,
there has been an increase in the number of rural hospitals
closing each year.”
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In addition to having ventilator equipment and ancillary
supplies, the researchers emphasize it is critical for healthcare
facilities to have sufficient staff and space to care for as
many patients as possible who require ventilation: “Legal
experts have advised that hospitals, public health entities, and
clinicians have an obligation to develop comprehensive, vetted
plans for mass casualty incidents involving large numbers of
critically ill patients,” Koonin, et al. (2020) say. “Considering
these critical factors (i.e., sufficient staff, supplies and space),
jurisdictions should plan for how they would allocate stockpiled
ventilators to their relevant healthcare facilities. Researchers
have proposed that allocation decisions for a limited supply
of stockpiled ventilators to healthcare facilities should not
use a pro-rata or ‘first come–first serve’” model, but rather
they should base allocation on a detailed assessment of
facilities’ capacity to absorb and use additional ventilators
and to ‘ensure the efficient, effective, and ethical distribution
of stockpiled ventilators’ to facilities that can best use them
during an emergency.”
In 2015, as part of a Pandemic Influenza Readiness
Assessment exercise, the CDC assessed all Public Health
Emergency Preparedness jurisdictions (n = 62) to ask about
their readiness to respond to a pandemic. Within the Med-
ical Countermeasures Module, jurisdictions were asked to
identify the key considerations they would use to determine
ventilator allocation to hospitals during a pandemic. Of the
62 jurisdictions queried, 57 responded. Several key findings
from the response included that almost two-thirds of the
jurisdictions had conducted a hospital-based assessment
between 2010 and 2014 to determine their mechanical
ventilation capabilities, and 48 percent of jurisdictions (in
aggregate covering 46.4 percent of the U.S. population at
the time) had not determined when or how they would train
healthcare systems to operate ventilators from stockpiles.
In addition, jurisdictions were asked about the key
parameters that they would consider when evaluating to
which facility they would allocate stockpiled ventilators. The
most frequent parameter cited was the availability of trained
and qualified staff, although this item as well as the number
of ICU beds and availability of equipment and space were all
cited by more than 70 percent of jurisdictions.
As Koonin, et al. (2020) explain, “Patients who need
mechanical ventilation will be critically ill and will require
trained clinicians to provide comprehensive intensive care. The
ability to absorb additional ventilators will depend on having
sufficient trained and qualified staff to operate ventilators
and care for patients, as well as adequate bed space, and
availability of essential equipment and supplies needed to
care for critically ill patients (e.g., oxygen, suctioning, airway
management, monitoring equipment).”
The researchers recommend, “As a part of pandemic
preparedness, public health officials should identify and query
healthcare facilities in their jurisdiction that care for critically ill
patients on mechanical ventilation to learn about their current
inventory of these devices and their ability to absorb additional
ventilators. Information about the types of patient populations
served (including facilities’ ability to care for critically ill neonatal
and pediatric patients and adults including pregnant patients)
should be collected. Healthcare coalitions that work with
these facilities may be able to assist public health partners in
april 2020 • www.healthcarehygienemagazine.com