Critical care

Type 3 provide intensive care for those patients whose conditions are life-threatening and who require comprehensive care monitoring and/or mechanical ventilation.

In a large-scale emergency setting, intensive care can be controversial and should be used in the context of social norms and pre-existing capabilities. ICU activities within the EMT should always be equal to the level of a tertiary referral centre and aim to reproduce the level of care available at national tertiary hospitals.

1. Intensive care considerations
   • Adapt the standard of care to the emergency context.
   • Provide clinical care and continuous monitoring of patients on a 24/7 basis.
   • Consider nutritional requirements of patients (enteral feeding).
2. Staffing
   • 1 : 2 nurse–patient ratio per shift, nurses trained and experienced in intensive care.
   • Multidisciplinary team including qualified intensivists and rehabilitation specialists.
3. Technical requirements
   • Minimum of four ICU beds and at least one incubator.
   • Maintain basic patient function, such as hydration, nutrition, hygiene, early mobilization, facilitate patient communication, prevention of contractures (physio), thromboembolism, pressure ulcers and pulmonary aspiration.
   • Manage hemodynamic instability/shock syndromes of any origin, for example, by safe management of fluids and other specific medications and blood transfusion.
   • Support/replace organ function such as by mechanical ventilation.
4. Ethical considerations
   • Determine triage (referral/admission) process and exclusion criteria. Clearly define an exit strategy for every admission.
   • Adapt treatment standards to emergency settings, balancing caseload, prognosis and resources.
   • Have clear discharge criteria.
   • Ceilings of care decisions, recognizing the need for transfer or considering end of treatment and palliative care, when needed. These decisions demand multidisciplinary decision-making and can be linked to the ethical committee.

Consider an additional anaesthesiologist outside of those assigned to OT (Type 3)