Caring for Critically Ill Patients in Humanitarian Settings

• Published in: American journal of respiratory and critical care medicine Vol. 199; no. 5; pp. 572 - 580
• Main Authors: Lee, James S, Roberts, Simon W P, Götsch, Kanya, Moeller, Ulrike, Hawryluck, Laura
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01-03-2019
• Subjects: Charters; Checklist; Critical Care; Critical Care - methods; Critical Care - organization & administration; Critical Illness - therapy; Critical thinking; Ebola virus; Emergency medical care; Health care; Health Services Accessibility - organization & administration; Hospital Rapid Response Team; Hospitals; Humanitarian aid; Humans; Medicine; Patient Care Team; Patients; Physicians; Relief Work - organization & administration; Resuscitation; Sepsis; Skills; Socioeconomic factors; Surgeons; Teams; Telemedicine; Terminal Care; Trauma care; Africa; intensive care; critical care; humanitarian action
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201806-1059CP

Critical care medicine is far from the first medical field to come to mind when humanitarian action is mentioned, yet both critical care and humanitarian action share a fundamental purpose to save the lives and ease the suffering of people caught in acute crises. Critically ill children and adults will be present regardless of resource limitations and irrespective of geography, regional or cultural contexts, insecurity, or socioeconomic status, and they may be even more prevalent in a humanitarian crisis. Critical care is not limited to the walls of a hospital, and all hospitals will have critically ill patients regardless of designating a specific ward an ICU. Regular and consistent consideration of critical care principles in humanitarian settings provides crucial guidance to intensivists and nonintensivists alike. A multidisciplinary, systematic approach to patient care that encourages critical thinking, checklists that encourage communication among team members, and context-specific critical care rapid response teams are examples of critical care constructs that can provide high-quality critical care in all environments. Promoting critical care principles conveys the message that critical care is an integral part of health care and should be accessible to all, no matter the setting. These principles can be effectively adopted in humanitarian settings by normalizing them to everyday clinical practice. Equally, core humanitarian principles-dignity, accountability, impartiality, neutrality-can be applied to critical care. Applying principles of critical care in a context-specific manner and applying humanitarian principles to critical care can improve the quality of patient care and transcend barriers to resource limitations.