Key learning on critical clinical care services during the 2009 pandemic to help future planning

ECDC comment

One of the main pressure points on health care in the 2009 pandemic was on critical or intensive care services in hospital.(1)  One EU member state (the UK) specifically its Department of Health in London has published a constructive report on critical care services covering work undertaken during the 2009/10 H1N1 pandemic to increase capacity to care for the sickest patients. The document was prepared by the group advising Department and identifies key learning points from the experience. While these were intended for the UK health departments and professional groups they will be relevant to many other countries in Europe.

There are in total six key learning points each of which are broken down into a proposed work programme.  Reviewing critical care (intensive care) networks to ensure that they are fully functioning in terms of allocation of resources and sharing of experience; 

  1. Incorporate the learning from the pandemic into national policies and guidance for clinical services in hospitals;
  2. Engagement with the professional bodies to develop further clinical advice rapidly;
  3. Further work on how to best train, support and place staff during temporary deployment in a crisis;
  4. Approaches to bed management should be built upon. An example is given regarding a national bed availability database for paediatric beds; 
  5. An assessment of the long term capacity needed for ECMO (Extracorporeal membrane oxygenation)  as part of the range of treatments available for patients in severe respiratory failure.

The report recognises that ‘triage’ (decisions on which patients to pass to higher levels of care and which not to) is a topic which raises special concerns for both clinicians and managers. Suggestions are made in the document on how to address the concerns and provide further guidance on helping with decision making.

The appendices of the report contain practical guidance for hospitals e.g. lists of consumables that are needed for critical care. Various associated and accompanying documents produced by the group are also provided such as the principles supporting planning for triage.

Much of the WHO guidance on clinical care can be found consolidated in a review that appeared in the New England Journal of Medicine.(1)

Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza, Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection N Engl J Med 2010 362: 1708-17