Critical Care Anywhere: Principles for High-Functioning Management in Low-Resource Environments Principles for high-functioning management in low-resource environments
Main Article Content
Abstract
Critically ill patients can present at any time and location, and they demand high quality care. Historical experiences from military, wilderness, and disaster medicine settings have helped shape the modern concept of caring for the most severely ill with limited available resources. We introduce a method to help design a successful critical care medical support endeavor, which includes properly defining components of Navigation, Environment, Resupply, Energy, Unconventional problems, and Support (NEREUS). Additionally, we provide recommendations for optimal team personnel composition, including utilization of paramedics, critical care providers, nurses, and respiratory therapists across the spectrum of care provided at point of injury, en route to definitive care, and definitive care. A review of critical care principles relevant to the austere setting proceeds with a systematic organization according to airway, breathing, circulation, and neurologic management. Lastly, we employ our proposed method of organizing a critical care medical support endeavor to a post-hurricane scenario. In summary, this review provides the historical background, modern definition, and practical framework for successfully administering critical care in scenarios with limited available resources. We emphasize the need to appropriately adapt critical care concepts to meet the unique demands of a specific scenario.
Article Details
How to Cite
STANKIEWICZ, Jason; WARD, Robert C.; MCCURDY, Michael T..
Critical Care Anywhere: Principles for High-Functioning Management in Low-Resource Environments.
Medical Research Archives, [S.l.], v. 9, n. 1, jan. 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2317>. Date accessed: 26 dec. 2024.
doi: https://doi.org/10.18103/mra.v9i1.2317.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Rodway GW. The foundations of wilderness medicine: some historical features. Wilderness Environ Med. 2012 Jun;23(2):165-9.
3. Pearn J. Gunpowder, the Prince of Wales’s feathers and the origins of modern military surgery. ANZ J Surg. 2012 Apr;82(4):240-4.
4. Roberts MJ. The development of intensive care in the military environment. J Anesth Hist. 2016 Oct;2(4):133-41.
5. Bowlby A. The work of the “clearing hospitals” during the past six weeks. Br Med J. 1914 Dec;2(2816):1053-4.
6. Olson CM, Bailey J, Mabry R, Rush S, Morrison JJ, Kuncir EJ. Forward aeromedical evacuation: a brief history, lessons learned from the Global War on Terror, and the way forward for US policy. J Trauma Acute Care Surg. 2013 Aug;75(2 Suppl 2):S130-6.
7. Thompson P, Strandenes G. The history of fluid resuscitation for bleeding. In: Spinella PC, (eds). Damage control resuscitation. Switzerland: Springer Nature; 2020: 3-29.
8. Welch PG. Deployment dialysis in the US Army: history and future challenges. Mil Med. 2000 Oct;165(10):737-41.
9. Slutsky AS. History of mechanical ventilation. From Vesalius to ventilator-induced lung injury. Am J Respir Crit Care Med. 2015 May;191(10):1106-15.
10. Morris MJ. Acute respiratory distress syndrome in combat casualties: military medicine and advances in mechanical ventilation. Mil Med. 2006 Nov;171(11):1039-44.
11. Butler FK. Two decades of saving lives on the battlefield: Tactical Combat Casualty Care turns 20. Mil Med. 2017 Mar;182(3):e1563-8.
12. Beninati W, Meyer MT, Carter TE. The critical care air transport program. Crit Care Med. 2008 Jul;36(7 Suppl):S370-6.
13. Dara SI, Farmer JC. Preparedness lessons from modern disasters and wars. Crit Care Clin. 2009 Jan;25(1):47-65.
14. Geiling J, Burkle FM, West TE, et al. Resource-poor settings: response, recovery, and research: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014 Oct;146(4 Suppl):6e168S-77S.
15. Centers for Disease Control and Prevention (CDC). Post-earthquake injuries treated at a field hospital --- Haiti, 2010. MMWR Morb Mortal Wkly Rep. 2011 Jan;59(51):1673-7.
16. Losonczy LI, Barnes SL, Liu S, et al. Critical care capacity in Haiti: a nationwide cross-sectional survey. PLoS One. 2019 Jun;14(6):e0218141.
17. Diaz JV, Riviello ED, Papali A, Adhikari NKJ, Ferreira JC. Global critical care: moving forward in resource-limited settings. Ann Glob Health. 2019 Jan;85(1):1-11.
18. Ervin JN, Kahn JM, Cohen TR, Weingart LR. Teamwork in the intensive care unit. Am Psychol. 2018 May-Jun;73(4):468-77.
19. Smith KK. Critical care nursing in an austere environment. Crit Care Med. 2008 Jul;36(7 Suppl):S297-303.
20. NHTSA Office of EMS. National EMS scope of practice model 2019. [cited 2020 December 19]. Available from: https://www.ems.gov/projects/ems-education-standards.html
21. American Academy of Pediatrics; American College of Emergency Physicians; American College of Surgeons Committee on Trauma; Emergency Medical Services for Children; Emergency Nurses Association; National Association of EMS Physicians; National Association of State EMS Officials. Equipment for ground ambulances. Prehospital Emerg Care. 2014 Jan-Mar;18(1):92-7.
