Critical Care Science in the Wider Context
Critical Care Science (CCS) is one of the smaller STP specialisms but deals with one of the most complex patient populations. Critical care patients range from elective cardiac surgery patients to major trauma and acute/chronic medical conditions. Critical care refers to specialised care for patients with life-threatening conditions; typically compromising of one or more organs that are failing. This level of care may be delivered in A+E, Intensive Care, High Dependency or specialist wards, e.g. long term ventilation. While a lot of the STP specialisms focus on a particular organ system or on a particular grouping of investigative techniques, the skills of CCS cover a holistic approach to clinical care, incorporating all areas of medicine and technology.
CCS belongs to the CCVRS branch of the Clinical Physiology grouping of specialisms, but the structure is different to Cardiac, Respiratory and Vascular specialisms. In our first year, we complete the ‘Introduction to Device Risk Management and Governance’ module instead of the ‘Clinical Assessment and Investigation’ module (though trainees from other specialisms sometimes come to CCS to complete some of their competencies for this module). Moreover, no other specialism completes the CCS core rotation module. This reflects the fact that CCS is a very technology-heavy environment, and while we do not fix any equipment requiring engineering work, we do a lot of troubleshooting, and often replace modular parts and consumables. This helps to minimise equipment downtime, improves safety through specialist knowledge and education which all contributes to improving patient care and reduces the pressure put on the medical engineering department. We also participate in other aspects of the equipment’s lifecycle, such as procurement and the service improvement trials of new and innovative devices.
Our second year teaching block has a large overlap with Respiratory & Sleep Science’s third year module. We cover non-invasive ventilation, oxygen therapy, cardiopulmonary exercise testing (CPET), as well as respiratory pathophysiology. We get CCS-specific teaching on invasive ventilation, and on various monitoring modalities, such as cardiac output monitoring. This reflects the fact that a lot of our patients require respiratory support, with some patients being completely dependent on the ventilators. Moreover, a large proportion of our patients are surgical patients, so rather than focusing on the diagnostic capabilities of CPET, we use it to help to stratify patients’ perioperative risk and direct them to the appropriate level of care.
Our third year has a large overlap with second-year Cardiac Science teaching. While we do not need to know topics such as cardiac pacing in depth, we have to be familiar with such modalities as temporary pacing, as well as be familiar with basic aspects of radiological and ultrasound interpretation. The rest of our teaching concentrates on advanced ventilation adjuncts such as nitric oxide ventilation and extracorporeal carbon dioxide removal, haemofiltration, and miscellaneous monitoring modalities (such blood clotting profiles and basic electroencephalography).
While in some specialisms, beyond the first year, you might never have to use the skills that you gained in your first year rotation, in CCS we have to keep up-to-date with a wide variety of skills. Moreover, we have a wonderfully varied balance of therapeutic and diagnostic interventions across all body systems.
In CCS we work across wide range units and age groups. While the Intensive Care Unit is probably the place where we spend most of our time, we also work on High Dependency Units, specialist Intensive Care Units, A&E/ED, burns, maternity and theatres. In our Trust we have one CCS team that covers the adult, paediatric and neonatal hospitals, with members rotating between the adult and children sites.
While CCS work might vary a lot from Trust to Trust, depending on how the local service is set up, the hospitals specialist services or the patient cohorts, CCS practitioners are likely to participate in a lot of non-routine and advanced work. As explained before Critical Care has a high heterogeneity of patients. It also has large staffing (e.g. 1:1 nursing in Intensive Care), so any nurse or doctor might only infrequently experience the use of a particular device or treatment modality. By having a dedicated team of scientists, patients who undergo these complex and non-routine interventions are guaranteed to experience a better level of care. This also decreases the pressure on nursing and medical staff and means that there is a dedicated group that can help with their formal and informal education relating to the use of physiological technologies. It also positively influences the future prospects of intensive care units, as technological and scientific advancements continue to snowball, the dedicated CCS team is able to assist in seamlessly introducing these innovations within a complex clinical environment.
We also support staff in other areas of patient care, such as patient transfers, and clinical research. In some Trusts staff might have developed special interests to suit their local needs; particular investigative procedures, or perform/assist in invasive procedures such as vascular access. There is a lot of scope for the roles’ development, so while we are not the most well-known specialism, we are still able to influence its direction. One of the vital tasks facing us is it to promote our specialism within the NHS, and also to school age children and teachers so as to influence future scientists. We look forward to shaping the future of the role by improving the multidisciplinary team’s knowledge of CCS as well as patients and the public.