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Intensive care units are expensive facilities and as a consequence intensive care units are usually maximally utilised. An additional requirement for intensive care facilities is likely to occur during an epidemic. Any additional requirement has the potential to overwhelm existing intensive care resources and therefore it may become necessary to rapidly increase the capability of existing intensive care facilities. The lack of preparedness and proper procedures to facilitate urgent expansion of intensive care unit (ICU) facilities during severe acute respiratory syndrome (SARS) was exposed during the outbreak, and several lessons have been learned. Recommendations for adequate expansion are made on the basis that a reasonable standard of ICU care will be maintained. An assessment of the need for additional staff is made, however, it is unlikely that expansion beyond an additional 60% of current capacity will be possible, based primarily on the necessity for suitably qualified nurses. There is a requirement for prospective training of anticipated additional staff, as well as the establishment of infection control procedures, good communication procedures and the resolution of anticipated ethical dilemmas. Certain other preparations for expansion should also be completed in advance. These specifically include the fit testing of negative pressure respirators, sourcing of material and designs that will allow physical modifications to the ICU and additional equipment supply sourcing, bearing in mind that supply companies will be under pressure from more than one end-user.

SARS, Bird Flu and other scares—epidemic and pandemic preparedness in intensive care