Delivering critical care: a challenge.

Because of the need for rapid diagnosis and management of patients acutely stricken by either injury or illness, critical care delivery cannot be limited to intensive care units. Instead, it must span the continuum from the scene of injury or illness to the patient's eventual arrival at the intensive care unit. University Hospital in Ghent, Belgium, has developed a comprehensive system that involves prehospital and in-hospital critical care, as well as a rapid and efficient interhospital and intrahospital transportation system. The prehospital system consists of a mobile intensive care ambulance, rapid-response systems known as flying squads, and a rendezvous system coordinating the ambulances and the rapid-response systems. The flying squad is staffed by a physician and the ambulance by a physician or a medical student in the last year of study. Both are also manned by an emergency department nurse and a professional driver who is also an emergency medical technician. The emergency department and its staff are available 24 hours a day to ensure uninterrupted delivery of critical care, including when patients are transported between various hospital departments. In addition, critical care specialists with at least 2 years' intensive care experience are available 24 hours a day. They also serve as coordinators for disaster planning for the hospital and the city of Ghent and its province.