Volume 6-Issue3-Autumn 2006 The OfficialManagementand PracticeJournal PPrrepepaarringing foforr DIDISASASTSTERER 4 6 5 7 - 377 =1 ISSN PLUS: • TRANSPORTVENTILATORS • INTENSIVE CARE • GLYCAEMIC CONTROL IN PORTUGAL What’sone waytodramatically impactCriticalCare? Achieve 1weaning00protocol compli% ance. ESICM -19thannualcongress Ventilation weaning protocolshavebeen showntoreducelength Barcelona, Spain of stay*;unfortunately,theycanalsobelaborintensiveforclinicians. 24-27 September2006 But withDrägerMedical’s SmartCare TM system,they’reautomatically CCIB Convention Center supported. Think of whatthatcanmeantoyour patients…your 27 -30 /39-42 productivity…and your bottom line. Yetit’sjustone aspectof our integrated CareArea™SolutionsforCriticalCare… and the entire careprocess. Todiscoverhowall our innovativesolutionscanimpactyour care process,visitwww.draegermedical.com. *E.WesleyEly,NewEngland JournalofMedicine (1996),Vol. 335:1864-9 EmergencyCare·PerioperativeCare·CriticalCare·PerinatalCare·Home Care Becauseyoucare Preparing for Disaster l a i r o t Ascriticalcarespecialists,weareaccustomed to di combating life-threatening illness and injuryon a E dailybasis.Our staff must bevigilantand must beprepared torespond rapidlytoanydeteriora- tion in apatient’scondition,asthatpatient’slife connectionswiththe departments,hospitals maydepend on immediatemedicalintervention. and agenciesthatmightprovecrucialpartners Every day,around the world,criticalcaredoctors in atime of crisis. and nursessavethousandsof lives. Thisissueof ICU Management focuseson dis- But whathappenswhen thousandsof livesare astermanagement,in ordertoshareinsights that put in peril all atonce,in one location? Thissum- mayhelp criticalcaremanagers strengthen their meralone,anumberof disastersituationsrocked disasterpreparedness programs.Inthisissue, the world –atrain bombing in India, atsunami in Drs.Faltlhauserand Thomassharetheirexpertise Indonesia, tropicalstormsin Chinaand armed on careand transport,including the recentex- warfareinthe Middle East,among others.Natural pansion of aeromedicalevacuation operations and man-made disasters alikecanwreckhavoc tonaturaldisastersituations.Dr.Maegele then wheretheystrike,leaving death,destruction, gives anoverviewof the specialconsiderations illness and injuryin theirwake.Trauma, shock, affecting patients who wereevacuated toEurope infectious disease–inthe spaceofafew following the 2004tsunami disaster.Finally, moments,adisastermayproducemoreimmi- Dr.Farmer highlights specificaspects of disaster nentlylife-threatening medicalsituationsthanthe preparedness thathospitaland criticalcareman- average hospitalwould encounterundernormal agers should take intoconsideration well before circumstancesin weeksoreven months. disasterstrikes.Eachofthesearticlesoffers a uniqueand helpfulperspectiveoncoping with When ahurricane,terrorist attackorotherdisas- very differentdisasterresponsesituations. terhits,criticalcarespecialists arecalled on more thanevertopracticetheirlife-saving services.But Disasters forceus tomake tough medicalman- the overwhelming numberof victims,along with agementdecisionsand enterintocollaborative the manylogisticaland infrastructureproblems relationshipsthatmightnotexist during regular produced byadisastersituation,posesignificant ICU operations.Inordertoaccomplishthiseffec- challengestodelivering timely,quality critical tively,wemust beorganized and develop plans care. Disasterresponserequiresphenomenal in advancetomanage worst-casescenarios. coordination of medicalresources,space,priori- Preparedness isthe keytosuccessfuldisaster tiesand personnel –bothwithin amedicalunit response. Ihope thatthe articlesin thisissue and across affected medicalfacilities.This,in turn, of ICU Management offerideasthathelp requirescriticalcaremanagers toplaninadvance, improveyour unit’sdisasterresponseplans. Jean-LouisVincent establishdisasterresponsestrategiesand forge Mayyouneverhavetousethem. Head,Departmentof IntensiveCare,Erasme HospitalFree University of Letters tothe Editor&Requests forReferencesCited in ICU Management Brussels,Belgium [email protected] www.icu-management.org1 Table of Contents Volume 6-Issue3-Autumn 2006 EDITORIAL Preparing forDisasterJ.