Adult Surviving Sepis Campaign Guidelines (Hour-1 Bundle)
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Adult ICU Liberation Guidelines and Bundle (A-F)
Management of Adults with COVID-19
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SCCM is updating its SCCM Connect Community. Access to SCCM Connect may be limited until April 23.
We were not prepared, yet we stood ready. Disaster management education, training, and even implementation were believed to be necessary and sufficient. We believed that we were prepared. The novel coronavirus 2019 (COVID-19) pandemic clarified that such preparation was indeed necessary but by no means sufficient. For individual hospitals as well as integrated healthcare organizations, mass casualty, as well as natural and man-made disaster planning, shelters under an all-hazards approach. COVID-19 brought all too many hazards instead. It is those hazards—insufficient personal protect equipment (PPE), inadequate critical care beds, scarce ventilators, and even too few experienced ICU clinicians—that threatened our patients’ lives while imperiling our safety. And it all occurred without a clearly successful virus-specific therapy. Such challenges threaten to topple systems. It is in response to these daunting tasks that our members, and our Society, embraced new approaches and drove innovative means of patient rescue.
The Society of Critical Care Medicine (SCCM) is well regarded for education. Cornerstone programs such as Fundamental Critical Care Support (FCCS) and Fundamental Disaster Management (FDM) formed the core of what was to blossom into a suite of COVID-19 resources. Importantly, these treasures were not sheltered behind a pay wall. They were instead provided as free open-access medical education (FOAMed) to all. Hundreds of thousands of clinicians accessed these programs! One of the driving forces behind their use of SCCM education is an SCCM-crafted assessment of U.S. ventilator and clinician resources authored by Neil A. Halpern, MD, MCCM, titled United States Resource Availability for COVID-19 and available at sccm.org/icuresourceavailability. Besides numeric data, the FDM tiered-staffing approach was featured as one way to staff novel ICUs where there were not enough existing ICU teams to do so. Attending physicians, fellows, and residents alike have been trained to help in the ICU by using these educational resources. In concert with changes in information, and how information is being used at the bedside, this living document undergoes regular revision during the pandemic.
Besides delivering high-quality bedside care, there is new information to share and knowledge to acquire. You may have noted SCCM’s programs, members, and leaders frequently appearing in print and online media as well as occasionally on the evening news. Leaders throughout the Society have been engaged with a host of federal agencies, from the Centers for Disease Control and Prevention to the Federal Emergency Management Agency, to the White House. Admiral Brett P. Giroir, MD, a pediatric intensivist by training, is integral to ongoing supply chain efforts to address several aspects of shortages. Dr. Giroir is featured within our disaster page specifically devoted to COVID-19—a new aspect of the website. Visit sccm.org/disaster/ covid19 to access.
On that page, you will also find a rapidly created registry titled Viral Infection and Respiratory Illness Universal Study: COVID-19 Registry (VIRUS), which engages members and nonmembers alike to share information about COVID-19 patient care. We hope that you will all share data so that we may together learn how best to care for patients during crises like this one. Despite our most fervent wishes, this crisis will not be the last one we will face together. VIRUS also includes a sect ion for those who have ventilated more than one patient at a time using only one ventilator. While we anticipate that this is a rare event, the desire to save lives will drive innovation.
Some innovations will garner tremendous at tent ion. It is, however, the less obvious innovations, the ones that make everyday workflow manageable during a crisis, that also deserve our attention. New note templates, order sets, and transport routes are the unsung heroes of daily care—but are critical nonetheless. Creative approaches to face and eye shields may seem less exciting than ECMO, but are as essential as the clinicians at the bedside—and on a much larger large scale. Everyone from lab technicians to cleaning staff needs to be protected. Many of you have spent large portions of clinical time in powered air-purifying respirators (PAPRs) either during airway control, surgery, bronchoscopy, or airway liberation. While there is no innovative way to address the need for that kind of high-level protection, there are ways to bring you comfort.
Many of our communities have responded with overwhelming outpourings of support. Food truck meals delivered fresh throughout the day and night, surprise pizza deliveries, care packages from unknown benefactors, and even PPE donations serve heartwarming tales of unity. “Light the Night” celebrations, heart-shaped arrangements of police cruisers with lights ablaze outside of hospital emergency department entrances, and other creative ways of honoring healthcare workers like you are unprecedented and welcomed. Sometimes these innovations help shape care, while others simply remind you that someone else cares. Clearly innovation arises within and without the medical community to which we all belong.
Some of you, like me, have been fortunate to spend some time working from home. Never before has the boundary between work and home balance been thrown into such sharp contrast. As we continue to struggle with patient management, plans for emerging into a new normal, and new processes for education, I encourage you to embrace the (few) quiet moments in between. Remember what guided you into critical care. Recall simple joys that buoyed you during uncertainty. Relish triumphs in which you have played a part during this crisis. And then share those memories with those you treasure both at work and at home. Take time for self-care, for you are truly our most precious resource.