Special Article

Intensive Care Medicine

, Volume 36, Issue 3, pp 428-443

First online:

Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster

  • Charles L. SprungAffiliated withDepartment of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical CenterGeneral Intensive Care Unit, Hadassah Hebrew University Medical Center Email author 
  • , Janice L. ZimmermanAffiliated withCritical Care Division, Department of Medicine, The Methodist Hospital, Weill Cornell Medical College
  • , Michael D. ChristianAffiliated withDepartment of Medicine, Infectious Diseases and Critical Care, Mount Sinai Hospital & University Health Network, University of Toronto
  • , Gavin M. JoyntAffiliated withDepartment of Anesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Prince of Wales Hospital
  • , John L. HickAffiliated withDepartment of Emergency Medicine, Hennepin County Medical Center
  • , Bruce TaylorAffiliated withDepartment of Critical Care, Portsmouth Hospitals NHS Trust
  • , Guy A. RichardsAffiliated withDepartment of Intensive Care, Johannesburg Hospital, University of the Witwatersrand
  • , Christian SandrockAffiliated withIntensive Care Unit, Division of Pulmonary and Critical Care Medicine, Infectious Diseases, UC Davis School of Medicine
  • , Robert CohenAffiliated withEmergency Medical Services, Israeli Ministry of Health, Hebrew University Faculty of Medicine
    • , Bruria AdiniAffiliated withEmergency Medical Services, Israeli Ministry of Health, Ben-Gurion University of the Negev

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To provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic.


Based on a literature review and expert opinion, a Delphi process was used to define the essential topics.


Key recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals should have appropriate beds and monitors for these expansion areas. Establish a management system with control groups at facility, local, regional and/or national levels to exercise authority over resources. Establish a system of communication, coordination and collaboration between the ICU and key interface departments. A plan to access, coordinate and increase labor resources is required with a central inventory of all clinical and non-clinical staff. Delegate duties not within the usual scope of workers’ practice. Ensure that adequate essential medical equipment, pharmaceuticals and supplies are available. Protect patients and staff with infection control practices and supporting occupational health policies. Maintain staff confidence with reassurance plans for legal protection and assistance. Have objective, ethical, transparent triage criteria that are applied equitably and publically disclosed. ICU triage of patients should be based on the likelihood for patients to benefit most or a ‘first come, first served’ basis. Develop protocols for safe performance of high-risk procedures. Train and educate staff.


Mortality, although inevitable during a severe influenza outbreak or disaster, can be reduced by adequate preparation.


Recommendations Intensive care unit Hospital Influenza epidemic Pandemic H1N1 Mass disaster Triage