Critical Care Medicine : Organizing and Staffing Intensive Care Units

Critical Care Medicine

An attempt has been made to direct the evolution of critical care medicine based on the authors’ personal experiences with the development of emergency care and intensive care programs during the past decade, and on review of the available literature. Critical care medicine (i.e., acute medicine) includes emergency medical services for life-threatening conditions and intensive care. In contrast to the hitherto often disorganized and haphazardous development of intensive care units, we propose a logical, community-oriented plan to implement present knowledge in multidisciplinary interdepartmental intensive care. Although in very large hospitals more than one intensive care unit may be necessary, the development of separated pure respiratory, medical or surgical intensive care units is discouraged, because most critically ill patients have multiple organ failure. Special intensive nursing care under physician direction, using standardized basic life support techniques, has decreased mortality, for instance, of patients with myocardial infarction. There is evidence suggesting that mortality and morbidity of other types of critically ill patients are further reduced where sophisticated life support around the clock has been provided by teams of physicians from several disciplines who are working fulltime or “most time” in the ICU. The team includes non-physicians, such as nurses, nurses’ helpers, inhalation therapists, bioengineers, technicians, administrators and others. Selection of team coordinator and ICU medical director, as well as

Organizing and Staffing Intensive Care Units

The intensive care unit and the anesthesiologist.

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The intensive care unit and the anesthesiologist.