Help, this patient is sick and requires immediate attention – this is a cry heard in hospitals across the globe. In the medical fraternity, these patients are referred to as critically ill as they are facing a life-threatening condition that, if left untreated, can lead to poor outcomes or even death. Patients with conditions like Sepsis, Pneumonia, Eclampsia, Hemorrhage, trauma, Peritonitis, Asthma, and Stroke are more prone to critical illness, resulting in many deaths worldwide. In this piece, we will look at the emergence of Critical Care Medicine in India, during the past two years, and how it has boosted the healthcare system.
As we inch closer to the 2nd anniversary of COVID19-induced nationwide lockdown on March 23rd, its imperative to understand the pivotal role Critical Care Medicine has played, and how it is poised to transform the post-COVID19 world.
Any patient who is facing critical illness requires immediate care and attention. In most situations, critical care focuses on resuscitating unstable patients, allowing time for recovery or the effect of specific therapies to improve outcomes and prevent death. In India, critical care evolved significantly, especially during the past two years, mainly due to the emergence of COVID19, which brought the Indian healthcare fraternity face-to-face with challenges they had never encountered before. COVID19 also brought to light the issue that the country faces a severe shortage of trained doctors. India currently has?one doctor for every 1457 citizens(WHO target 1:1000).
While the total number of doctors with specialized Intensive Care training in India remains unknown, as per ISCCM. Similarly, nursing capacity in our country, especially that of trained critical care nurses, sees a major gap. Crucially, workforce shortages were further enhanced due to staff isolation policies deployed in the COVID19 care areas, which mandated isolation after every 4/5-day shift. In India, there have been reports of the?entire hospital staff being asked to close down temporarily when a few caregivers were reported positive in that hospital; most hospitals created separate COVID19 entities, so the day-to-day non-COVID19 work continued unhampered.
Recognizing the limited availability of trained critical care doctors and nurses, new measures are being taken to increase the number of qualified caregivers, in a bid to boost Critical Care offerings. Additionally, in view of the COVID19 pandemic, every citizen understands the importance of urgent care, which is why many patients now enquire about the doctors’ qualifications and critical care/ ICU support available in a hospital. There has also been an evolution of medical equipment and technology upgradation in the past few years, including adoption of advanced ventilators and monitors. Remote monitoring accelerated by the pandemic resulted in many people consulting doctors online.
A combination of medical urgency, technology advances, and e-payment policy supported this change. The adoption of telemedicine through digital devices was however limited only to urban and suburban areas. However, access to rural areas is also accelerating, so doctors and specialists can reach out to patients in regions where digital devices/internet are not so popular but are slowly gaining traction. If judiciously expanded to rural areas, tele-medicine can be an effective medium to improve outcomes in critical areas and create a standardized protocols for critical care throughout the entire region. This can be done by comparing the systems and procedures of different ICUs across the state and implementing those that are most effective, easy to standardize and can enable early adoption.
Coming to comorbidities and non-communicable diseases, it is essential to understand that they played a vital role in the overall outcomes of COVID19. People with underlying health conditions, including non-communicable diseases (NCD) like Cardiovascular Diseases (CVD), Diabetes, and Cancer, had a higher risk of severe COVID19 illness and were more likely to die from the virus. This is because these non-communicable diseases made patients more vulnerable to becoming severely ill. For example, smokers may have reduced lung capacity, significantly increasing the risk of serious illness.
Understanding the above situation, the public and private sector must work together to create effective schemes that tackle these specific issues. Enhanced access to Critical Care Medicine, training of critical care doctors and nurses, upgradation of Critical Care units or building a super-specialized ICUs in each district, and robust tele-medicine & e-ICU support across each district is the key. Making concerted efforts to enhance our country’s Critical Care index will go a long way in retaining trained talent, enabling specialized manpower across all hospitals, building a strong network of Intensivists & importantly, improving the Intensivist to patient ratio – which is the need of the hour!