Project Details

On 11 June 2009, the World Health Organization raised the level of influenza pandemic alert from phase 5 to phase 6 indicating the start of an influenza pandemic (WHO press release). H1N1 swine influenza has the potential to cause life threatening illness. However, the likely impact of the pandemic on current critical care capacity is unknown. Estimates of the impact are extremely uncertain but suggest that current critical care resources, including any possible surge capacity gained through expansion into other hospital beds and operating theatres, could be overwhelmed.

Excessive demand, where resources are finite, creates an ethical dilemma and many emergency plans apply a utilitarian approach. In this situation, the principles of biomedical ethics and international law dictate that triage be used to guide equitable and efficient resource allocation and that the rationale for triage should be fair and transparent and meet the principles of distributive justice.

We intend to develop triage models, building on previous efforts, at first using existing data and then subsequently refining the models on an ongoing basis with emerging data from the current pandemic. Our models will provide the ability to triage all referrals, or solely pandemic-related referrals, for critical care.

Our modelling will be underpinned by the rationale that, at the peak of the pandemic, it will be unrealistic to expect all decisions regarding delivery of critical care to be made by senior critical care consultants and there will be a need to empower other medical staff to do so.

We will rapidly develop and implement a UK-wide, real-time high quality clinical database of adult and paediatric patients with confirmed, probable or suspected H1N1 swine influenza considered for referral to critical care.

The primary purpose of the ongoing H1N1 swine influenza pandemic-related data collection is to allow policy makers within the NHS to assess, in real-time, the burden of severe H1N1 swine influenza throughout the NHS and to rapidly respond to escalation in the number of severe cases.

(i) To develop triage tools to guide use of critical care services using existing, available data, from within and outside ICNARC;

(ii) To establish ongoing H1N1 swine influenza pandemic-related data collection for patients considered for referral for critical care;

(iii) To refine the triage tool, on a regular basis, using emerging data from objective (ii);

(iv) To identify all relevant jurisdictions and establish the content required, and timelines for, regular reporting to guide immediate policy and practice on the use of critical care services during the H1N1 swine influenza pandemic;

(v) To deliver regular reports plus any ad hoc analyses requested and participate in H1N1 swine influenza pandemic meetings, as required, throughout the pandemic; To publish a final report describing the impact of the H1N1 swine influenza pandemic on ciritcal care services, use and patients' care and outcomes.