What exactly does “critical care” mean in the context of medical transport?
Definition of CAMTS
When the 11th edition of the Accreditation Standards was released in 2018, we divided Critical Care into two distinct categories as follows:
- Emergency Intensive Care (ESC): Ability to provide out-of-hospital care during the acute phase
resuscitation phase before definitive treatment (comparable to emergency
service for stabilization of care or transfer to intensive care for more definitive care).
- Intensive Critical Care (ICC): Ability to provide out-of-hospital care comparable to
tertiary intensive care during interfacility transport to a higher level tertiary intensive care unit.
The intention was to continue to accredit at the ECC level only, but to track and track trends in the number of clinical and quality parameters submitted with each accreditation application. Using this data, as well as the disciplines, experience and training of the care providers, the Council felt it would be able to define and differentiate between “emergency” critical care and “intensive” intensive care. in the 12th edition standards and then to begin accreditation to either level of critical care.
Using this data, as well as the disciplines, experience and training of the care providers, the Council felt that it would be able to define and differentiate “emergency” critical care from “intensive” intensive care.
For example, performing certain procedures may indicate an “intensive” level of intensive care. Extracorporeal membrane oxygenation (ECMO) was one of the few interventions suggested as representative of CHF. But more and more programs were doing ECMO transports, and if they used the right team with current training and equipment, they would be up to standard. In many cases, some of the larger programs had bases capable of performing ECMO and others not, depending on the needs and capabilities in a specific coverage area. It would be difficult to get accredited as an entire company under separate types of critical care in this case, unless each base is accredited as emergency or critical intensive care, which is a logistical nightmare .
Necessary data on intensive care transports
As the Board discussed the issue of CHF, there were other factors such as the number of each procedure performed and the training to perform and remain competent. Even if a program only performed a few advanced procedures per year, wouldn’t thorough and consistent training qualify as ICC? Although ECMO, intra-aortic balloon pump or Impella transports are usually performed infrequently – how many are not enough to differentiate between intensive care types? The studies were not there to answer these questions.
After numerous individual meetings and correspondence with the Association of Critical Care Transport, one of our member organizations, and accredited programs that primarily provide inter-facility transport to a higher level of care, the Board has decided to combine the “intensive” and “emergency” intensive care in one definition of intensive care.
The Council decided to combine “intensive” and “emergency” intensive care into a single definition of intensive care.
The 12th edition standards, which will be published later in 2022, will combine the criteria formerly under the separate headings of critical care into just “critical care”.