-L.Vincent 1 NEWS AND INNOVATIONS 4 COVER STORY: PREPARING FOR DISASTER Strategicaeromedicalevacuation in naturaldisasters: A.Faltlhauser,A.Thomas 6 Newtasksformilitary aeromedicalevacuation systems Tertiary intensivecaretovictimsrepatriated toEurope M.Maegele 10 ICU Management is afterthe 2004tsunami disaster the OfficialManagement and PracticeJournalof The evolving role of criticalcaremedicine in disastermedicalresponse J.C.Farmer 14 the InternationalSymposium on IntensiveCareand MATRIX FEATURES EmergencyMedicine and Tightglycemiccontrol during criticalillness:Overcoming the obstacles S.Nasraway 15 waspreviouslypublished asHospitalCriticalCare. Benefits of aseparateairwayemergencyresponseteamB.Smith,S.Afifi, 17 M.Ault,L.Morris Editor-in-chief Prof. Jean-LouisVincent PRODUCT COMPARISON:TRANSPORTVENTILATORS Belgium Transport ventilators ECRI Europe 21 Editorialboard Prof. Antonio Artigas MANAGEMENT Spain Useofseverity scoresin clinicalpracticeM.Capuzzo 26 Dr.RichardBeale Motivating staff R.Pauldine,T.Dorman 29 United Kingdom Dr.Todd Dorman Evidence-based design supportsevidence-based United States medicine in the ICU D.K.Hamilton 31 Prof. HansKristianFlaatten Norway VIEWS &INTERVIEWS Prof. Luciano Gattinoni Inside the ESAwithSirPeterSimpson A.Heggestad 32 Italy Prof. Armand Girbes EU FOCUS Netherlands Institution Series:EuropeanCourtof Auditors I.Raath 34 Dr.Claude Martin France COUNTRYFOCUS: PORTUGAL Prof. KonradReinhart Anoverviewof the healthcaresystem in PortugalA.L.Jardim 37 Germany Intensivecaremedicine in PortugalR.Moreno 39 Prof. JukkaTakala Switzerland Intensivecaremedicine and emergencymedicine in PortugalR.Matos 40 Intensivecaretraining in PortugalT.Fevereiro,L.Amado 43 Correspondents Prof. David Edbrooke Sepsisand organfailureinPortugalI.Miranda 44 United Kingdom Dr.Anders Larsson CONGRESS PREVIEWS Denmark SCCM’sannualCongress:Improving patientcareSCCM 46 Prof. Esko Ruokonen Finland AGENDA 48 Prof. RetoStocker Switzerland Dr.PatriciaWegermann Letters tothe Editor&Requests forReferencesCited in ICU Management Germany [email protected] www.icu-management.org3 N e w s NeWwsorld PRNewswirepress release,the Triage MeterPro the useofthe AutoPulse. The studyanalyzed WHO findsmost countriesfall short combinesBiosite's rapid,easy-to-usetechnology out-of-hospitalcardiac arrest casesbetween of ensuring asafe blood supply withamoreconvenientuserinterface. January 2001and March2005and evaluated www.who.int databeforeand afterRAA paramedicsbegan The Triage MeterProisaportable,rapid testing using the AutoPulse. World Blood DonorDaywasJune 14,2006.To platformdesigned toprovide rapid,quantitative markthe occasion,the World Health orqualitativeresults forimmunoassays using The AutoPulseisdesigned tohelp improveblood Organization (WHO)released anannouncement urine,whole-blood orplasmaand featurescom- flowtothe heart and brain during sudden car- stating thatthe world ismaking slowprogress prehensivebuilt-in quality control capabilities. diac arrest bydelivering continuous,uninterrupt- towardsthe goalof100%unpaid,voluntary blood The Triage MeterPro's user-friendlyfeaturesare ed chest compressions.* donation. According tothe WHO, regular,volun- expected tomake testing even easiertoperform, tary donors aredesirable,astheyareless likely while maintaining the high quality and perfor- According toits MedicalDirectorJoseph P. tolie about theirhealthstatus and maybemore mancestandardsof the existing Triage Meter Ornato,MD, RAA isthe first EMS agencyin the likelytokeep themselveshealthy.Nevertheless, platform. According toBiosite,enhancements to U.S.tohaveshownthatsignificantlymore manycountriesstill fall short of ensuring the the Triage MeterProinclude analphanumeric patients cansurviveand bedischarged from the safety and the sustainability of blood supplies. keypad,75percentlargerdisplay,backlighting hospitalwithuseofthe AutoPulse. Most developing countriesstill depend on paid and fasterprinting. The Triage Meters also donors orfamilymembers; however,some have feature"Test Select™,"enabling healthcare *Clinicaldataavailable upon request. made progress byapplying stricterprinciples providers tocustomizetest menus based on within theirAIDS prevention programs. physicianpreferenceorpatientpresentation when using Triage Test Panelswithmultiple ana- AWHO surveyshowed 56of 124countriespar- lytes.Thisallows customers tousethe same ticipating in the surveysawanincreasein multi-analyteTriage Panel but choosewhich unpaid voluntary donation. The remaining 68 assays torunatthe time of testing. haveeithermade no progress orhaveseen a decline in the numberof unpaid,voluntary Biosite's announcementassuresthatcurrent donors.Ofthe 124countries,49 havereached and futureTriage tests will continuetobecom- 100%unpaid voluntary blood donation. patible withthe Triage MeterProand the Triage TeleflexMedicalexpands Furthermore,the numberof donationsper1,000 MeterPlus.The Triage MeterProisnowavailable respiratory offering population remainsabout 15 timesgreaterin in the United Statesand will launchinternation- www.teleflex.com high-income thaninlow-income countries, allyin the second half of 2006. despitethe increased need forsustained,safe blood suppliesin developing countries. TeleflexMedicalrecentlyissued apress release announcing the launchofaninnovativeinterface Recentstudynotesautomated