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Fundamentals Training Helps Save Critically Ill Veteran

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In February 2018, Ronnie C. Marrache, MD, participated in the Society of Critical Care Medicine’s (SCCM) Fundamental Critical Care Support (FCCS) course. Dr. Marrache is chief of medical services at the Veterans Administration Maine Healthcare System in Augusta, Maine, USA, and provides care to patients at a small community hospital in Waterville, Maine, USA.

Dr. Marrache took the FCCS course because it offered the opportunity to review and “freshen up” his clinical skills. FCCS prepares intensivists to manage critically ill patients for the first 24 hours until transfer or appropriate critical care consultation can be arranged—focusing on the most current guidelines and critical care practices. “As hospitalists, we see critical patients, but those of us in rural settings don’t get the same daily exposure as those in tertiary care centers,” Dr. Marrache said. Within a week after he completed the course, those skills were put to the test when a U.S. Marine Corps veteran arrived one evening to the Inland Hospital emergency department with acute respiratory failure and shock.

Because Inland Hospital has only a five-bed intensive care unit, the medical team investigated transferring the patient to a larger, tertiary care facility. But nearby hospitals were at capacity and inclement weather prevented a medical airlift, so the only option was to keep the patient overnight and provide care.

For Dr. Marrache, one of the most useful aspects of FCCS was the precourse. “The precourse was great,” said Dr. Marrache. “It really put me in the correct mindset and fostered the ability to jump right into the simulations.” And jumping right into action is exactly what Dr. Marrache and the medical team did that evening in February.

Applying what he had reviewed during the FCCS course, Dr. Marrache and the medical team were able to provide care to the critically ill veteran overnight. The team intubated the patient and started treatment—including fluids, antibiotics, and vasopressors.

Anesthesia was used to help with the arterial and central lines. Because the patient had septic shock, he needed dobutamine support. He also had a non-ST-elevation myocardial infarction. With proper treatment, by morning, he showed signs of improvement. His oxygen and norepinephrine requirements were half the original doses and the dobutamine was stopped altogether, allowing him to be safely transported to a tertiary care facility the next day.

For Dr. Marrache, FCCS was a valuable resource. “The course is a great refresher for physicians in basic immediate care of the critically ill patient,” he said. “FCCS is a good foray into the critical care realm for NPs [nurse practitioners] and PACs [certified physician assistants], the course layout really hits the high points, the time commitment is reasonable, and it offers lots of live CME [continuing medical education]!”

The Fundamentals courses help support SCCM’s mission to ensure the highest-quality care for critically ill and injured patients by assisting in the preparation of future intensivists and other healthcare providers. More than 11,000 clinicians a year on five continents now participate in FCCS training. To learn more, visit