CRITCON Levels - winter flu vs pandemic
03/04/20 14:24
CRITCON Levels are based (though for some reason are in reverse order) to DEFCON levels which tells us how close we are to nuclear war.
They have been modified for use by critical care networks in Winter Flu to describe the strain an ICU is under. See London Critical Care Network example.
CRITCON levels for Winter Flu do not work as well in pandemic situations. The difference is that the CRITCON levels for Winter Flu were designed to describe the current number of ICU patients and how they may, or may not be exceeding normal bed capacity. The desired ambition is to get the numbers of patients back within the normal bed state.
In pandemic situations the desire is to open many more additional beds than normal and hold those beds open until the pandemic subsides. ICU capacity is created for future patients who are not even here yet. The result is that one actually can have many empty beds, at least initially.
In the example above from London only at CRITCON Level 3, which is only one better than disaster, is elective surgery minimised to urgent/cancer and lifesaving only and the Trust operating at or near maximum physical capacity. Yet what we have seen in pandemic planning is that elective surgery was minimised very early and the Trusts have many empty beds, even before normal ICU capacity was exceeded.
Last night on my ICU we would on patient numbers alone be CRITCON 1, yet had opened extra quasi-critical care areas CRITCON 2, and had minimised surgery CRITCON 3.
So below is a table that proposes Pandemic CRITCON Levels that we hope better explains what we are observing during COVID-19 as well as gives proposed guidance on the ethical steps that may need to be made in patient care when resources are simply not available. My ICU would, by this system, still be Pandemic CRITCON 1. I hope it stays this way.
They have been modified for use by critical care networks in Winter Flu to describe the strain an ICU is under. See London Critical Care Network example.
CRITCON levels for Winter Flu do not work as well in pandemic situations. The difference is that the CRITCON levels for Winter Flu were designed to describe the current number of ICU patients and how they may, or may not be exceeding normal bed capacity. The desired ambition is to get the numbers of patients back within the normal bed state.
In pandemic situations the desire is to open many more additional beds than normal and hold those beds open until the pandemic subsides. ICU capacity is created for future patients who are not even here yet. The result is that one actually can have many empty beds, at least initially.
In the example above from London only at CRITCON Level 3, which is only one better than disaster, is elective surgery minimised to urgent/cancer and lifesaving only and the Trust operating at or near maximum physical capacity. Yet what we have seen in pandemic planning is that elective surgery was minimised very early and the Trusts have many empty beds, even before normal ICU capacity was exceeded.
Last night on my ICU we would on patient numbers alone be CRITCON 1, yet had opened extra quasi-critical care areas CRITCON 2, and had minimised surgery CRITCON 3.
So below is a table that proposes Pandemic CRITCON Levels that we hope better explains what we are observing during COVID-19 as well as gives proposed guidance on the ethical steps that may need to be made in patient care when resources are simply not available. My ICU would, by this system, still be Pandemic CRITCON 1. I hope it stays this way.