Intensive Care for the Developing World The BASIC approach Colin Graham & Charles Gomersall

Challenges Education Equipment Supplies Finances….

What is Intensive Care? Increased nursing capability…

What is Intensive Care?

Level 1 Monitoring –HR, NIBP, SpO 2, RR, urine output POCT –Hb –Glucose, electrolytes and renal function test

Level 1 Organ support: –fluid challenge, blood transfusion –high flow oxygen therapy,& nebulisation of drugs –continuous intravenous infusion of drugs (insulin,heparin, nicardipine, labetolol, dopamine…) with syringe pump Not epinephrine and norepinephrine –NG nutrition

Level 1 Patients: –Post-operative (including multiple trauma) –Medical (DKA, severe asthma, severe pneumonia, severe dehydration…) –Obstetric emergencies (including eclampsia)

Level 2 Level 1 + Continuous ECG monitoring POCT –blood gases and cardiac enzymes Organ support –management of arrhythmias (pharmacological, defibrillation) –NIV Patients: –cardiovascular emergencies –acute respiratory failure requiring non-invasive ventilation

Level 3 Level 2 + Monitoring –invasive BP Investigations –Microbiology and high level of pathology tests (biochemistry, haematology…) Organ support: –epinephrine and norepinephrine infusion via central venous catheter –invasive mechanical ventilation Patients: –multiple trauma, poisoning, infectious disease such as tetanus and severe CNS infections (malaria, meningitis…)

BASIC collaboration Informal Intensivists with an interest in providing free, high quality, practical course material Hosted by Dept of Anaesthesia & Intensive Care, The Chinese University of Hong Kong

BASIC collaboration

“Products” Packaged, self-contained courses Focused on specific target audience Practical No license fees Minimal cost

Finances Dept of Anaesthesia & Intensive Care, CUHK Commercial sponsorship Profits from HK-based courses “Turn the wheel of learning”

BASIC course venues Hong Kong, Guangzhou, Shunde, Hainan, Zhengzhou Brisbane, Sydney Hawkes Bay, Hamilton, Middlemore, Christchurch London, Birmingham, Oxford, Colchester, Brighton, Wessex Johannesburg, Cape Town, Sun City Kuala Lumpur Bali Beijing, Shanxi Hama Mumbai, Kolkata, Pune, Jaipur, Chennai, Agra, Coimbatore, Aurangabad Perth Dubai Phnom Penh Seoul Riyadh Kuwait Doha Muscat Bahrain Adelaide Jerusalem Dublin Melbourne Fiji Singapore Berlin Sinaia Athens Colombo Khartoum Alice Springs

Course material Course manual Pre-course “open book” MCQ CD-ROM Lectures Skill stations Post-course “closed book” MCQ

Course material Enough for 2.5 days Usually run over 2 days Select what is relevant to your situation

Course manual Addresses knowledge aspect of course

Pre-course MCQ Aim is to encourage candidates to read course manual On-line Immediate feedback –Identify knowledge deficiencies

CD-ROM Interactive tutorial on arterial blood gas interpretation –Practical application of knowledge Narrated lecture on acute respiratory failure CVP line insertion –“Demonstration” component of practical skills teaching

Lectures Emphasize key points Case based lectures –Practical application of theoretical knowledge NOT a textbook projected onto a wall

Skill station Practice skills Application of knowledge to solve problems Revision of key material Learn from mistakes –Allow the trainee to make mistakes

Post course MCQ Motivational Clinical scenarios

Course development Continuous, iterative process Tailored to needs of participants High quality course material –Extensive use of graphics

Laryngeal mask

Courses BASIC Very BASIC BASIC DHS Not so BASIC BASIC4NOW Mechanical ventilation: beyond BASIC Intensive Care Nephrology: beyond BASIC

What can we offer? Course material Experience in course development Instructors –Train the trainers Sustainability

Courses BASIC –Introductory course in Intensive Care (level 3) Very BASIC –Acute care training for final year medical students and interns, includes non-invasive ventilation (level 2) BASIC DHS –Acute care training for doctors in developing healthcare systems, not including ventilation (level 1)

How can you help us? Insight Purpose

Synergy Successful Intensive Care MSFBASIC StaffEquipmentResources Course materialInstructors Insight Feedback