Intensive care medicine involves the assessment, stabilisation and ongoing care of patients who require special observation and support or are critically ill. Many hospitals though not all, have an intensive care unit (ICU) which is a ward where patients who are very sick are provided with a higher level of medical care and observation than other areas in the hospital can provide.
The College is the organisation responsible for providing training in intensive care medicine. Following the completion of a basic medical degree and some time working in a hospital, doctors will join the College to undertake an additional six years of training to become fully qualified to specialise in intensive care medicine. The College is the sole provider of a qualification in intensive care medicine in Australia and Aotearoa New Zealand.
The College has two main purposes. Firstly we train doctors to become intensive care specialists. Not only do we set the standard for the level of training which must be completed, but we also set minimum standards for the ICUs in which doctors are trained, in order to ensure all trainees receive the same high level of training. This includes developing the training syllabus for College trainees.
Secondly, the College also has a role in communicating with other relevant organisations including government, medical councils, and other medical professional bodies and professional membership organisations to promote the maintenance of excellence in intensive care training and practice.
Learning in intensive care medicine does not end once a doctor has graduated from the training program. Fellows of the College are required to continuously learn and ensure their medical skills are always up-to-date; this is called Continuing Professional Development (CPD). Fellows are required to participate in a CPD program which involves attending courses or workshops, reading the latest medical research, or visiting other ICUs to feed their knowledge.
People are admitted to the ICU for one of two main reasons. After some major operations it is safer for people to spend one or two days in the ICU for support and so that any complications can be prevented or detected early by the specially trained doctors and nurses. For example, in Australia and Aotearoa New Zealand all patients having heart surgery are admitted to ICU after the operation.
Other people are admitted as emergencies because they are very sick and have an illness or injuries that are very serious. Without the skills of the ICU doctors and nurses, these people would likely suffer permanent health problems or even die.
Intensive care specialists (Intensivists) are the specialist doctors who look after patients in an ICU. They have already completed their basic medical degree and have also completed additional training to learn the specific skills required in an ICU. The doctors who have completed our training program have studied for an additional six years to learn how to look after very ill patients in ICU.
These doctors undergo a rigorous training and certification program as determined by the College of Intensive Care Medicine. Intensivists are responsible for assessing, transporting and coordinating all aspects of the care of critically ill patients in the ICU.
ICUs are staffed by large and varied teams including the highly trained specialised doctors and nurses, as well as pharmacists, dieticians, physiotherapists, occupational and speech therapists, orthotists, radiographers and social workers. Much of the patient care is delivered by younger doctors who are still in training (they are usually called registrars or senior registrars). These doctors are often very experienced and are always supervised by specialist Intensivists and won’t make any decisions about patient treatment until they have discussed it with their supervisor.
If a family member or a friend has been admitted to ICU they require special help and attention. The length of stay for patients will vary depending on their illness and could vary from a couple of hours to several months, although the majority of patients usually stay less than a week. The ICU specialist should be able to give you a rough estimate of how much time the patient will spend in ICU, the hospital ward after ICU and in rehabilitation.
ICUs look very different to a regular ward in the hospital: there are many machines and monitors, some of them beeping, and more staff than you would expect to see in a ward. Some patients are unconscious or unable to talk so being in ICU either as a patient or visitor can be overwhelming.
When you first see your loved one in the ICU it may come as a shock as they may be heavily sedated and connected to tubes and machines. For example, it is quite common for patients to be on a breathing machine (ventilator) and processes associated with this could cause the patient to cough, but this is normal. Patients can also sometimes display behaviours that are out of character because of medication or their illness. Sometimes staff may ask you to leave the bedside and this could be for a number of reasons such as the need to perform a procedure that requires room around the bed, or the procedure may be upsetting for you to see. When a shift changes staff need to handover information about the patients, and this is best done without distractions so the staff can ensure they have shared all the information correctly.
As a friend or relation of the patient, it is normal to feel anxiety and it can be overwhelming to see someone you love so ill. The ICU staff are there to answer your questions, so you should not be afraid to ask. It is advisable however, to have one family member who is the main contact for the doctors and nurses to communicate information with, as this allows the staff to concentrate on caring for your loved one while ensuring the correct information is being given. Because ICUs operate around the clock, the ICU specialists, registrars and nurses will be rostered to work on different days which means you won’t always speak to the same staff member. Rest assured that ICUs have detailed handovers so that accurate information is transferred from one staff member to the next.
When a patient is very sick and on multiple supports (e.g. for the heart, the lungs and the kidneys), even the ICU staff may not be able to tell you whether your loved one will live or die. This can be an extremely difficult time - like a roller coaster – when on some days things seem to have improved and on others they seem to be worse. ICU staff are specifically trained not only to care for very ill patients, but also to care for their family and friends, so they will understand any concerns or fears you may have.
Sometimes despite the doctors’ and nurses’ best efforts, patients are just too ill and will die. Often the ICU staff will have time to prepare you for this and explain in detail what is happening to your loved one, however sometimes it can be quite sudden and unexpected. If it becomes clear that a patient cannot survive, you may be asked to discuss a number of things with the ICU doctors and nurses, include turning off life support machines and possible organ donation. Intensive care specialists have extensive training in how to have these very difficult conversation.
If you have been a patient in ICU, you would most likely have been heavily sedated or unconscious and this would mean you may not remember what happened to you. Your illness or the medication may also have meant you have suffered nightmares or hallucinations. These things can be very upsetting but they are very common and nothing to be embarrassed or ashamed about. It can help to discuss these things with a counsellor or one of the people in the ICU team. After you have left hospital contact may be made via the social work department if you wish to arrange counselling.