How does China's critical care medicine lead the world?
"In the most challenging scene, giving patients the most chances of life-this is the mission of critically ill doctors." Qiu Haibo, vice president of Southeast University and leader of the Critical Care Science Department of Zhongda Hospital affiliated to Southeast University, said these words. The voice of the critically ill doctor.
SARS, avian influenza, Wenchuan earthquake, H1N1 influenza, new crown pneumonia epidemic... Every major disaster and epidemic scene, the critically ill doctors are never absent.
The Department of Critical Care Medicine, a rising star that has only developed in China for about 30 years, has demonstrated its strength in the sudden outbreak of new coronary pneumonia.
Nowadays, how my country's intensive care department will develop is also a question that the leaders of each discipline are thinking about.
"We have the economic strength to rapidly expand ICU beds, and the talent training system is gradually improving, but to play a leading role in the world, there is still too much work to be done in clinical research." Qiu Haibo believes that in the future 10-20 In years, China's critical care medicine will certainly play a leading role in the international arena.
Rising star-the critical care medicine department at the forefront
What is critical care medicine?
As a builder of the first batch of ICUs in China, Guan Xiangdong, director of the Department of Critical Care Medicine at the First Affiliated Hospital of Sun Yat-sen University, said that critical care medicine is a medical discipline that studies the law of the occurrence and development of life-threatening disease states and plays a role in disasters and epidemics. The effect of this is particularly shocking.
"The ICU is the safest department in the hospital. On average, more than 90% of patients facing life-threatening can be transferred from the ICU to the general ward. These are all modern critical medicine disciplines playing an active role." Guan Xiangdong said.
Qiu Haibo, known as China's first doctor of critical care medicine, also witnessed the development of China's critical care medicine department.
“When the traditional disciplines based on organ/cell clusters are divided into more and more detailed disciplines, we need a horizontally linked discipline to look at patients as a whole. This is the trend of medical development.” Qiu Haibo pointed out that traditional disciplines are diagnostic-oriented, For critically ill patients who may be life-threatening at any time, they are completely unable to adapt. The subject of intensive care medicine, a targeted treatment subject oriented by physiological disorders, came into being.
Qiu Haibo uses simple metaphors to explain the difference between critical care medicine and traditional disciplines.
The traditional discipline is to aim first and then fire, while the intensive care department fires while aiming, and its aim is not to diagnose, but to a physiological disorder that endangers the life of the patient.
"The patient must first survive, otherwise the diagnosis is meaningless." Qiu Haibo said.
In 1991, the former Ministry of Health took the establishment of the Critical Care Medicine Department as the evaluation criteria for graded hospitals, starting the initial construction and development of China's critical care specialty.
On July 4, 2008, with the approval of the National Standards Committee of the State Council, the major of critical care medicine was recognized as a secondary discipline. Since then, the major of critical care medicine has become one of the youngest disciplines in my country.
In 2009, the former Ministry of Health added the "Department of Critical Care Medicine" to the "Directory of Diagnosis and Treatment Subjects of Medical Institutions".
"Intensive care doctors are facing patients who are struggling with life and death every day. It is very challenging. If you deal with it correctly, the patient can live; if it is wrong, the person may be gone." Qiu Haibo said that the young man chose intensive care medicine. The direction is precisely because it is full of challenges.
Since the development of the discipline is still very young, there has been a lack of norms and guidelines before. As the most cutting-edge discipline of clinical medicine, the Department of Critical Care Medicine has always been on the cusp.
The epidemic has exposed shortcomings, and critical care medicine is ushered in development opportunities
Although my country's Critical Care Medicine has made great progress in the past decade, the shortcomings in the development of the discipline are still exposed in the 2020 new crown epidemic.
At the beginning of the Wuhan epidemic, there was a lack of adequate beds and equipment, and no professional medical staff capable of supporting severe treatment.
"The medical crisis of Wuhan's new crown epidemic is actually a crisis of critical care medicine. This also makes us realize that the medical resources of critical care medicine are actually the country's strategic medical resources." Qiu Haibo pointed out that in the early stage of the epidemic, not only Only in Wuhan, New York in the United States, and Rome in Italy are also facing the problem of insufficient development of critical care medicine and difficulty in adapting to the needs of major public health events, and this crisis has caused social panic.
How can ICU beds be expanded rapidly in major emergencies without wasting resources at ordinary times?
