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The Maryland (USA) Critical Care Coordination Center (C4): From Pandemic to Permanence

Published online by Cambridge University Press:  14 June 2023

Melissa A. Kelly Open the ORCID record for Melissa A. Kelly [Opens in a new window] ,
Luis M. Pinet-Peralta Open the ORCID record for Luis M. Pinet-Peralta [Opens in a new window] ,
Tara M. Roque ,
Thomas M. Scalea ,
Theodore R. Delbridge  and
Samuel M. Galvagno Open the ORCID record for Samuel M. Galvagno [Opens in a new window]
Melissa A. Kelly*
Affiliation:
Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland USA
Luis M. Pinet-Peralta
Affiliation:
Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland USA University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland USA
Tara M. Roque
Affiliation:
Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland USA Suburban Hospital, Johns Hopkins Medicine, Department of Critical Care, Bethesda, Maryland USA
Thomas M. Scalea
Affiliation:
University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, Maryland USA
Theodore R. Delbridge
Affiliation:
Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland USA
Samuel M. Galvagno
Affiliation:
Maryland Institute for Emergency Medical Services Systems (MIEMSS), Baltimore, Maryland USA University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, Maryland USA
*
Melissa A. Kelly 653 W. Pratt Street Baltimore, Maryland 21201 USA E-mail: mkelly@miemss.org
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Abstract

Introduction:

The 2019 coronavirus disease (COVID-19) pandemic created overwhelming demand for critical care services within Maryland’s (USA) hospital systems. As intensive care units (ICUs) became full, critically ill patients were boarded in hospital emergency departments (EDs), a practice associated with increased mortality and costs. Allocation of critical care resources during the pandemic requires thoughtful and proactive management strategies. While various methodologies exist for addressing the issue of ED overcrowding, few systems have implemented a state-wide response using a public safety-based platform. The objective of this report is to describe the implementation of a state-wide Emergency Medical Services (EMS)-based coordination center designed to ensure timely and equitable access to critical care.

Methods:

The state of Maryland designed and implemented a novel, state-wide Critical Care Coordination Center (C4) staffed with intensivist physicians and paramedics purposed to ensure appropriate critical care resource management and patient transfer assistance. A narrative description of the C4 is provided. A retrospective cohort study design was used to present requests to the C4 as a case series report to describe the results of implementation.

Results:

Providing a centralized asset with regional situational awareness of hospital capability and bed status played an integral role for directing the triage process of critically ill patients to appropriate facilities during and after the COVID-19 pandemic. A total of 2,790 requests were received by the C4. The pairing of a paramedic with an intensivist physician resulted in the successful transfer of 67.4% of requests, while 27.8% were managed in place with medical direction. Overall, COVID-19 patients comprised 29.5% of the cohort. Data suggested increased C4 usage was predictive of state-wide ICU surges. The C4 usage volume resulted in the expansion to pediatric services to serve a broader age range. The C4 concept, which leverages the complimentary skills of EMS clinicians and intensivist physicians, is presented as a proposed public safety-based model for other regions to consider world-wide.

Conclusion:

The C4 has played an integral role in the State of Maryland’s pledge to its citizens to deliver the right care to the right patient at the right time and can be considered as a model for adoption by other regions world-wide.

Keywords

COVID-19critical careemergency health servicesreferral and consultation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 3 , June 2023 , pp. 311 - 318
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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