Zoltán Massay-Kosubek

– Lessons Learned after the Policy Debate in the EP on 16/05/2012

“We believe what we repeatedly tell ourselves. What are you repeatedly telling yourself? “


Under the auspices of the following 3 public health NGOs

European Society of Intensive Care Medicine [ESICM],
European Public Health Alliance [EPHA], and

a policy debate took place on 15 May 2012 in the European Parliament chaired and moderated by Dr. Cristian Silviu BUŞOI, MEP (ALDE, RO). The public debate focused on better understanding of intensive care medicine (hereinafter referred to as ICM).

As part of my foreword, I am very pleased to present the 6 speakers following the order of appearance and express my gratitude for having the opportunity to participate in that awareness-raising event.
(I will adress the speakers key-messages later-on.)

1. Prof. Andrew RHODES, ESICM President,
2. Prof. Richard BEALE, Chair of ESICM Research Committee,
3. Ms. Laura WAGNER (ICU and H1N1 surviver)
4. Mr. Stefano SORO, Head of Unit, Medicinal products, DG SANCO
5. Dr. Cornelius BARTELS, Senior Expert, ECDC
6. Prof. Jean-Daniel CHICHE, ESICM President-Elect

Instead of providing the reader with a detailed report of what was said exactly, I rather decided to set up a concise analysis in order to better adress the key messages of the meeting which would be interesting not only for the health professionals but also for a wider public.

Why intensive care medicine (ICM) is so important?

ICM means most commonly all joint efforts of health professionals intending to save the patients’ life in emergency health situations.

In a wider sense, the ambulance makes an integral part of the emergency medicine where the patient being in life-danger first meets the ICM.

In a more restricted sense, ICM means the professional activity of the Intensive Care Unit (hereinafter referred to as ICU) which is usually integrated in the organization of Hospitals.

But whatever approach are we following, it is out of question that ICM requires a very complex team-work of doctors, nurses, and other health professionals on the one hand, and a very expensive and sophisticated, always modernising technical equipment, on the other.

Core elements of ICM

ICM is one of the most expensive and technologically advanced medical care fields, therefore we will have to have a closer look on ICM’s main characteristics.

Multidisciplinarity is the most essential attribute of ICM since ICM covers a high number of medical areas such as cardiovascular, neurological, respiratory, renal, digestive, haeatological, microbiological, trauma, etc. This special branch of medicine concerns the diagnosis and management of life threatening conditions requiring sophisticated organ support and invasive monitoring while usually the patient moves from one location (place of accident ex. a heart-attack) to another location (ambulance car, hospital). More detailed information on ICM is here.

What are the key-words for Intensive Care Units (ICU)?

ICUs are the organizational frames where ICM is enforced in practice.
In order to reach an effective function, ICUs need 3 main requirement: staff, machines, money.

Staff. The most important part of the ICM sector is the health staff: doctors, nurses, nurse-assistants, pharmacists, social workers, ambulance men, and even social workers.

Machines. Another important characteristic of that field is the need for usually very expensive and modern technical equipments which are required for life-saving in emergency situations. May I simply refer to the example of Cardiopulmonary resuscitation (CPR) techniques.

Money. Not surprisingly, as a necessary conclusion following the above mentioned 2 factors (Staff, Machine), ICM is one of the most resource-needed sector in the health-care system.

I have already drawn the attention to the importance of healthcare fundings in respect of the EU budget in my 10. blog entry (4/May/2012). However, these fundings for ICM are often considered as investments in future rather than single costs since ICM is strongly correlated to the level of mortality.

The challenges of ICM and 6 different approaches to adress them

During the public debate, 6 speakers with different professional backgrounds shared with the audience their approaches to adress appropriately the challenges of ICM and their solutions/proposals.
In the following paragraphs I underline some remarking points and/or key messages of the 6 speakers to stimulate further re-thinking.

1. Overview of Intensive Care Medicine: Particularities and challenges
Prof. Andrew RHODES, ESICM President,

“It is not just about money, it is about how we organize our efforts.”
ICM combinates high-intensive hands-on care and modern technology. However, the appropriate staff (men) are much more important than just the expensive equipment (machines). By attracting highly skilled doctors and nurses, not only ICM will be cheaper and more cost effective but also the mortality rate can be reduced.

How do we attract more doctors/nurses?

