ISSUE 03
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Durban declaration: a call to action for critical care
he Durban Declaration, a unique outline for the future of Critical Care provision around the world, was issued today by the organisers of the 11th Congress of the World Federation of Societies of Intensive and Critical Care medicine, currently underway in Durban. “We recognise that access to critical care is a basic human right,” said Dr Sats Bhagwanjee, co-Chair of the Congress. “This Declaration can be seen as a founding statement for the discipline of critical care worldwide. It outlines what we believe are the key factors that must be considered when we look at providing critical care for all.” The Durban Declaration provides very specific objectives for all people accessing critical care, from the patients and their broader community to the health care providers, funders and governments. “We recognise that different countries have different resources, but we also believe that the access to critical care must be the same, no matter where you are. If there is only one ICU bed available, it must be of equal quality to an ICU bed anywhere in the world,” Dr Bhagwanjee explained. The 10 Key Tenets in the Durban Declaration are expanded upon in a 10-point plan which the signatories hope will be the basis of change in the provision of critical care around the world. The Durban Declaration is endorsed by the Presidents of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM); the World Federation of Paediatric Intensive and Critical Care Societies (WFPICCS); the World Federation of Critical Care Nurses (WFCCN); the Critical Care Society of South Africa (CCSSA) and the Chairpersons of the Global Sepsis Alliance and InFact. The declaration is summerised below and is available in full at http://goo.gl/rUyykl
The 10-point plan 1. It is a basic human right for all people to have access to nationally available Critical Care services. Access to Critical Care is a basic human right. Consequently, all
By LYNNE SMIT countries must provide critical care services. Access to Critical Care services must be facilitated for all people within a country. Whilst it is clear that low-income countries may not have the ability to invest the same resources as high-income countries, the quality of care provided in both should always be equivalent. 2. Critical Care must be an established specialty throughout the world. For the delivery of effective services, Critical Care must be an established specialty. The co-ordination of the discipline into a specialty requires the definition of the scope of practice of a multi-disciplinary team. 3. Patients, their families and their communities must be empowered to make informed Critical Care choices. A key goal must be to empower patients, their families and communities pre-emptively such that they are adequately informed to make choices and to be advocates for the well being of the individual, at the same time serving the interests of the broader communities from which they come. 4. The Critical Care needs of the most vulnerable populations must be properly identified. At-risk populations, such as people at extremes of age and those lacking mental capacity, represent a group that require particular attention by virtue of their vulnerability. 5. All basic ethical principles must be applied to ensure rational decision-making in Critical Care. Ensuring respect for patient autonomy is fundamental to ethical Critical Care practice. Beneficence and non-maleficence further drive caregivers to ensure care is appropriate and without harm. Since Critical Care is a limited resource, the social justice principle as a competing interest must be recognized. 6.Appropriately trained and supported health care personnel are fundamental to effective Critical Care practice. Recruiting, training and retaining skilled personnel must occur in the context of
creating effective Critical Care by a cohesive team. It is crucial to provide adequate support and care for healthcare workers involved in Critical Care, as it is a very highrisk environment for the personnel. 7. Adequate infrastructure must be provided to ensure safe and effective Critical Care services within the broader health care system Whilst economic resources of countries vary, the healthcare system must provide vital infrastructure that is well defined, and ensure the availability of essential equipment, drugs and disposables for the provision of Critical Care specific to each environment. 8. A culture of learning must be fostered within the Critical Care domain. Continuing medical education is essential for existing personnel. Training programs must aim to develop all healthcare providers in a nurturing environment that will foster a culture of learning. 9. All stakeholders must be committed to the development of strategies necessary to implement Critical Care services appropriate to the needs of each community. Patients and families, healthcare providers, policy makers and funders as major stakeholders, must share the commitment and implementation strategies to develop Critical Care services appropriate to the needs of each community. Key opinion leaders have the responsibility of leading all facets of the Critical Care agenda in achieving the goal of providing Critical Care for all. 10. Effective, clinically relevant, collaborative Critical Care research programmes need to be developed and existing programmes expanded. The vast global differences in disease patterns, human capacity and infrastructure demand that effective and innovative research programs be created that will direct caregivers to provide the best possible care based on evidence derived from suitably designed clinical research projects.