Surging to the Right Standard of Care

W e commend Hick and O’Laughlin for systematically addressing a difficult issue in their article entitled ‘‘Concept of Operations for Triage of Mechanical Ventilation in an Epidemic’’ in this issue of Academic Emergency Medicine. Until Hurricane Katrina hit the Gulf Coast in 2005, the United States had been fortunate in not having to face the issue of health care resource triage on a large scale since the 1918 influenza pandemic. Unlike other countries where catastrophic tsunamis, earthquakes, and typhoons have produced tens of thousands of casualties, we have not really exceeded our health care resources to the point where patients are dying from lack of care. We remain at risk, however, for an event that could produce an even larger number of casualties, on the order of 100,000 victims or more, whether a catastrophic earthquake on the New Madrid fault in the central United States, a large-scale terrorist incident, or a naturally occurring influenza pandemic such as one that could occur from the H5N1 avian flu. The two main public health issues that need to be addressed are 1) a system for surge capacity and 2) a process to maximize patient outcomes in the face of health care needs that exceed available resources. We will refer to this process here as a medical and health-oriented emergency management program.