– Harmonisation of professional status (to be equivalent to other disciplines)
– Revision of the 2005/36/EC Professional Qualification Directive (There is a need for a larger scope of the automatic recognition of health professionals. The free movement of doctors is of utmost importance. Another piece of legislation, the working-time directive has to be taken into account.)
– Appropriate training (which must be competency based rather than regulating just their duration)
– Access to resources
– Quality control

3 key messages:

– The need for ICM is growing of an alarming rate.
– We need to urgently develop plans to train more doctors and nurses in this speciality.
– We must increase research funding towards understanding how and when and why to use intensive care.

2. Surviving Sepsis Campaign: An international effort to improve sepsis outcomes
Prof. Richard BEALE, Chair of ESICM Research Committee,

“In order to avoid sepsis, sometimes it is enough to do simple things properly.”

The SEPSIS is suitable to present the importance of ICM, since sepsis is responsible for a high rate of mortality. Sepsis is the body’s response to serious infection which may lead to organ damage or shock.

ESICM started a campaign to appropriately handle the situation which started with the Barcelona declaration in 2002.

The 3 core messages of that campaign was:

– Declaration of Barcelona
– Evidence-based guidelines
– Education and awareness

Further details about the ‘Surviving Sepsis Campaign’ are here.

3. Testimony of an ICU survivor: How flu has changed my life?
Ms. Laura WAGNER (ICU and H1N1 surviver)

“I am very thankful that I can be here and that both my child and me survived the H1N1 flu”.
The example of a surviver clearly shows the significance of patients. They are the most important since behind the figures and numbers, there are always ordinary people.

4. Revision of the Clinical Trials Directive (2001/20/EC).
Mr. Stefano SORO, Head of Unit, Medicinal products, DG SANCO

“The Clinical Trials Directive is probably the most criticized piece of the European Health legislation.”
Although there is no final decision taken, the Commission intends to re-cast the Clinical Trials Directive (2001/20/EC). According to the projections, the new legislative proposal – which will be a Regulation instead of a Directive – might be presented in middle July 2012 at the earliest.

The urgent revision is needed since the number of clinical trials is decreasing according to the administrative burdens and fragmented legislation. The Directive is equally criticized by the patients/academical research/industry.

The impact assesment is already prepared which takes into account the direct and indirect effects of the old Directive.

The core concept of the new legislation would be the destruction of the wide authorization obligation and in the future, one single authorization will be enough in the EU.

5. Frontline detection of public health risks in the ICU
Dr. Cornelius BARTELS, Senior Expert, ECDC

“The barrier nursing in case of pandemic infection would require 5 doctors and 8 nurses for just 1 patient /24 hours.”

The European Centre for Disease Prevention and Control (ECDC) is a Stockholm based agency of the EU. EU Agencies are technical bodies for a specific area, slightly outside from the governmental sphere, with a high level of professional and budgetary indpendence (they are very likely to the national agencies and authorities)

The List of the recent epidemics:
(1995 – Sarin gas attack – Tokyo – not a traditional pandemic but it had similar effects)
2001 – Anthrax – U.S.A.
2003 – SARS – Toronto, Hong Kong
2009 – H5N1 pandemic – Middle and Far East (Human cases since 2006)
2011 – EHEC – Northern Germany
(H1N1 2008 can be considered as a ‘soft’ pandemic)

6. Presentation of LIFE-PRIORITY & European Parliament exhibition
Prof. Jean-Daniel CHICHE, ESICM President-Elect

“Just 3 simple moves can mean the difference between life and death.”
LIFE-PRIORITY has launched a campaign in 2010 – focusing on teaching people life-saving techniques. Although athletes are often touched by heart attack, statistics prove that during the championships, the overall number of heart attacks are higher in the whole population who are following these events through TV.

Since heart attacks concern mainly (but not only) sportsmen, the main ambassador of the campaign was Eric (Sylvain) Abdal, a famous French soccer-player.

(Comment: The conference was followed by the opening of the “15 minutes to Save a Life” exhibition at the European Pariament (ASP 3rd floor balcony, zone G) which included a teaching session of life saving cardiopulmonary resuscitation (CPR) techniques.)

I remain at your disposal.

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Related earlier EU updates:

Legal Framework for Public Health Policies and Financial Viability of Lifelong Disease Prevention

How Healthy is Our Way of Thinking about Healthcare Cost Cuts?

The Choice is Yours: either You Drink or… Re-think the EU’s Alcohol Strategy

(Photo © Christiana Care)

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