Critical Care in 1964 - Historical Video
Craig Stenhouse and Patrick Harris have generously shared a video showing how critical care was delivered at Burton General Hospital in 1964. It’s a fascinating insight of the early years of intensive care.
Click here to watch -
Captivating, isn’t it. The video follows the clinical management of a patient with tetanus, sustained following an injury to her knee, through her critical illness to her recovery and rehabilitation. Now consider how our pioneers would cope in today’s modern Critical Care Units – we think you’d be surprised.
This was the start of an incredible journey at our hospital, started by enthusiasts to push the boundaries, question their current pathways, and introduce a new service. Their please to the hospital’s Management Committee was to cohort a group of severely sick patients from around the hospital, and then to pool the expertise both of medical, nursing and other staff to ensure life-saving treatments were available for those who would benefit most. It’s important to note this was 1964 – the very early days of our specialty – 12 years after the Copenhagen polio epidemic, and at least 6 years before hospitals had physical Critical Care Units, which started in the 70s. Until then critical care was delivered on the general ward.
Multi-disciplinary teamwork is central to patient management. The anesthetists working with surgeons to secure an earlier tracheotomy for airway and respiratory management. A team of nurses provide 24 hour care, with specific training and working to guidelines that are clearly displayed by the bedside. There is regular suction, monitoring, positioning of the patient and fastidious attention to antisepsis. The nutritional needs for the patient are detailed, as is elimination and skin care. Periods of instability, potentially sepsis and ARDS (Ashbaugh was yet to describe this in his seminal Lancet paper of 1967) were treated with fluid, blood transfusion, positioning and steroids. All through the journey the team try to normalise the physiology. The patient was paralysed for a considerable period of time, which we’re sure we’d try to avoid today, but we wonder how well she’d have coped with the mode of ventilation?
As a junior doctor in 1990 I worked on the unit – a small cramped space at the end of a surgical ward – that was established at Burton following the film. When I returned 8 years later as a consultant to the new, lighter, purpose built area, the machines were more abundant, but we still had the issue of patients out with the walls of our Critical Care Unit that could have benefited from our care. We believe that we continued in the footsteps of our predecessors by developing the Modified Early Warning System (MEWS) in January 1998 at Burton and starting our critical care outreach service.
As we write this piece we’re about to embark on a merger with our small District General Hospital – sorry, vibrant District General Hospital. Being integrated with a near neighbor left us wondering about how our critical care service will develop over the next few years and just how much it’s changed over the last 54 years. Well, the quick answer would be the doctors definitely didn’t look younger, but the machines are definitely shinier and more complex. However, the core principles of attention to detail and team working remain core to any Critical Care Service.
Craig Stenhouse and Patrick Harris