SCCM Members Extend Commitment to Ukrainian Clinicians

Members of the Society of Critical Care Medicine (SCCM) returned to Lviv, Ukraine, in September 2023 to provide advanced training courses that combined elements of its Fundamental Critical Care Support (FCCS): Surgical and ICU Liberation courses. With funding and support from the humanitarian aid organization Direct Relief, a multiprofessional group of SCCM members trained more than 300 clinicians to support patients who are admitted to the intensive care unit (ICU) after surgical procedures to begin recovery and rehabilitation.
 
Following the successful ultrasound training SCCM held in March 2023, the Ministry of Health of Ukraine requested that SCCM return to Ukraine to provide FCCS: Surgical and ICU Liberation courses to clinicians, according to ICU Liberation team leader Jaspal Singh, MD, MS, FCCM, medical director of pulmonary and critical care education at Atrium Health in Charlotte, North Carolina, USA. “They wanted the FCCS: Surgical course to provide fundamental skills in the stabilization of critically ill surgical patients and the ICU Liberation course to help move ICU patients more quickly from the ICU to lower levels of care to free up critical ICU capacity,” said Dr. Singh.
 

Mary J. Reed, MD, FCCM leads the Fundamental Critical Care Support (FCCS): Surgical course in Lviv, Ukraine.

SCCM’s FCCS: Surgical course prepares non-surgeons to manage critical care patients after surgery. The course teaches healthcare professionals to recognize and assess seriously ill surgical patients and surgical emergencies of the airway, abdomen, and cardiovascular system. The ICU Liberation course incorporates recommendations from the pain, agitation/sedation, delirium, immobility, and sleep disruption guidelines and provides implementation strategies through the ICU Liberation Bundle (A-F).
 
“We provided the education to the experts in Lviv so they can then teach other clinicians in the country. This training can help in any situation where clinicians need to quickly assess whether someone is seriously ill and recognize critically ill patients early so they can intervene and prevent worse complications,” said FCCS: Surgical and mission leader Mary J. Reed, MD, FCCM, an associate in the critical care medicine and general surgery departments at Geisinger Medical Center in Danville, Pennsylvania, USA. “These clinicians really want to expand their education, and they are doing an excellent job in the middle of an incredible amount of stress,” said Dr. Reed. Approximately 300 participants representing 24 regions of the country attended. Most were physicians, but nurses and physical therapists also attended.
 
The courses were once again taught at Lviv Territorial Medical Union, Multidisciplinary Clinical Hospital of Emergency and Intensive Care. Lviv is in western Ukraine, about 50 miles from the Polish border. It is not on the war’s front lines, but the city has been attacked by air, and the hospital receives many wounded patients from the war zone. “The hospital is running into massive capacity issues,” Dr. Singh said. “Patients are surviving their initial injuries, but it is common that breathing devices are left in too long or patients are slow to recover. Patients are experiencing long lengths of stay. ICU Liberation training can help patients recover faster, which can help alleviate the significant shortage of hospital beds and improve clinicians’ ability to care for more patients.

Jaspal Singh, MD, MS, FCCM, teaches the ICU Liberation course with a patient simulation.

On the grounds of the Lviv Territorial Medical Union lies the Unbroken National Rehabilitation Center, which provides patients free prosthetics and rehabilitation, as well as mental health care. The ICU Liberation course was particularly helpful to rehabilitation professionals, teaching them how to practice ICU liberation on a daily basis with the goal of discharging patients more quickly from the ICU.
 
SCCM members also accompanied Ukrainian physicians on rounds for bedside teaching. “That was really helpful for us to see what they’re dealing with,” Dr. Singh said. “I think it was also impactful for the patients and the teams there on site to understand what we’re trying to accomplish and what they can do by themselves with very little technology, with just training and oversight.” Dr. Reed said that seeing the U.S. non-physician clinicians rounding illustrated the importance of teamwork. “I think that exchange was really beneficial,” she said.
 
Ultrasound Training Expanded
Funded by Direct Relief, SCCM also provided two full-day Advanced Critical Care Ultrasound courses, teaching point-of-care ultrasound (POCUS) skills to quickly diagnose critically ill and injured patients. The ultrasound training was a continuation of courses SCCM members provided in person in Lviv in March 2023. Both ultrasound missions were led by Jose L. Díaz-Gómez, MD, MAS, FCCM, a recognized expert in POCUS. Dr. Díaz-Gómez is the medical director of cardiothoracic, mechanical circulatory support, and transplant critical care; program director of the anesthesia/critical care fellowship; and director of critical care echocardiography at Baylor St. Luke’s Medical Center in Houston, Texas, USA.
 
SCCM’s March 2023 mission trained more than 140 clinicians. The September mission trained another 50 clinicians, who will go on to provide the training locally. “We obtained meaningful feedback,” said Dr. Díaz-Gómez, “facilitating more enduring educational interventions that can lead to critical care ultrasonography best practices in a country facing a humanitarian crisis.”
 
Dr. Díaz-Gómez left his home country of Colombia more than 20 years ago for the U.S. because of the lack of academic opportunities and unrelentless violence. “It is impossible to forget how violence demands the delivery of best care to increase the chances of survival,” he said. “I strongly believe that our Ukrainian clinicians can save lives with such a powerful tool—ultrasound.”
 
The mission, coordinated through SCCM’s Global Health program, was made possible by a $2.5 million grant from SCCM’s partner Direct Relief. Course materials were translated into Ukrainian and provided to participants on preloaded tablets for them to keep. Participants also received access to online course materials, including lectures and pre- and posttests. “The team of SCCM members was just phenomenal—people who are highly skilled at what they do, people who are service-oriented and leaders in their field,” Dr. Singh said. “When you get to work with a group like that, it’s a once-in-a-lifetime opportunity.”