Patient & Family Resources

Critical Care Questions

» What is critical care?
» What kinds of illness and injury usually require critical care?
» What is the difference between critical care and emergency medicine?
» What is an intensivist?
» How does my family physician fit into the team?
» What resources are available when facing end-of-life (EOL) decisions?
» How can I obtain copies of living wills and other documents?

What is critical care?
Critical care is the multiprofessional healthcare specialty that cares for patients with acute, life-threatening illness or injury. Nearly 80 percent of all Americans will experience a critical illness or injury, either as the patient, family member or friend of a patient.

Critical care can be provided wherever life is threatened - at the scene of an accident, in an ambulance or medivac helicopter, in a hospital trauma center or emergency room, or in the operating room. Most critical care today, however, is delivered in highly specialized intensive care units and trauma centers.

Critical care is provided by multiprofessional teams of highly experienced and professional physicians, nurses, respiratory care technicians, pharmacists and other allied health professionals who use their unique expertise, ability to interpret important therapeutic information, access to highly sophisticated equipment and the services of support personnel to provide care that leads to the best outcome for the patient.

Patients are rarely admitted directly to the critical care unit. Rather, they are usually admitted from the emergency room, trauma center or surgical area where they are first given care and stabilized. The continuum of critical care begins at the moment of illness or injury and continues throughout the patient's hospitalization, treatment and subsequent recovery.
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What kinds of illness and injury usually require critical care?
Typical examples of critical illness include heart attack, poisoning, pneumonia, surgical complications, premature birth, and stroke. Critical care also includes trauma care - care of the severely injured - whether due to an automobile accident, gunshot or stabbing wounds, a fall, burns, or an industrial accident.
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What is the difference between critical care and emergency medicine?
Critical care refers exclusively to the treatment of patients who suffer from life-threatening conditions. Emergency room physicians and nurses treat patients who suffer from relatively minor emergencies (sprained ankles, broken arms) to those with major problems including heart attack, knife or gunshot wounds or drug overdoses. In the Emergency Department, physicians and nurses stabilize patients and transport them to the ICU or other area of the hospital for further treatment. The long-term management of critically ill and injured patients is provided by critical care professionals, often in the ICU.
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What is an intensivist?
An intensivist is a physician with subspecialty training, or equivalent qualifications, in critical care. An intensivist directs the care of critically ill and injured patients and works in collaboration with other health care professionals necessary for the care of patients in critical care units.
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How does my family physician fit into the team?
Your family physician is an important link between the critical care team and the patient and family. The family physician has a complete medical history of the patient, is often a trusted confidante of the family and is may be aware of the patient's values, attitudes and health care preferences. Critical care teams often work closely with the family physician to determine pre-existing illness, allergies, use of medications, and other factors which may influence the health of the patient.
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What resources are available when facing end-of-life (EOL) decisions?
The Society provides resources that are relevant to end-of-life decisions to assist critical care providers, patients and their families during these difficult situations. We encourage you to ensure that your own wishes are adequately documented in the advent that you are not able to personally direct your own care.

• The Society recently produced the Compassionate Care in the ICU DVD that initially was sent to all SCCM members.  The professional version went to individual SCCM members, and the family version was sent  to ICU directors.  If you need an additional copy of these DVDs please contact SCCM Headquarters at +1 (847) 827-6888.  Supplies are limited.
• The Society’s ICU Issues and Answers brochure on "What Are My Choices Regarding Life Support?" is available free online and also available in printed copy through the SCCM catalog and online store.  Of note, additional online information for personal advanced care planning is available from the National Hospice & Palliative Care Organization (www.caringinfo.org).
• The Society's American College of Critical Care Medicine (ACCM) previously published Recommendations for End-of-Life Care in the ICU, which is available here.
• The Society also has participated in the process to establish practice parameters on the Assessment and Management of Patients in the Persistent Vegetative State issued by the American Academy of Neurology.  A copy of these parameters, along with an ethics statement, is available online. 
• Society members were major participants in a Robert Wood Johnson Foundation research grant that focused on end-of-life care.  The outcomes for this report is published: Quality indicators for end-of-life care in the intensive care unit (Crit Care Med 2003; 31: 2255-2262). The complete article is available here as a PDF file, and an accompanying editorial written by the 2005 SCCM President is also available here.
• Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003 included major contributions by SCCM members and was published in Critical Care Medicine: (Thompson BT, Cox PN, Antonelli M, et al executive summary. Crit Care Med. 2004; 32:1781-1784).  A copy is also available as a PDF file here.

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How can I obtain copies of living wills and other documents?
Your local hospital and personal physician is likely to have advance directives, living wills and other documents available. A national organization, Choice in Dying, can also provide you with the forms. They may be contacted at 800/989-WILL.
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