Intensive care and emergency medicine

These disciplines are essential parts of the healthcare system, dedicated to the care of people in life-threatening conditions.

Emergency medicine deals with medical situations that require immediate attention. Central emergency departments are the contact points for patients who require immediate clinical attention following emergencies, accidents, or symptoms of severe disease such as strokes or heart attacks. It is therefore a central building block in the healthcare system's care structures, ensuring patient care between elective, stationary hospital stays and outpatient treatment by GPs and specialist physicians close to home.

Intensive care units (ICUs) ensure the close monitoring and care of people after serious surgery and in the event of serious illnesses. Patients who have undergone emergency treatment and require monitoring are also admitted to this station.

Over time, both disciplines have made significant progress to continuously improve. Medical technology and therapies play a decisive role in this, such as high-resolution imaging procedures or diagnostic tests that provide answers in just a few minutes. You can read more about this in our topic of the month “Point-of-care diagnostic at the deployment site”. Organizational improvements and increasing professional specialization are also contributing to advances here.

One of the biggest challenges for both fields is to ensure that everyone, regardless of the severity of illness or injury, receives the best possible medical care. This requires a team of specialty medical professionals who are on duty around the clock and are aware of their responsibility to save lives. This is why the skilled worker shortage in the healthcare sector is also hitting intensive and emergency care hard. During the coronavirus pandemic, ICUs were particularly challenged. Read our Topic of the Month to find out how special, smart solutions can help intensive care medicine.

In acute health crises, the rapid and effective treatment of time-critical and serious health problems and the safeguarding and preservation of vital functions are paramount. Emergencies or accidents can occur at any time and require an immediate response to save patients' lives and prevent serious consequential damage. This is why fast reaction in the event of a stroke is extremely important.

Rapid and precise clinical diagnosis is the top priority here. After all, targeted treatment can only be initiated if the condition of the person affected is correctly assessed. On the one hand, this includes the administration of medication. On the other hand, technology-based measures are also used, such as artificial respiration (also for premature babies) or defibrillation in the event of cardiac dysfunction. Early detection of serious illnesses gives medical staff a decisive time advantage.

While the available technologies are constantly improving, structural challenges are arising. Coverage by emergency services is becoming scarcer in rural areas, and more time is needed to get people from there to the nearest hospital with a suitable central emergency room. In future, telemedicine solutions that connect ambulances and hospitals already before the patient arrives at the hospital can also help here.

Specialist staff also face organizational challenges: Many different people and disciplines are often involved in emergency operations. Ambulance services must provide all the necessary information when the patient is admitted to the hospital in an emergency case. In addition to standardized internal processes and tools such as checklists and questionnaires that can be processed efficiently, electronic patient files that are available from any location can also help with a smooth execution.

The structure and organization of emergency departments and ICUs aim to ensure high-quality and efficient medical care in time-critical settings. Emergency departments must first triage patients on admission, i.e. determine the severity of their condition and prioritize treatment accordingly. Physicians are called in directly from the emergency department or from the specialist departments for this purpose. Once the emergency phase has been overcome, further treatment takes place in the ICU.

Various specialist areas work together to provide care. These include

• physicians,
• specialized intensive care nurses,
• anesthetists,
• surgeons,
• paramedics and emergency doctors who provide care and transportation between the scene of the emergency and the hospital.

This cooperation allows a combination of specialist knowledge and competence. However, it also requires effective communication and coordination between the specialists. Ideally, this enables a rapid diagnosis and targeted therapeutic measures.

Intensive treatment follows high standards, which are ensured by many years of training and regular further training for specialists. The establishment of standard operating procedures (SOPs) can also ensure consistent quality and help to avoid errors.

These play a decisive role in emergency care to save patients' lives and restore their health. This includes specific measures aimed at safeguarding vital functions.

In the case of injured patients, bleeding must be stopped, and the person must be treated to the extent that they can be transported. However, their condition often requires a multidimensional approach, as several dangers need to be tackled simultaneously.

In the case of unconscious persons, the focus is on securing the airways. These must not be blocked by fluids or foreign bodies because unconscious people often require manual (or mechanical) breathing support. In these cases, it is a necessity to remove all blockages before intubation can take place.

Closely related to this is the monitoring of the cardiovascular system. People can go into shock or cardiac arrest due to injury, pain, or blood loss. In these cases, active circulatory support through the administration of drugs, defibrillation, or cardiac massage (manual or mechanical) is necessary.

A relatively new approach in emergency medicine is the use of drones that can bring a defibrillator to the scene of an emergency.

As people in ICUs are often already weakened and bedridden for long periods of time and have catheters and accesses through which pathogens could enter the body, it is necessary to prevent infections in this patient group. This is achieved through strict hygiene measures for staff, regular testing of all accesses and catheters and, if an infection is present, rapid diagnostics. This is now often carried out using point-of-care test devices, meaning that it is no longer necessary for all samples to undergo lengthy laboratory tests. Targeted antibiotic therapy can then be initiated.

Intensive medical care is particularly stressful for premature babies is associated with a high level of stress, which can limit the success of treatment. Against this, an empathic incubator, which uses contactless monitoring technologies, is designed to help. It is intended to protect premature babies from sensory overload.

Intensive care and emergency medicine face constant challenges, but also great opportunities to save lives and improve the health of patients. Through innovation and research, new therapies and methods are being developed that help to further improve medical care and maintain quality of life even after accidents or serious illnesses.