Beyond Ebola: Our ICUs should be long-term federal priority

Americans across the country are inundated daily with media reports of an Ebola epidemic that many believe may arrive imminently at our doorstep.  Ironically, Ebola will not even come close to affecting the hundreds of thousands of American patients who will require hospitalization this winter for Influenza or the similar number of children who will require hospitalization for Respiratory Syncytial Virus.  And while it’s vital to take the threat of Ebola seriously, it’s just as crucial that we think more strategically about how to provide our intensive care units (ICUs) with the support they need so they are equipped for what could come.

Critical care is primary care for the critically ill patient whose illnesses or injuries present a significant danger to life, limb, or organ function.  Each year, over five million Americans are admitted into medical, surgical, pediatric, and neonatal ICUs, with the majority of these ICUs already operating at or near capacity every day.  In the event of a wide-spread emergency, our critical care system would be stretched beyond its limits.  The care provided in the ICU is highly specialized and complex due to the extreme severity of illness of the patients, often involving multiple disease processes in different organ systems at the same time.  Moreover, providers of critical care require specialized training because the care delivered in the ICU is technology-intensive and the outcomes have life or death consequences.

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Despite the significant role critical care plays in providing high quality care for the seriously ill and injured, and the prospects of an array of new demands on our ICUs this fall, critical care is generally not an area on which federal policymakers focus except when there is a high-profile problem, like an ICU nurse who contracts Ebola.  Washington policymakers must make a more strategic, concerted and long-term effort to assess the overall health and preparedness of our critical care system, and now is the time to begin that process. 

When President Obama signed the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) into law last year, the nation’s critical care system was prioritized within federal disaster planning efforts for the first time in history.  And while the legislation marks an important step forward towards enhancing the nation’s ability to care for the critically ill and injured in the aftermath of a public health emergency, it must be viewed as only the first step in a more targeted effort to improve the state of our nation’s critical care infrastructure. There are several important factors that need to be addressed in order to boost the overall preparedness of the country’s ICUs such as:

  • The dearth of specialist physicians, nurses and other vital clinicians in the ICU delivery system.  Between drains on federal funds for medical training and the workforce shortages we have seen in many fields (like intensivists), real limitations on our ICU workforce are a serious impediment to managing ICU capacity surges.  This needs to be studied and we must consider what policy tools can help measure and respond to this shortage.  As new challenges such as Ebola remind us, we cannot afford a scarcity of trained, specialized personnel working in our ICUs; and
  • The associated lack of support for researching innovative therapies in the ICU over the past several decades.  While clinicians and patients have benefitted from major therapeutic breakthroughs arising from funded research in a range of specific disease classes such as heart disease and cancer, very little research funding is dedicated to critical care and there is a lack of coordination among relevant research projects. There must be a federal push for ICU therapeutic innovation, emphasizing the need to prioritize and coordinate federally funded critical care research and clinical pathways for critical care therapies that recognize and reflect the unique nature of these patients and what we can measure as “improvement.”

Congress may be adjourned until after the midterm elections, but the need for policy to gauge and boost the health of our critical care infrastructure is nevertheless acute.  Health crises don’t follow the Congressional calendar, and when policymakers return, they must rise to take a serious look at what they can and must do now to ensure that as episodic, or even regularized, crises arise our critical care infrastructure is prepared to respond with the staff, therapies and systems they need.

To be prepared in the ICU – not to mention the pediatric, or “PICU” and neonatal, or “NICU” - where our nation’s sickest patients are being treated, our nation must be proactive and plan for a full, coordinated response to crises that arise.  Maintaining hospital preparedness funding is essential if we are to ensure the best possible outcomes for these patients in the event of a widespread public health emergency. 

Poss is professor of Pediatrics, University of Utah School of Medicine, and Casey-Lockyer is senior associate for Disaster Health Services Program Development at the American Red Cross. Poss and Casey-Lockyer serve on the Board of Directors of the Roundtable on Critical Care Policy; Poss is chairman.

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