Event Priorities

Event Details

Know broad population needs. Example: for marathon you have runners, walkers and an audience
Have/share pre-established assessment and treatment protocols
Know the rules of the sporting event: adding a participant, official distances, etc
Be ready for surprise injuries: ex. dislocated jaw

Providing care to participants as well as spectators (ex kid with anaphylaxis) including providers and event staff
Working with law enforcement and public safety
Risks for 2020: Clean, isolate, tracking

Conventional Capacity: ability to continue usual standard of care increasing capacity to 20% above normal (ex. in mass causality situations) using existing staff and resources
Contingent Capacity: able to expand critical capacity 100%; modify existing spaces; re-deploying selected staff and augment ventilator supply (ex. vents for OR or transport, noninvasive ventilation); standard of care near prevailing community standard
Crisis Capacity: severe limitations of space, staff and supplies does not allow hospitals to provide the usual standard of care. Demand exceeds capacity and triage protocols become active

Triage requires a community to accept that some individuals will not receive critical care resources as they normally would under normal circumstances.
Three overarching goals:
- Deliver the greatest benefit to the greatest number of people
- Prevent random or unequal distribution of resources
- Provide compassionate supportive care to patients who do not receive critical care resources
Patient consent is not required to implement the allocation treatment plan for the patient
Triage incorporates multiple ethical principles (multi-principal approach).

Utilitarian: Priority is given to patients who are more likely to survive in the near-term as a consequence of care (ex. low SOFA, fewer organs failing) or given to patients who have a better prognosis after discharge
Stewardship: Patients who are too sick, near immediate death are not excluded form allocation
Save Two Lives: Priority is given to female patients who are pregnant with fetus > 24 weeks
Seasons of Life: Given comparable short term prognosis and long term prognosis, priority is given to younger patients
Equality: Priority is given to those who have a better lottery score (ex. lowest number, coin-flip)
Reciprocity: Front line workers and research subjects are given priority.

Infectious disease epidemiology plays a factor in biologic events.
- Host: immune status, genetics, age, gender, behaviors
- Agent: virulence factors, genetic adaptability, infectivity
- Environment: vector, reservoir, climate, land use, population density
The number of people that one sick person will infect (on average) is called Ro. Ro for several viruses listed below:
- Hepatitis C - 2
- Ebola - 2
- HIV - 4
- SARS - 4
- Mumps - 10
- Measles - 18
Phases of a pandemic:
- Phases 1-3: Predominantly animal infections, few human infections
- Phase 4: Sustained human to human transmission
- Phases 5-6: Widespread human infection
- Post Peak: possibility of recurrent events
- Post Pandemic: disease activity at seasonal levels
Pandemic severity index (based on case fatality rate):
- Category 1: <0.1%
- Category 2: 0.1% - <0.5%
- Category 3: 0.5 - <1.0%
- Category 4: 1.0 - <2%
- Category 5: >2%
Goals of Community Mitigation:
- 1) delay outbreak peak
- 2) decompress peak burden on hospitals/infrastructure
- 3) diminish overall cases and health impacts