Critical care
Share this page
5.1.14
Critical care
WHO EMT TECHNICAL INFORMATION
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.
WHO EMT MINIMUM TECHNICAL STANDARD
- 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).
- Staffing
- 1 : 2 nurse–patient ratio per shift, nurses trained and experienced in intensive care.
- Multidisciplinary team including qualified intensivists and rehabilitation specialists.
- 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.
- 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.
WHO EMT RECOMMENDATIONS FOR OPTIMAL PATIENT CARE
Consider an additional anaesthesiologist outside of those assigned to OT (Type 3)