17th February 2022 Members of the NAS Critical Care and Retrieval Services are pictured here with two of their dedicated transportation vehicles
A HSE service which transfers critically ill patients between hospitals has had its busiest year to date having carried out a total of 469 critical care retrievals.
The Mobile Intensive Care Ambulance Service (MICAS) is one of three critical care retrieval services that the National Ambulance Service (NAS), provide as part of NAS Critical Care & Retrieval Services (NASCCRS). MICAS is the adult service specialist critical care retrieval service available throughout Ireland to assess, stabilise and transfer critically ill adults between hospitals. NASCCRS also includes specialist neonatal and paediatric services: National Neonatal Transport Programme (NNTP) and Irish Paediatric Acute Transport Service (IPATS).
Last year was the busiest year to date for MICAS with 469 critical care retrievals, including a large number of transports linked to COVID-19 and consequent ICU requirements. This compares to 290 critical care retrievals carried out in 2020.
The patients MICAS retrieves require a level of medical support over and above that which can be provided by an ambulance crew. This can include ventilation, invasive pressure monitoring, sedative and cardiac medication infusions and even Extra Corporeal Membrane Oxygenation (ECMO). The latter is provided in partnership with the Mater Misericordiae University Hospital.
This year the service celebrates 25 years in operation.
“Patients requiring MICAS retrieval are typically being moved from one intensive care unit to another. However, patients may also be moved to/from emergency departments, interventional radiology units and operating theatres as well as non-critical care areas in smaller hospitals“, said Dr David Menzies, a consultant in Emergency Medicine at St Vincent’s University Hospital in Dublin and the HSE National Clinical Lead for Adult Critical Care Retrieval services.
“The philosophy of care in MICAS is to provide the highest quality care to critically ill patients whilst transporting them to a facility that meets their medical needs by an appropriately qualified and skilled team of critical care staff. It ensures every patient is transported in a way that maximised, not only their medical care but the safety, dignity and comfort of the patient and their families.”
Critically ill patients
MICAS provides a critical care doctor and critical care nurse together with a critical care ambulance and NAS emergency medical technician (EMT) to facilitate the inter hospital transport of critically ill patients. More recently, a cohort of critical care paramedics has also joined the service, providing much needed resilience during the recent pressures on ICUs nationally.
Medical and nursing teams are provided by the National Ambulance Service and also in partnership with hospitals including: Mater Misericordiae University Hospital, Beaumont Hospital, St Vincent’s University Hospital, Cork University Hospital and University College Hospital Galway.
Patients requiring MICAS retrieval include critically ill patients, who require an increase in the level of care provided (e.g. dialysis) when the facilities needed for this are not available at the referring hospital or patients who require specialised treatment in a specialised centre e.g. the use of an ECMO life support machine, neurosurgery, cardiothoracic surgery.
Patients may also be transported in order to access a critical care bed elsewhere due to capacity issues at the referring hospital. The service also facilitates repatriation of critical care patients to their local hospital for on-going care when appropriate, maximising available capacity in the hospital system.
MICAS currently provides a critical care retrieval service for patients aged 16 years and over from three sites (Dublin, Cork and Galway).
The safe transport of a critically ill patient requires a structured approach to: assessment, diagnosis, stabilisation and management of clinical conditions as well as knowledge of logistics and transport specific equipment in the ambulance environment.
Usually, an ICU bed must be secured in the receiving hospital prior to activation of the MICAS Team. Exceptions to this include mandatory transfers from smaller hospitals without critical care facilities, or patients who are being transferred directly to theatre or interventional radiology.
Referrals to MICAS are coordinated through the Critical Care and Retrieval Desk at the NAS National Emergency Operations Centre (NEOC) in Tallaght. Once a call is received, the NEOC dispatcher will connect to the MICAS consultant coordinator for the day. The MICAS coordinator will conference in the referring consultant, the consultant on call for MICAS, and the receiving consultant or additional specialists if required. The referring/receiving consultants will then decide on a clinical plan and timeframe for the retrieval.
Commenting on the service Dr Menzies said:
“It is generally accepted that trained specialist retrieval teams have lower rates of morbidity, mortality and adverse clinical events. I believe that an increasing number of transports undertaken by MICAS will result in a reduction in adverse clinical events in transfer and increased staff and patient satisfaction. Additionally, the use of the specialist retrieval team removes the need to deplete the referring hospital of resources. The expansion of critical care retrieval activity recently due to Covid19 has demonstrated the importance of this service, which is likely to get busier still as the national trauma system rolls out.”