Critical Care Anywhere: Principles for High-Functioning Management in Low-Resource Environments

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.

Learning from critical care nurses' wartime experiences and their long‐term impacts

“…Interviewees related improved administrative and organizational skills during their deployment, a subtheme not found in other studies, although Scannell‐Desch and Doherty 37 noted that military nurses improved their clinical skills during the Iraq and Afghanistan wars. This point is in contrast to Stankiewicz et al's 1 recommendation that deployed critical care personnel to the disaster arena with a resource‐limited sting should be prioritized to well‐experienced providers with disaster relief. Despite their growing competencies, most interviewees would probably have agreed with Stankiewicz et al 1 that pairing experienced with inexperienced personnel in disaster zones should be prioritized.…”

“…This point is in contrast to Stankiewicz et al's 1 recommendation that deployed critical care personnel to the disaster arena with a resource‐limited sting should be prioritized to well‐experienced providers with disaster relief. Despite their growing competencies, most interviewees would probably have agreed with Stankiewicz et al 1 that pairing experienced with inexperienced personnel in disaster zones should be prioritized.…”

“…Together with nursing responses during disasters and public health emergencies, the experiences of battlefield nurses have informed the development of critical nursing, 1 the nineteenth century being a decisive period in the development of critical care medicine. Florence Nightingale's contribution to knowledge about the importance of sanitary conditions in significantly reducing fatalities during the Crimean War (1854–1856) is well known.…”