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COVID-19 Critical Care Surge Resources
Topic Collection
April 7, 2020

Topic Collection: COVID-19 Critical Care Surge Resources

This Topic Collection focuses on plans, tools, templates, and other immediately implementable resources to help with COVID-19 preparedness, response, recovery, and mitigation efforts, focusing on critical care surge.

Please refer to CDC’s Coronavirus Disease 2019 webpage for the most up-to-date clinical guidance on COVID19 outbreak management.

If you have COVID-19 best or promising practices, plans, tools, or templates to share with your peers, please visit the ASPR TRACIE Information Exchange COVID-19 Information Sharing Page (registration required) and place your resources under the relevant topic area. Resources specific to critical care surge can be placed under the COVID-19 Critical Care Surge Resources Topic.

Select Resources


American Society of Anesthesiologists and Anesthesia Patient Safety Foundation. (2020). APSF/ASA Guidance on Repurposing Anesthesia Machines as ICU Ventilators. (Added 4/7/2020.)
These resources jointly developed by the American Society of Anesthesiologists and Anesthesia Patient Safety Foundation guide the safe and effective use of anesthesia machines as intensive care unit (ICU) ventilators should supply be insufficient during the COVID-19 pandemic. Resources include a guidance document on purposing anesthesia machines as ICU ventilators, a quick reference bedside took on setup and monitoring instructions, guidance on use of volatile anesthetic for sedation of ICU patients, and a procedural checklist for supporting patients during the anesthesia machine power up test.
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Einav, S., Hick, J., Hanfling, D., et al. (2014). Surge Capacity Logistics: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement. Chest. 146(4_supplement):e17S–e43S.
The authors list 22 suggestions specific to surge capacity and mass critical care under the following topics: stockpiling of equipment, supplies, and pharmaceuticals; staff preparation and organization; patient flow and distribution; deployable critical care services; and using transportation assets to support surge response. The document includes supply and equipment lists (Tables 3, 4, 5, and 6) and staffing recommendations that may help inform a hospital’s COVID-19 response.
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This figure depicts the proportion of critical care, intermediate care and telemetry unit, and general hospital ward patients during routine operations and during a medical surge. The proportion of critical care patients increases during a medical surge incident as lower acuity patients are directed to community-based care.
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Guan, W., Ni, Z., Hu, Y., et al. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. The New England Journal of Medicine .
The authors reviewed data from 1,099 laboratory-confirmed COVID-19 patients in 552 mainland China hospitals through January 29, 2020. The cumulative risk of the composite end point of admission to an intensive care unit, use of mechanical ventilation, or death was 3.6% for all patients and 20.6% for patients with severe disease. The authors noted that 15.7% developed severe illness after hospital admission; 1.4% died; 43.8% of patients presented with fever, but 88.7% developed a fever while hospitalized; and 2.9% of those with severe and 17.9% of those with non-severe disease had no radiologic abnormalities on initial presentation.
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This two-pager summarizes critical care planning for COVID-19. It includes a figure depicting the expansion of critical care from conventional to contingency/crisis levels. The document offers key points to operationalize the concept in terms of space, staffing, supplies and to provide critical care.
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Hick, J., Einav, S., Hanfling, D., et al. (2014). Surge Capacity Principles: Care of the Critically Ill and Injured During Pandemics and Disasters. Chest. 146(4_supplement): e1S–e16S.
This article presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care in disasters or pandemics.
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Hick, J., Einav, S., Hanfling, D., et al. (2020). Surge Capacity Principles: Care of the Critically Ill and Injured During Pandemics and Disasters – Figure 1. Chest. 146(4_supplement): e1S–e16S. .
This figure depicts a framework for how critical care expands from conventional to contingency to crisis based on morbidity and incident demands and operating conditions. The goal is 200% expansion of critical care capacity during a crisis.
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This article lists considerations related to identifying alternate staffing resources, developing a team-based approach to patient management, and addressing administrative concerns on staffing, nursing leadership concerns, and nurse safety and resilience while planning for COVID-19 critical care surge.
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This document outlines a process states can use to gather hospital data needed to identify where ventilators are needed and deliver them directly to receiving hospitals. Access the accompanying Excel spreadsheet here: https://files.asprtracie.hhs.gov/documents/covid-state-ventilator-planning-template.xlsx.
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SCCM, AARC, ASA, APSF, AACN, and CHEST. (2020). Joint Statement on Multiple Patients Per Ventilator.
This consensus statement issued by the Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of Critical-Care Nurses (AACN), and American College of Chest Physicians (CHEST) recommends that mechanical ventilators not be shared by multiple COVID-19 patients.
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Society of Critical Care Medicine. (2020). Critical Care for the Non-ICU Clinician. (Added 4/7/2020.)
These free, online modules provide training for non-intensive care unit clinicians to provide care during a surge of critically ill patients.
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This article describes the epidemiological and clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in a single hospital. While the article is the largest case series to date, it was published before outcomes were known for most patients.
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WHO-China Joint Mission. (2020). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). World Health Organization.
This report describes the joint World Health Organization-China 25-member mission to understand the evolving COVID-19 outbreak in China. The report details epidemiologic and clinical data through February 20, 2020 and describes measures taken by China to prevent transmission, slow the outbreak, and reduce cases. The report offers recommendations for China, for countries with imported cases or outbreaks, for countries with no known cases, for the public, and for the international community.
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The authors describe their findings from a retrospective cohort study of 201 hospitalized COVID-19 patients in a single Chinese hospital between December 25, 2019 and January 26, 2020 with final follow-up on February 13, 2020. They found that 41.8% of patients developed acute respiratory distress syndrome (ARDS) and 52.4% of those who developed ARDS died. The authors concluded that a less rigorous immune response in older adults was associated with a greater risk of developing and death and that while fever was associated with developing ARDS, those with ARDS and fever had better outcomes. The also cautiously noted that methylprednisolone may be a beneficial treatment for ARDS, but additional research is needed.
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Clinical Guidelines


