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 As you complete your post-therapy assessment of a child with asthma, the hospital administrator announces that an accident occurred at Polygon Chemical and Plastics, approximately 12 miles from your hospital.
An airborne vapor plume of pneumotoxicants is impinging upon several schools, area businesses, and residential neighborhoods, and extending onto a major highway. Several commuters and pedestrians have been exposed to the airborne chemicals, some losing consciousness due to hypoxia. The county emergency management authority declares a mass casualty incident and advises residents and building occupants to shelter-in-place.
Your hospital implements its external disaster plan. Patients begin to arrive at the hospital emergency department with varying degrees of respiratory distress, ocular irritation, and traumatic injuries resulting from secondary motor vehicle collisions, stampedes, and falls. Local emergency medical technicians are en route with several immediate patients on high-flow oxygen, others have been field-intubated, and still others are receiving oxygen and bronchodilators.
Several hours later, many patients arrive via ambulances and private vehicles exhibiting latent onset non-cardiogenic pulmonary edema and severe obstructive airway disease. Your hospital's oxygen resources are dwindling, and re-supply has been delayed.
The realities of response
As may be evident by the preceding scenario, supplemental oxygen for normobaric oxygen therapy, resuscitative needs, inter- and intra-facility transports, and positive pressure ventilation remains a primary and critical component of health care system response to high impact, high consequence events.
Therefore, the provision of viable and sustainable oxygen supply and distribution systems is of paramount importance in medical planning and preparedness efforts. Natural and man-made events can disable and disrupt the chain of oxygen production, distribution, maintenance, and delivery of oxygen supplies to hospitals and home care patients. It is important to note that the Nation's Strategic National Stockpile does not provide medical gas capabilities.
In addition, mass casualties generated from an incident or event can quickly overwhelm existing critical medical infrastructure. High acuity patients will likely require high volume supplemental oxygen and varying levels of critical care, including positive pressure ventilation, which would increase oxygen consumption. Depending on the type, scope, magnitude, and severity of an incident or event, oxygen resources could become severely disrupted and rapidly depleted.
Local health care facilities must maintain a self-reliant posture, including critical medical infrastructure, for up to 96 hours, as per recent Joint Commission guidelines. While challenging, resource allocation may remain manageable in localized incidents or events, even those requiring mutual aid from a nearby jurisdiction. The key is to plan ahead.
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