1. Acute Medicine
We can generally distinguish two runs of critically ill people: traumatic and non-traumatic. The traumatically afflicted people become most often patients of surgical depart-ments. Out of non-traumatic, i.e. internally afflicted patients, the coronary events have been separated long time ago because of their frequency. The first specialized coronary units came into existence just for them. We can accordingly distinguish three basic runs of critically ill people: traumatic, coronary and generally medical (metabolic).
Into the concept ”acute medicine” we subsume: pre-hospital emergency care, provided by Emergency Medical Service (EMS) as well as in-hospital intensive/critical care, provided in departmental intensive care units (ICU) or critical care units (CCU) in hospitals. The natural bolt of acute medicine are Emergency Departments (ED) in hospitals where both pre-hospital and hospital emergency care of acutely ill and injured people meet. There still do not exist separate Emergency Departments in Czech Republic now.
Acute Medicine is consuming vast material and personal resources. The way of its financing is cardinal question. The ascertainment, that the final outcome of the treatment of critically ill or injured patients are now not considerably different from those that have been reached earlier with much less equipment and lower costs, is reason for discomposure.
2. Consensus Conferences
NCAM project came into existence in Czech Republic in the year 1995 because of the need to manage well the expense for the treatment of critically ill patients. NCAM project consists of three parts: main programme (Consensus Conferences), satellite panel (Czech Intensive Care Standards) and satellite classes (Informations in Medicine). Main programme is the cycle of multidisciplinary consensual conferences on grave, life endangering states. Their aim is to unify continually the diagnostic and therapeutic methods and organization of the work both in pre-hospital and hospital care and in rehabilitation.
The co-ordinator of the topic is responsible for preparation, course and results of each consensual conference. He or she makes up and leads work of the committee which prepares programme and proposal of recommendation. The participants of the conference will receive proposal of recommendation with the questions concerning the topic in advance to read them up.
The programme of the conference is divided into discussion panels. Selected lectures in the introduction of each panel will sum up recent state of knowledge of the topic. In the following discussion (as main contents of the panel) the participants are trying to answer the questions prepared in advance and express their opinions of the proposal of recommendation. The result of the conference are consensually accepted diagnostic, medical and organizational recommendations.
The whole creative process of clinical recommendations must be methodically correct. It is meaningless to create specifically Czech recommendations. That is why the basis of NCAM recommendations are already existing recommendations, most of which were already put globally into force. Our objective is their authorization and time schedule for their adoption in our country. Diagnostic, medical and organizational recommendation are necessary for financial evaluation of intensive care. The recommendations can become the basis for economic considerations of the Ministry of health and health insurance office.
Last but not least: We stress also the importance of establishment of a branch called ”Emergency Medicine” inside academic institutions in Czech Republic. The meaning is to centralize intensive care within the frame of organisation of working activities in the hospitals. We expect medical, economic and mainly organizational effects.
© 1995, Vít Mareček
Last updated: 1999-09-06