22. Schauer SG, Naylor JF, Uhaa N, April MD, De Lorenzo RA. An inventory of the combat medics’ aid bag. J Spec Oper Med. 2020 Spring;20(1):61-4.
23. Maddry JK, Ball EM, Cox DB, Flarity KM, Bebarta VS. En route resuscitation - utilization of CCATT to transport and stabilize critically injured and unstable casualties. Mil Med. 2019 May;184(5-6):e172-6.
24. Kashani KB, Farmer JC. The support of severe respiratory failure beyond the hospital and during transportation. Curr Opin Crit Care. 2006 Feb;12(1):43-9.
25. Keenan S, Riesberg JC. Prolonged field care: beyond the “golden hour.” Wilderness Environ Med. 2017 Jun;28(2S):S135-9.
26. Fink M, Vincent J, Abraham E, Moore F, Kochanek P, editors. Textbook of Critical Care. 7th Ed. Philadelphia, PA: Elsevier Inc.; 2017.
27. Irwin R, Lilly C, Mayo P, Rippe J, editors. Irwin & Rippe’s Intensive Care Medicine. 8th Ed. Philadelphia, PA: Wolters Kluwer; 2018.
28. Parrillo J, Dellinger R, editors. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. 5th Ed. Philadelphia, PA: Elsevier Inc.; 2019.
29. Ferrada P, Callcut RA, Skarupa DJ, et al. Circulation first - the time has come to question the sequencing of care in the ABCs of trauma; an American Association for the Surgery of Trauma multicenter trial. World J Emerg Surg. 2018 Feb;13(1):4-9.
30. Iwami T, Kitamura T, Kawamura T, et al. Chest compression only cardiopulmonary resuscitation for out-of-hospital cardiac arrest with public-access defibrillation: a nationwide cohort study. Circulation. 2012 Dec;126(24):2844-51.
31. Brown CA, Cox K, Hurwitz S, Walls RM. 4,871 emergency airway encounters by air medical providers: a report of the Air Transport Emergency Airway Management (NEAR VI: “A-TEAM”) project. West J Emerg Med. 2014 Mar;15(2):188-93.
32. Mommers L, Keogh S. SPEEDBOMB: a simple and rapid checklist for prehospital rapid sequence induction. Emerg Med Australas. 2015 Apr;27(2):165-8.
33. Wallace MC, Britton T, Meek R, et al. Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment. Mil Med Res. 2017 Jun;4(1):1-10.
34. Son M, Zimmer D, McCauley R, et al. Evaluation of Google Glass with camera adapter and GoPro as teaching tools for endotracheal intubation in the austere medical environment. Open J Anesthesiol. 2018 Aug;8(1):229-39.
35. Paix BR, Griggs WM. Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple “scalpel-finger-tube” method. Emerg Med Australas. 2012 Feb;24(1):23-30.
36. McNiven ND, Pracy JP, McGrath BA, Robson AK. The role of scalpel-bougie cricothyroidotomy in managing emergency front of neck airway access. a review and technical update for ENT surgeons. Clin Otolaryngol. 2018 Jun;43(3):791-4.
37. Johnson CA, Goodwine DS, Passier I. Improvised cricothyrotomy on a mountain using hiking gear. Wilderness Environ Med. 2016 Dec;27(4):500-3.
38. Sahu AK, Bhoi S, Aggarwal P, et al. Endotracheal tube placement confirmation by ultrasonography: a systematic review and meta-analysis of more than 2500 patients. J Emerg Med. 2020 Aug;59(2):254-64.
39. Halpern P, Dang T, Epstein Y, Van Stijn-Bringas Dimitriades D, Koenig KL. Six hours of manual ventilation with a bag-valve-mask device is feasible and clinically consistent. Crit Care Med. 2019 Mar;47(3):e222-6.
40. L’Her E, Roy A, Marjanovic N. Bench-test comparison of 26 emergency and transport ventilators. Crit Care. 2014 Oct;18(5):1-14.
41. Marjanovic N, L’Her E. A comprehensive approach for the ergonomic evaluation of 13 emergency and transport ventilators. Respir Care. 2016 May;61(5):632-9.
42. Blakeman TC, Branson RD. Oxygen supplies in disaster management. Respir Care. 2013 Jan;58(1):173-83.
43. Blakeman TC, Rodriquez D, Britton TJ, et al. Evaluation of oxygen concentrators and chemical oxygen generators at altitude and temperature extremes. Mil Med. 2016 May;181(5 Suppl):160-8.
44. Schauf M. EMS Airway: what? we ran out of oxgygen? [cited 2020 Dec 19]. Available from: https://www.emsairway.com/2020/01/09/what-we-ran-out-of-oxygen/#gref
45. Lutman D, Petros AJ. How many oxygen cylinders do you need to take on transport? a nomogram for cylinder size and duration. Emerg Med J. 2006 Sep;23(9):703-4.
46. Fludger S, Klein A. Portable ventilators. Contin Educ Anaesthesia, Crit Care Pain. 2008 Dec;8(6):199-203.
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