I was asked what would happen to 50 serious casualties from a bomb explosion on a bus outside our hospital. I am sure the staff would be galvanised into action and the "Dunkirk spirit" would suddenly appear. Extra beds would be put up, nurses with previous experience of critical care would step forward from different parts of the hospital and the word would get around to retired nurses at home in the area. Doctors would all pull together no matter their speciality and I expect the corps of administrators would drop their clipboards and help with bandages and the fetching of blood. Why can we not respond in a similar manner to small-scale emergencies?
I would suggest the following reasons: insufficient critical care beds; loss of highly-trained nurses due to the stress of continuous working in busy ICU wards; vested interest in maintaining boundaries around very highly specialised critical care units.
The first item requires money, but the other two need a change in nurse training, and, much more difficult, a shift in the attitude of some doctors and nurses. Critical care ranges from the very stressful intensive care of children, neurological cases and general medicine and surgery, to less demanding coronary care, recovery from routine surgery and high dependency. Usually each of the facilities is separate physically and even more so emotionally.
I propose the following: establish a multidisciplinary nurse training course covering all aspects of critical care; rotate nurses to the separate units to widen and maintain experience and interest and relieve stress; ensure that when the most appropriate unit is full, the patient will be looked after in one of the other units, with staff capable of moving temporarily; maintain the high-quality specialist skills in each unit with a core of experienced nurses and doctors.
These measures would ensure that the doors of major hospitals would remain open. Serious operations would not be cancelled at the last moment, vital organs desperately needed would not be turned away and dying patients would not be sent long distances in search of a special bed.
Professor Sir Roy Calne
Department of Surgery,
University of Cambridge