Who Benefits from Intensive Care in the Field?

Abstract

The limited capacity and resources of a Field Hospital Intensive Care Unit may necessitate the triage or prioritisation of critically ill patients requiring admission. The use of critical care resources by members of the local population in certain Areas of Operation, who can not be discharged or transferred to equivalent care in their local health service, impacts significantly on bed occupancy. Therefore available resources must be distributed efficiently and equitably with decisions guided by the principles of advocacy for the patient. Patientsmust be admitted only on the concept of potential benefit and reasonable chance of recovery, which would not be available elsewhere. Discriminating between seriously ill patients before admission and decision making regarding withdrawal of care is very difficult. Senior clinicians working regularly in a critical care setting demonstrate a better level of discrimination in assessing outcome of seriously ill patients and are best placed to make decisions regarding admission, continuation and withdrawal of treatment.

Assessing trauma care provider judgement in the prediction of need for life-saving interventions

“…The confrontation between the classically expertjudgement-based ''art of medicine'' point of view and that of ''evidence-based medicine'' is neither the focus nor the concern of the present study; however, the need to merge the two effectively in computer-based support systems is of concern across many health care disciplines, most particularly in critical care, to allow for better triage and distribution of resources [23][24][25][26]. Within this general debate, the clearest role for math-based systems development-computer modelling and instrumentation based on this work-is in improved data-gathering and decision-assist tools [27,28].…”

Multinational Medical Support to Operations: Challenges, Benefits and Recommendations for the Future

“…This can bring ethical dilemmas for the clinicians providing the emergency care that is required in line with international medical ethics and the Law of Armed Conflict. The issue is that following emergency treatment, longer term care will be undertaken in the home nation, in which the standards of care will usually be less than those pertaining in the clinicians' home nation [3,19,20]. The medical rules of eligibility published in AD 83-1 [13] had been developed utilising the broad experience and differing perspectives within the NATO military medical community in order to provide pragmatic yet ethically based guidance.…”