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You work in a small city that has several nearby colleges. Many students and faculty come from around the globe, including Southeast Asia where yet another flu strain seems to be developing. Early reports indicate the severity of the illness and affected population to be potentially greater than that of nH1N1 in 2009.

At 10 am on August 27, a handful of patients are referred from the college's Health Clinic to your hospital's emergency department (ED), with fever, cough, sore throat, and muscle aches months before the normal start of the influenza season. A few are presenting with exacerbations of their asthma.

By evening the ED is overflowing with patients presenting with typical flu-like symptoms. A handful of patients in acute respiratory distress are arriving by ambulance. The EMT says that this is the sixth case and third hospital to which he has transported such a patient today.

The pattern recurs and worsens the following day. Half of the ED patients are experiencing what appears to be primary viral pneumonia and those admitted the previous day are developing multiorgan failure. Many are transferred to the intensive care unit (ICU) and require mechanical ventilation. Meanwhile, patients have overflowed from the ED into the hallways as they await diagnosis, treatment, and final disposition.

Three days into this event, all of the nearby hospitals are reporting an influx of patients with similar symptoms. Their EDs are overcrowded, every inpatient bed is filled, and the night shift—already sparse—is short staffed because some health care workers (HCWs) are afraid to come to work due to the mysterious infectious outbreak being reported on the television news.


  • Critical care providers must be aware of challenges for the ICU, hospital, and community in disaster preparation and response. Failure to fully understand and appreciate the applicable concepts of disaster medicine will impede the provision of optimal critical patient care in a disaster.

  • Hazard Vulnerability Analysis is a tool to aid in hospital and ICU emergency planning in terms of likelihood and risk to demand ratios for hospital services. Given these likely events, hospitals and ICUs must then develop and test Emergency Operations Plans.

  • Preparing and exercising plans challenge hospitals and ICUs that already suffer from fiscal and time constraints for high risk, but low probability events. However, a variety of funding sources, exercise development resources, and modeling applications exist to aid in medical surge planning relevant to critical care.

  • Incidents such as intentional explosions and disease outbreaks will likely have a direct, though vastly different, impact upon demand for hospital-based critical care resources. Acute traumatic events tend to surge demand for surgical services with short ICU stays, whereas pandemic flu, for instance, will more likely isolate its effects in the ICU for a prolonged period of time.

  • The “stuff,” “staff,” and “space” paradigm provides three key ...

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