Odisha Government Strengthening of critical care of COVID – 19 management.

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Bhubaneswar : Odisha Government have been pleased to approve the following recommendations for implementation of the same at your end for strengthening of critical care for management of COVID 19.
1. Decentralization of Critical Care: The Covid patients requiring critical care should be first managed in the ICU/ HDU of all districts instead of being referred to Bhubaneswar or Cuttack in a routine manner.
2. Training More training should be imparted at grass root level and district-level hospitals, so that patient management is accurate and referral will be reduced.
3. Referral policy: All facilities should follow the notified referral policy to enable seamless coordination between the sending and receiving hospitals. The Cluster district concept must be followed.
Bhubaneswar or Cuttack should be counseled and dissuaded, as there is life risk in transport. Patients insisting on being referred to
4. Transport: Patients in transit should be accompanied by Emergency Medical Technician so that the patients do not develop hypoxia during transport. Unless stable, the patients should not be transported
5. Close monitoring and timely early stage treatment should be given to cases in wards so that fewer patients become serious to be put in ICU.
a. The emphasis should be on providing non-invasive care like HFNC, may be provided in al the Covid Hospitals.
b. Remdesivir can be considered for moderate patients, if allowed under ICMR protocol.
c. Care should be taken for early detection of lungs infection.
6. Step-down ICU: To decrease the load on ICU, there should be Step-down ICUs. The patients who become stable in ICU shouls be shifted to the Step-down ICU. The HDU/ Semi ICU beds should be at least half the no of ICU beds.
7. The concept of virtual ICU may be started so that appropriate care can be given by expert advice from remote tertiary hospital level.
8. More number of dialysis beds, maternity beds, Oncology beds, trauma beds may be created for Covid patients, especially in peripheral facilities.
a. AHPGIC can have 25 beds to take care of Chemotherapy requirement of Covid cases with cancer.
b. SCB can have NICU to take care of Covid positive infants.
9. Diagnostic facilities such as CT scan (interpreted by Radiologist) and ultrasound of lungs should be strengthened in peripheral hospitals. Peripheral doctors can be trained in these diagnostic procedures.
10. Re-deploying resources: Wherever possible, trained manpower can be mobilized from low-burden districts to high burden districts.
11. Support to hospital teams: Treating teams should be provided with timely required support in terms of equipment and drugs.
12. Morale building: the teams working in Covid facilities and especially in the ICUs should be regularly encouraged and their efforts appreciated to keep up their morale in these difficult times.
13. Continuing Education: There should be continued structured discussions amongst treating teams and State level experts through online meetings/seminars so that latest protocols can be discussed and there is cross learning and mentoring across teams.

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