American Society of Health-System Pharmacists. (2020). Assessment of Evidence for COVID-19-Related Treatments. (Added 4/7/2020.)
This periodically updated table summarizes current evidence related to the use of various drugs to treat patients with COVID-19.
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Australian and New Zealand Intensive Care Society. (2020). ANZICS COVID-19 Guidelines.
These guidelines provide critical care recommendations and suggestions for a pandemic setting. They are intended as a living document based on previous experience and are updated as the evidence base for COVID-19 clinical care grows. The document includes three sections: 1) Planning for a Pandemic – An Operational Guide, 2) Providing a Safe Working Environment – Staff Protection and Sustainability, and 3) Identification and Treatment of Patients with COVID-19 Infection – The Basics.
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Beth Israel Lahey Health. (2020). COVID-19 Materials.
This web page includes frequently updated COVID-19 information for healthcare workers. Resources include: testing and patient evaluation algorithms, clinical guidance, operational guidance, personal protective equipment information, resources for patients and their caregivers, symptom screening tools, and sample signage.
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These COVID-19 guidelines are based on current available evidence and continually updated based on feedback from practitioners. Included are one-page quick guides and information organized under: non-ICU management, triage, and transfers; respiratory support; therapies and clinical trials; cardiac complications; shock; thrombotic and coagulation manifestations; renal manifestations; and other related issues. A COVID ICU Bundle Checklist is included as an addendum.
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Hackensack Meridian Health. (2020). COVID-19 Clinical Protocols and Policies.
This frequently updated page includes information on: 1) screening a suspected COVID-19 case, 2) communicating a suspected COVID-19 case, 3) masking guidelines, 4) personal protective equipment information, 5) respiratory etiquette, 6) ambulatory scheduled video visits, and 7) protocols and policies for a variety of clinical settings and activities.
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These guidelines highlight recent updates and general considerations followed by a table showing treatment considerations and special considerations for various clinical situations. Extensive references are listed for each of the therapeutic options.
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Intermountain Healthcare. (2020). Clinical Guidance: Triaging/Testing.
This page provides clinical guidance for physicians and advanced practice providers, surgical operations, frontline receptionists, hospital and clinic caregivers, and home care. Documents include: assessment guidance, care processes, testing guidance and procedures, imaging guidelines, personal protective equipment guidance, decision pathways, scripts, cleaning guidance for rooms and equipment, waste disposal guidance, and frequently asked questions.
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Massachusetts General Hospital. (2020). COVID-19 Treatment Guidance.
This frequently updated page includes both inpatient and outpatient care recommendations as well as fast literature updates. Documents include: treatment and critical care guidance, algorithms, protocols, workflows, figures, frequently asked questions, and supporting literature.
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These guidelines reflect the best information available to guide decision making in the management of COVID-19 patients. Included is information on screening and triage, infection prevention, specimen collection, clinical management, treatment options, telemedicine, emergency medical services, and ethical considerations. It also includes appendices with checklists, supply lists, algorithms, and other tools.
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Michigan Medicine. (2020). Inpatient Guidance for Treatment of COVID-19 in Adults and Children. University of Michigan.
This document includes treatment information for patients admitted to an inpatient floor or intensive care unit. It summarizes clinical symptoms, treatment options, clinical syndromes, agents under investigation for COVID-19 treatment, and other information.
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Nebraska Medicine. (2020). COVID-19 Resources for Providers.
This frequently updated page includes: information on use, donning and doffing, and decontamination of personal protective equipment; protocols and checklists; inpatient, ambulatory, surgical, special patient populations, treatment, and patient transport guidance; and other related resources for healthcare providers.
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Queen Alexandria Hospital Portsmouth, Academic Department of Critical Care. (2020). COVID-Specific Critical Care Guidelines. Portsmouth Hospitals NHS Trust.
These guidelines from a hospital in the United Kingdom offer a one-page summary listing necessary equipment and supplies, staffing roles, patient preparation steps, and an airway assessment and intubation plan. Also included is a one-pager depicting the equipment assembly for COVID-risk intubation in critical care patients.
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This frequently updated page includes information on clinical and administrative policies and protocols. It includes information on personal protective equipment; a dashboard on testing, virtual visits, and hospitalized patients; and testing, inpatient, and emergency department clinical pathways.
