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Critical Care Fundamentals Around the World

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Each year, more than 15,000 clinicians on five continents undergo the Society of Critical Care Medicine’s (SCCM) Fundamentals training, which includes Fundamental Critical Care Support (FCCS), Pediatric Fundamental Critical Care Support (PFCCS), and Fundamental Disaster Management (FDM). Through these programs, nonintensivists are trained in how to properly care for critically ill and injured patients during initial intake, a time when proper care is vital to survival.

In countries where critical care remains informal, uncoordinated, or even absent, the shortage of trained healthcare providers can put thousands of sick and injured patients at risk every day. In its efforts to improve critical care medicine around the world, the Society has developed programming geared toward serving resource-limited areas. It has already brought its FCCS and PFCCS programs to Ethiopia, India and Nepal.

This year, PFCCS was held in Ethiopia for the first time. Course consultant Olubunmi A. Okanlami, MBA, MD, FAAP, emphasized the potential impact of PFCCS on critical care in this region. She noted that, although at least two of the major hospitals in Addis Ababa have pediatric intensive care units (ICUs), there is no training program for pediatric intensivists at either of them, creating an urgent need to train healthcare providers in the fundamentals that PFCCS covers.

Nepalese PFCCS course director Ajay Khilanani, MD, echoed this sentiment, noting that Fundamentals training provides a way to bridge gaps in knowledge and clinical experience. This leaves physicians better equipped to assess, stabilize, and intervene in the ICU.

"Ultimately, I believe that empowering Nepalese physicians through a course such as PFCCS provides a sustainable and
cost-effective way in which physicians can directly impact health outcomes for children in their own country,” said Khilanani.

In addition to the feedback from Fundamentals consultants and instructors, course participants have also shared how this training is making an impact​.

Cordelia V. Sharma, MD, who served as faculty for FCCS in India, reported that the course was well-attended and feedback was positive from participants from a variety of specialties, including nurses, physicians, residents, and healthcare professionals trained in alternative medicine. “I have learned to prioritize critically ill patients better,” said one participant in the course evaluation. “Very nice program. Excellent. First of its kind we have experienced,” said another.

Additionally, Sharma reported that some resident and physician participants expressed interest in having their ​institutions continue to offer this course, concluding that, “Uniformly, the course raised the level of confidence of the providers caring for the critically ill.” Through this training, Sharma explained, participants gained specific skills related to airway management and central lines. This course increases participants’ confidence with ventilator management and in their ability to develop a strategic approach to assess, prioritize, evaluate, and manage critically ill patients.

While Fundamentals training is already making a difference for participants and, in turn, the regions they serve, this training has the potential to have an even wider reach​.

As India FCCS course consultant Jagdip B. Shah, MBA, MD, said, “We live in a global village. We are not immune from health crises occurring in remote faraway places. Recent outbreaks of SARS [severe acute respiratory syndrome], Ebola, and Zika virus infection and natural and man-made disasters illustrate the need to train professionals in distant places too.”​

Through Fundamentals training, Shah envisions a reduced need for outside participation as these physicians and their institutions learn how to more effectively control any magnitude of disaster. “ICU-trained physicians are the best-qualified gatekeepers for better healthcare around the world,” said Shah.

Okanlami echoed Shah’s sentiment about the global importance of Fundamentals training and its ability to improve outcomes in a sustainable way. “I am looking forward to exposing providers to the basic tools to evaluate, stabilize, and treat critically ill children and training some of the participants to become future instructors,” she shared, noting that she would like to see Addis Ababa continue to offer training in the future that is accessible and affordable for other providers in northeastern regions of Africa.

Further illustrating this concept of a global village, Khilanani said, “Beyond the wide-reaching clinical impact our courses have additionally provided forums for longterm relationships between physicians from Nepal and the United States, and for continued knowledge-sharing ​among our local course participants.”

SCCM is grateful for the enthusiasm and hard work of its Fundamentals consultants, instructors, and participants. As more healthcare providers receive Fundamentals training, it is the dedication of these individuals and their collaborative efforts that will transform healthcare for critically ill and injured patients around the world.​