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Biomedical subjects

John L Hick

Publications and source records attributed to John L Hick.

9 recordsLinked to original sources
PubMed2006

Concept of operations for triage of mechanical ventilation in an epidemic.

The recent outbreak of severe acute respiratory syndrome and the growing potential of an influenza pandemic force us to consider the fact that despite great advances in critical care medicine, we lack the capacity to provide intensive care to the large number of patients that may be generated in an epidemic or multisite bioterrorism event. Because many epidemic and bioterrorist agent illnesses involve respiratory failure, mechanical ventilation is a frequently required intervention but one that is in limited supply. In advance of such an event, we must develop triage criteria that depend on clinical indicators of survivability and resource utilization to allocate scarce health care resources to those who are most likely to benefit. These criteria must be tiered, flexible, and implemented regionally, rather than institutionally, with the backing of public health agencies and relief of liability. This report provides a sample concept of operations for triage of mechanical ventilation in epidemic situations and discusses some of the ethical principles and pitfalls of such systems.

Bioterrorism↗
PubMed2006

Emergency management of sickle cell disease complications: review and practice guidelines.

The prevalence of sickle cell disease (SCD) in Minnesota is increasing because of the influx of immigrants from Africa, India, and countries in Latin America. Clinicians, families, and individuals with the disease have expressed the need to educate health care professionals in emergency settings about the standards of care for treating pain and other complications of SCD. Late last year, the Minnesota Department of Health and the Minnesota Hemoglobinopathy Collaborative created guidelines for treating patients with complications of SCD in the emergency department. This article provides additional background information to support the guidelines.

Anemia, Sickle Cell↗
PubMed2005

Preparedness progress: update on Minnesota hospitals.

Since 2002, all states have received federal funds for disaster preparedness through Health Resources and Services Administration (HRSA) Bioterrorism Hospital Preparedness Program grants. Minnesota has received dollar 19.4 million, which has been spent to improve communications and coordination among hospitals and emergency providers, purchase equipment and medications, and train staff. The Minnesota Department of Health, which administers the funds, recently assessed the state's level of preparedness, finding that the state is well-prepared for smaller events such as a chemical incident or a limited outbreak of an infectious disease. A catastrophic event such as pandemic influenza would likely overwhelm the state's systems and providers.

Disaster Planning↗
PubMed2004

Health care facility and community strategies for patient care surge capacity.

Recent terrorist and epidemic events have underscored the potential for disasters to generate large numbers of casualties. Few surplus resources to accommodate these casualties exist in our current health care system. Plans for "surge capacity" must thus be made to accommodate a large number of patients. Surge planning should allow activation of multiple levels of capacity from the health care facility level to the federal level. Plans should be scalable and flexible to cope with the many types and varied timelines of disasters. Incident management systems and cooperative planning processes will facilitate maximal use of available resources. However, resource limitations may require implementation of triage strategies. Facility-based or "surge in place" solutions maximize health care facility capacity for patients during a disaster. When these resources are exceeded, community-based solutions, including the establishment of off-site hospital facilities, may be implemented. Selection criteria, logistics, and staffing of off-site care facilities is complex, and sample solutions from the United States, including use of local convention centers, prepackaged trailers, and state mental health and detention facilities, are reviewed. Proper pre-event planning and mechanisms for resource coordination are critical to the success of a response.

Community Networks↗
PubMed2003

Establishing and training health care facility decontamination teams.

Recent terrorist events, changes in Joint Commission on Accreditation of Healthcare Organizations requirements, and availability of grant funding have focused health care facility attention on emergency preparedness. Health care facilities have historically been underprepared for contaminated patients presenting to their facilities. These incidents must be properly managed to reduce the health risks to the victims, providers, and facility. A properly equipped and well-trained health care facility team is a prerequisite for rapid and effective decontamination response. This article reviews Occupational Safety and Health Administration (OSHA) training requirements for personnel involved with decontamination responses, as well as issues of team selection and training. Sample OSHA operations-level training curricula tailored to the health care environment are outlined. Initial and ongoing didactic and practical training can be implemented by the health care facility to ensure effective response when contaminated patients arrive seeking emergency medical care.

Decontamination↗
PubMed2003

Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations.

After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices. Review of existing databases, relevant published literature, and individual case reports reveal some provider health risks, especially when the exposure involves organophosphate agents. However, reported risks from secondary exposure to contaminated patients at health care facilities are low. These risks should be adequately addressed with Level C personal protective equipment, including air-purifying respirator technologies, unless the facility determines that specific local threats require increased levels of protection.

Decontamination↗