Intensive Care Medicine

, Volume 36, Supplement 1, pp 11–20

Chapter 2. Surge capacity and infrastructure considerations for mass critical care

  • John L. Hick
  • Michael D. Christian
  • Charles L. Sprung

DOI: 10.1007/s00134-010-1761-4

Cite this article as:
Hick, J.L., Christian, M.D. & Sprung, C.L. Intensive Care Med (2010) 36: 11. doi:10.1007/s00134-010-1761-4



To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations.


Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations.


Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards.


Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.


Surge capacityRecommendationsStandard operating proceduresIntensive care unitHospitalH1N1Influenza epidemicPandemicDisaster

Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • John L. Hick
    • 1
  • Michael D. Christian
    • 2
  • Charles L. Sprung
    • 3
  1. 1.Department of Emergency MedicineHennepin County Medical CenterMinneapolisUSA
  2. 2.Department of MedicineInfectious Diseases and Critical Care, Mount Sinai Hospital & University Health Network, University of TorontoTorontoCanada
  3. 3.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael