Getting help when we are sick or injured is a necessity for us to function, both as individuals and collectively as a society. This makes healthcare a societal function that needs to work, both in everyday life and in a health crisis. In any health crisis, be it a natural disaster, a war in an unstable Europe or a new pandemic, the number of patients in need of care will increase. And of these patients, a certain number we will be critically ill and in need of intensive care.
In a health crisis, intensive care is likely to be one of the types of care that will reach its maximum capacity, especially since Sweden already has a very limited number of intensive care beds per capita. Scaling up intensive care quickly is also a major challenge, because it requires a large stock of advanced technical equipment, but perhaps most of all because it requires a large number of specially trained staff.
When the resources do not meet the needs
The definition of a health crisis is a situation when the available resources do not match the needs. This means that it is not only the event itself, such as a pandemic, a terrorist attack or a war, that determines whether a health crisis occurs, but also what resources are available from the outset. Increasing regular resources in intensive care may push the point of when a crisis occurs further away, but it seems neither realistic nor desirable that regular resources are so oversized as to be suitable for a crisis that could potentially never occur. It is therefore important that we prepare and increase our ability to respond when a crisis occurs.
Someone who has taken an interest in the question of preparedness in intensive care and how to manage situations when needs exceed resources is Märit Halmin, anaesthesiologist and expert coordinator in intensive care with limited resources at the Centre for Health Crises.
- "Intensive care is a resource-intensive form of care. It is also a form of care that often comes into particular focus in a health crisis. War, infectious disease outbreaks, a chemical accident, the list of potential events is long, but they all lead to increased pressure on intensive care. That's why I think it's important to look at preparedness in that area."
Prioritisation is needed
Märit has experience of working in low-resource contexts and in health crises abroad, where the situation of needs exceeding available resources is a normal state of affairs. At the same time, it is also a state that she has experienced herself in Swedish healthcare, not least during the COVID-19 pandemic. One observation she makes is that a crisis requires prioritisation.
- "I think we should be honest about the fact that prioritisations are already being made today" says Märit. "Our resources are not unlimited, but in a health crisis, much harder prioritisations must be made. Prioritisations that determines who should get the last intensive care bed, and by extension, who should be given the chance to survive. Making such decisions is difficult. Support and tools are needed to ensure that decisions are made fairly and equally across the country."
At the Centre for Health Crises, Märit, along with other colleagues, is working with questions related to prioritisation in various ways, with a special focus on how to increase preparedness to manage situations where needs exceed resources. Among other things, Märit has conducted a pilot study on how medical students view prioritisation. Together with colleagues at the Centre, she is currently conducting focus group interviews mapping the experiences of healthcare professionals from the COVID-19 pandemic, in which priorities are one of the issues they are looking at.
