Table 1 Pre-planning action list for intensive care unit and mass casualty events

1. Logistics

   Intensivist participates or is represented on the hospital major incident committee.

   The major incident/disaster plan reflects the most likely events to be encountered, critical care elements are specifically addressed by the plan, and the plan is easily accessible.

   Plans are rehearsed and reviewed at regular intervals to reflect changes in circumstances and new evidence. Additional training for key staff is required (clinical training as well as disaster response 'mechanics').

   The plan contains provisions if decontamination and/or total intensive care unit (ICU) isolation becomes necessary.

   Staging areas for staff, volunteers, and helpers are identified and practiced.

   Are protocols in place for rationing (prioritisation) of ICU equipment if demand exceeds capacity (for example, mechanical ventilators)?

2. Communication

   Up-to-date contact details are provided to all staff. Is this information easily accessible in an emergency?

   Back-up communication systems when conventional systems are overwhelmed or fail are in place.

   Liaison staff to deal with queries from relatives, the public, and media has been identified.

   Links are established to inform local/regional back-up hospitals if we need help.

3. Capacity (including staffing)

   How do we ensure that security (including checking of staff identity) is maintained?

   Who is the lead intensivist and who is the senior nurse? Are their roles clearly defined?

   What is the absolute limit in terms of increasing bed capacity? (This includes limits in terms of staffing.)

   Transfer agreements with nearby intensive care units are in place.

   How do we increase staffing, both clinical and non-clinical, and what is the fall-back position if this is not possible?

   If the level of ICU care must be degraded because demand perniciously exceeds capacity, what is the plan to ensure that this occurs decrementally with defined priorities (as opposed to haphazardly)?

4. Equipment

   Inventory and servicing of equipment are up to date (including back-up equipment).

   What are our levels of supplies of consumables, and how do we rapidly increase delivery when there is a sudden increase in demand? How many supplies and doses of key medications do we have?

   How do we cope with limitations in infrastructure (for example, power failure and communications failure)?