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The First Affiliated Hospital, Zhejiang University School of Medicine. (2020). Handbook of COVID-19 Prevention and Treatment. Jack Ma Foundation and Alibaba Foundation.
This guide is based on the experience of clinicians treating patients at The First Affiliated Hospital. It includes sections on prevention and control management, diagnosis and treatment, and nursing. It includes tables, step-by-step lists, infographics, algorithms, and images supporting the descriptive text.
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The University of Texas Health Science Center at Houston. (2020). COVID-19 Clinical Management and Guideline Updates.
This web page includes COVID-19 clinical management resources, including intubation guidelines and clinical pearls for proning.
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This frequently updated page of one health system's clinical practice documents includes: an airway management safety diagram, an acute respiratory distress syndrome bedside card, an intubation checklist, a pharmacotherapy flowsheet, a tidal volume per IBW table, intubation precautions, code blue guidance, and intensive care unit care guidelines.
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University of California San Francisco, Department of Hospital Epidemiology and Infection Control. (2020). UCSF Health COVID-19 Clinical Resources.
These frequently updated guidelines offer: 1) information on personal protective equipment, 2) algorithms, 3) other clinical information and announcements, 4) control plan and testing, 5) signage in multiple languages, 6) forms, 7) staff education materials, 8) provider and staff training resources, 9) patient education, 10) email digests, and 11) external resources.
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University of Washington Medicine. (2020). UW Medicine COVID-19 Resource Site.
This page includes policies and protocols developed by the University of Washington health system and its partners to address COVID-10. Frequently updated, the page includes: 1) patient care protocols and algorithms, 2) other inpatient clinical guidance, 3) neonatal care protocols, 4) policy statements on personal protective equipment, patient care, post-acute and long term care, operations and facilities, staff, and other (autopsy, information technology, and vendor and delivery driver access).
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Van Ierssel, S., Dauby, N., Bottieau, E., et al.. (2020). Interim Clinical Guidance For Adults with Suspected or Confirmed COVID-19 in Belgium. (Added 4/7/2020.)
This frequently updated document provides guidance to clinicians caring for COVID-19 patients in Belgium.
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This document reflects the guidance of the Surviving Sepsis Campaign COVID-19 panel, composed of 36 experts from 12 countries. The panel issued 54 statements on: 1) infection control, 2) laboratory diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy. Of the 54 statements, four are best practices, nine are strong recommendations, 35 are weak recommendations, and six questions have no recommendations. Accompanying infographics depict a summary of recommendations on managing patients with acute respiratory distress syndrome and COVID-19 and a summary of recommendations on the initial management of hypoxic COVID-19 patients.
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This document provides clinicians with information on managing suspected adult, pregnant, and pediatric COVID-19 patients. It provides information on screening and triage, infection control, collection of laboratory specimens, management of various symptoms and levels of illness, therapies, care of at-risk population groups, and clinical research on potential treatments.
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Clinical Rounds


Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: Critical Care (3/24/2020). U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This webinar is the first in the series focused on lifesaving treatment and clinical operations. Speakers from Emory University School of Medicine/Emory Critical Care Center and University of Minnesota/ Minnesota Health System discuss clinical and team management in the COVID-ICU and use of Extracorporeal Membrane Oxygenation (ECMO) in COVID-19.
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Office of the Assistant Secretary for Preparedness and Response. (2020). National COVID-19 Clinical Rounds: Critical Care Resources (3/31/2020). (Added 4/7/2020.) U.S. Department of Health and Human Services.
This webinar is part of the National COVID-19 Clinical Rounds hosted by ASPR, Project ECHO, NETEC, and other public-private partners. This webinar is the second in the series focused on lifesaving treatment and clinical operations. Speakers from New York City Health + Hospitals Bellevue Hospital Center and Singapore's National Centre for Infectious Disease discuss their observations from treating COVID-19 patients.
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Agencies and Organizations


Association of American Medical Colleges. COVID-19 Clinical Guidance Repository.
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European Society of Intensive Care Medicine. COVID-19 Resource Page.
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Society of Critical Care Medicine. Emergency Resources: COVID-19.
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