More patients were being seen in emergency departments (ED) than there was room for in hospital ICUs. Due to the increased boarding and congestion in EDs, new techniques for delivering critical care were necessary. Several hospitals across the country created ED-based resuscitative care units or devised hospital- and ED-level ICU boarding mitigation methods to enhance patient care and disposition. These have only been discussed in the context of major medical facilities; they have not been broadly applied to rural community ED settings. When an ICU bed was not immediately accessible, researchers developed an ED model using a physician and nurse on-call team to better care for critically sick patients who need resuscitation. 

For a study, they sought to present a unique method of critical care delivery in a rural health system. One emergency physician and one emergency or critical care nurse made up the Emergency Medicine Stabilization Team (EMSTAT), a mobile resuscitation team based on the community health system. They reported information from the program’s first 12 months, including diagnosis, treatments, temporal patterns, and durations of stay.

EMSTAT was called for 195 patients over a year, and in 131 cases, they made it to the patient’s bedside. Sepsis, respiratory failure, and emergency diabetes situations were the three most frequent diagnoses. There were 99 reported procedures carried out; intubations, arterial lines, and central venous catheters were the most frequent. The remaining 27 patients were either transferred to palliative care, released, demoted to a lesser level of care, or passed away. In contrast, 104 people were brought to the critical care unit.

They described an innovative mobile critical care team headquartered in a rural community that operated for an entire year. The team showed that it could promptly go to the patient’s bedside, continue CPR, find a disposition, and give them personalized care. The model can be used as a guide for creating programs for community-based cardiopulmonary resuscitation.

Reference: www.sciencedirect.com/science/article/pii/S0735675722006702