Clinical review: Critical care transport and austere critical care

05 March 2008, 00:00:00 David H Rice, George Kotti and William Beninati

The development of modern intensive care units (ICU) has allowed the survival of patients with advanced illness and injury, although at a cost of substantial infrastructure. Natural disasters and military operations are two common situations that can create critically ill patients in an environment that is austere, or has been rendered austere. It is impractical to replicate the resources of a full ICU in this setting. This has driven the development of two related strategies. Portable ICU capability can be rapidly established in the area of need. This provides relatively advanced capability but limited capacity and sustainability. The other strategy is to rapidly evacuate critically ill and injured patients following their initial stabilization. This permits medical personnel in the austere location to focus resources on a much larger number of less critical patients. It also permits the most vulnerable patients to receive care in an advanced center. The optimal strategy has not been determined, but a combination of these two approaches has been used un recent disasters and military operations and is promising.