Research Article
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Published Online: 27 July 2009

Palliative Care Considerations in Mass Casualty Events with Scarce Resources

Publication: Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
Volume 7, Issue Number 2

Abstract

Catastrophic mass casualty events, such as pandemic flu outbreaks or large-scale terrorism-related events, could yield thousands of victims whose needs would overwhelm local and regional healthcare systems, personnel, and resources. Such conditions will require deploying scarce resources in a manner that is different from the more common single-event disaster. This article introduces the topic of palliative care during a mass casualty event and reviews the major findings for a federally funded planning guide that examined palliative care issues associated with providing medical care under circumstances where resources are scarce. We focus on the role of palliative care in the support of individuals not expected to survive and offer recommendations of specific actions for a coordinated disaster response plan. Semistructured telephone discussions with disaster management experts and a group meeting of experts identified issues, roles, responsibilities, procedures, and resources that offer the benefits of integrating palliative care into disaster planning and response. The investigations identified 5 domains of concern, along with guidance: (1) the role of palliative care in a mass casualty event with resulting scarce resources; (2) the triage and ensuing treatment decisions for those “likely to die”; (3) the critical palliative care services to provide, along with the personnel and settings; (4) the pragmatic plans needed for ensuring training, supplies, and organizational or jurisdictional arrangements; and (5) unusual issues affecting palliative care under mass casualty event scenarios. Palliative care minimizes the suffering of those who die, ensures comfort, addresses their needs, and may also free up resources to optimize survival of others. Planning to provide palliative care during mass casualty events should be part of the current state and local disaster planning/training guidelines, protocols, and activities.

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cover image Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
Volume 7Issue Number 2June 2009
Pages: 199 - 210
PubMed: 19635004

History

Published online: 27 July 2009
Published in print: June 2009
Accepted: 12 May 2009
Received: 18 September 2008

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Marianne Matzo
Marianne Matzo, PhD, GNP-BC, is Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing, Sooner Palliative Care Institute, College of Nursing, and an Adjunct Professor, Department of Geriatric Medicine, University of Oklahoma, Oklahoma City. Anne M. Wilkinson, PhD, is WA Cancer Council Chair of Palliative and Supportive Care, School of Nursing, Edith Cowan University, Perth, Western Australia. Joanne Lynn, MD, is Bureau Chief, Chronic Disease and Cancer, Community Health Administration, Department of Health, Government of the District of Columbia, Washington, DC. Maria Gatto, MA, APRN, ACHPN, NP, BC-AHN, HNP, is Director of Palliative Care, Bon Secours Health System, Marriottsville, Maryland. Sally Phillips, RN, PhD, is Director, Public Health Emergency Preparedness Research Program, Agency for Healthcare Research and Quality, Rockville, Maryland.
Anne Wilkinson
Marianne Matzo, PhD, GNP-BC, is Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing, Sooner Palliative Care Institute, College of Nursing, and an Adjunct Professor, Department of Geriatric Medicine, University of Oklahoma, Oklahoma City. Anne M. Wilkinson, PhD, is WA Cancer Council Chair of Palliative and Supportive Care, School of Nursing, Edith Cowan University, Perth, Western Australia. Joanne Lynn, MD, is Bureau Chief, Chronic Disease and Cancer, Community Health Administration, Department of Health, Government of the District of Columbia, Washington, DC. Maria Gatto, MA, APRN, ACHPN, NP, BC-AHN, HNP, is Director of Palliative Care, Bon Secours Health System, Marriottsville, Maryland. Sally Phillips, RN, PhD, is Director, Public Health Emergency Preparedness Research Program, Agency for Healthcare Research and Quality, Rockville, Maryland.
Joanne Lynn
Marianne Matzo, PhD, GNP-BC, is Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing, Sooner Palliative Care Institute, College of Nursing, and an Adjunct Professor, Department of Geriatric Medicine, University of Oklahoma, Oklahoma City. Anne M. Wilkinson, PhD, is WA Cancer Council Chair of Palliative and Supportive Care, School of Nursing, Edith Cowan University, Perth, Western Australia. Joanne Lynn, MD, is Bureau Chief, Chronic Disease and Cancer, Community Health Administration, Department of Health, Government of the District of Columbia, Washington, DC. Maria Gatto, MA, APRN, ACHPN, NP, BC-AHN, HNP, is Director of Palliative Care, Bon Secours Health System, Marriottsville, Maryland. Sally Phillips, RN, PhD, is Director, Public Health Emergency Preparedness Research Program, Agency for Healthcare Research and Quality, Rockville, Maryland.
Maria Gatto
Marianne Matzo, PhD, GNP-BC, is Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing, Sooner Palliative Care Institute, College of Nursing, and an Adjunct Professor, Department of Geriatric Medicine, University of Oklahoma, Oklahoma City. Anne M. Wilkinson, PhD, is WA Cancer Council Chair of Palliative and Supportive Care, School of Nursing, Edith Cowan University, Perth, Western Australia. Joanne Lynn, MD, is Bureau Chief, Chronic Disease and Cancer, Community Health Administration, Department of Health, Government of the District of Columbia, Washington, DC. Maria Gatto, MA, APRN, ACHPN, NP, BC-AHN, HNP, is Director of Palliative Care, Bon Secours Health System, Marriottsville, Maryland. Sally Phillips, RN, PhD, is Director, Public Health Emergency Preparedness Research Program, Agency for Healthcare Research and Quality, Rockville, Maryland.
Sally Phillips
Marianne Matzo, PhD, GNP-BC, is Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing, Sooner Palliative Care Institute, College of Nursing, and an Adjunct Professor, Department of Geriatric Medicine, University of Oklahoma, Oklahoma City. Anne M. Wilkinson, PhD, is WA Cancer Council Chair of Palliative and Supportive Care, School of Nursing, Edith Cowan University, Perth, Western Australia. Joanne Lynn, MD, is Bureau Chief, Chronic Disease and Cancer, Community Health Administration, Department of Health, Government of the District of Columbia, Washington, DC. Maria Gatto, MA, APRN, ACHPN, NP, BC-AHN, HNP, is Director of Palliative Care, Bon Secours Health System, Marriottsville, Maryland. Sally Phillips, RN, PhD, is Director, Public Health Emergency Preparedness Research Program, Agency for Healthcare Research and Quality, Rockville, Maryland.

Notes

Address correspondence to:
Marianne Matzo, PhD
Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing
Sooner Palliative Care Institute
University of Oklahoma College of Nursing
1100 N. Stonewall Ave.
Oklahoma City, OK 73117
E-mail: [email protected]

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