Qiu Haibo suggested that when a new tertiary hospital is equipped, it should have the potential to turn into a critically ill hospital.
This idea is called "Invisible ICU" by Guan Xiangdong. It can be freely converted during peacetime and war. The infrastructure construction of the ward meets the standards required by ICU. It is a normal ward at ordinary times and can be quickly converted to ICU in wartime. , Which not only avoids the unsaturation of "normal time", but also meets the needs of "wartime", which can greatly reduce the mortality rate.
In order to solve this problem, in May 2020, the National Development and Reform Commission, the National Health Commission, and the State Administration of Traditional Chinese Medicine jointly issued the "Public Health Prevention, Control and Rescue Capacity Building Plan" and proposed to upgrade and upgrade major epidemic treatment bases.
Each province builds 1-3 major epidemic treatment bases to undertake the task of centralized treatment of critically ill patients and centralized storage of emergency supplies.
Take the first national major epidemic treatment base in Hebei Province, which completed the capping of the main project on September 15 this year, as an example. It has 450 general hospital beds at ordinary times, mainly responsible for the treatment of common diseases, and does not accept the treatment of infectious diseases.
In the event of a major public health emergency, it can be quickly switched to 240 intensive care beds in the "wartime" state of a major epidemic.
In addition to hardware shortcomings, the problem of talent pool also needs to be solved urgently.
"my country's intensive care personnel training is seriously insufficient, and there was a lack of training mechanisms before it." Qiu Haibo pointed out that intensive care medicine is the last line of defense of life, and patients whose lives are on the line put forward higher requirements for intensive care doctors.
In Wuhan, experts in intensive care medicine including Qiu Haibo and Guan Xiangdong have seen the differences between intensive care doctors in different regions and different levels of hospitals, as well as the shortage of talents.
"The training of intensive care medical personnel must be considered at the national level." Guan Xiangdong said.
“It turns out that there is no intensive care medicine in the resident training system in our country. This epidemic has greatly promoted the development of the industry.” Jiang Li, director of the Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, said that due to the impact of the new crown pneumonia epidemic, severe illness The role of medicine has been affirmed. With the support of the leadership of the State Council and the National Health Commission, in May 2020, the Critical Care Medicine specialty will be added to the catalog of standardized resident training programs, and the training of discipline talents will be more standardized.
"Strategic reserve of critical care doctors is a very important system design. Doctors who have received critical care medical resident training are equivalent to reserve service, which is very important to the development of the discipline." Qiu Haibo said that if a large number of resident doctors have undergone critical care medical training, It means that no matter which department he enters in the future, he will have a foundation in critical care medicine. Once he encounters a major emergency, he can quickly be converted to a critical care doctor.
"Critical Care Medicine has withstood the test of this epidemic, and seized the opportunity to achieve great development. It has been paid attention to and valued by more people. The value it embodies will attract more young people to join it." Sichuan Kang Yan, director of the Department of Critical Care Medicine at West China Hospital of the University, said that this is a new beginning for the development of the discipline into a virtuous circle.
Only when the scientific research station is on the commanding heights can China's critical care medicine lead the world
In spite of many shortcomings, in the sudden outbreak of new coronary pneumonia in 2020, the Department of Critical Care Medicine still shows its strength and has become the "last fortress" to protect the lives of patients.
Although initially caught off guard, the death rate of Wuhan's new crown epidemic was soon brought under control.
"In the local epidemics after Wuhan, there were few deaths. This is the'Chinese miracle'." Guan Xiangdong said that it is precisely because of the increased attention to life in the epidemic, it also reflects the critical care medicine department. The effect, "can give people a shock." Some "Chinese programs" summarized by Chinese critical care experts, such as the first prone position ventilation, have also become "world programs" in international exchanges.
“In recent years, the discipline construction, talent echelon training, and scientific research level of critical care medicine have made great progress, and the gap with Western countries is getting smaller and smaller, and even leading in some areas. But to truly play a leading role in the world, you need to be in academic Standing on the commanding heights.” Qiu Haibo emphasized that the commanding heights of medical development require scientific research and innovation, and the development of critical care medicine in China also requires scientific research and innovation.
Although China has the world's largest intensive care medical team, the largest number of critically ill patients, and is establishing a strong innovation-driven scientific research system, there is still too much to be done in clinical research.
"I am confident that in terms of scientific research, we will definitely be able to do research that represents China's level and leads the world."
Beijing News reporter Wang Kara