Organizational characteristics of the austere intensive care unit: the evolution of military trauma and critical care medicine; applications for civilian medical care systems.
Critical care in the U.S. military has significantly evolved in the last decade. More recently, the U.S. military has implemented organizational changes, including the use of multidisciplinary teams in austere environments to improve outcomes in severely injured polytrauma combat patients. Specifically, organizational changes in combat support hospitals located in combat zones during Operation Iraqi Freedom have led to decreased intensive care unit mortality and length of stay as well as resource use. These changes were implemented without increases in logistic support or the addition of highly technologic equipment. The mechanism for improvement in mortality is likely attributable to the adherence of basic critical care medicine fundamentals. This intensivist-directed team model provides sophisticated critical care even in the most austere environments. To optimize critically injured patients' outcomes, intensive care organizational models similar to the U.S. military, described in this article, can possibly be adapted to those of civilian care during disaster management to meet the challenges of emergency mass critical care.
Grathwohl
Kurt W
KW
Department of Anesthesia and Operative Services, University of Texas Health Sciences Center, San Antonio, TX, USA. kurt.grathwohl@amedd.army.mil
Venticinque
Steven G
SG
D000346:Afghanistan; D019985:Benchmarking; D003422:Critical Care / Q000458:organization & administration*; D004189:Disaster Planning; D006287:Health Planning Guidelines; D006301:Health Services Needs and Demand; D006772:Hospitals, Military / Q000458:organization & administration; D006775:Hospitals, Packaged / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007493:Iraq; D054542:Iraq War, 2003-2011; D007902:Length of Stay / Q000706:statistics & numerical data; D054527:Mass Casualty Incidents / Q000517:prevention & control; D008887:Military Medicine / Q000458:organization & administration*; D008952:Mobile Health Units / Q000458:organization & administration; D017146:Models, Organizational; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009936:Organizational Innovation; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D014187:Transportation of Patients / Q000458:organization & administration; D014481:United States