Opened in 1959. The first resuscitation/intensive care unit in UK to admit patients directly from the ambulance. Mr Badger, Consultant trauma Surgeon, was a driving force in the establishment of the unit
Colin Thomas was the first consultant anaesthetist to have overall responsibility for the work of the unit alongside his Team 2 duties. Prior to his appointment patients were the responsibility of the consultant anaesthetist for their admitting team. After Colin Thomas left his role was taken by Anne Sutcliffe and following her departure by Magdi Ghoris. Principles of Care
Primary triage was done by WMAS who alerted the unit directly of impending admissions. There was a dedicated telephone line into the unit from Ambulance Control. The unit accepted patients of all ages from infant to elderly, although the unit mainly dealt with adults and rarely treated infants. The information was then relayed to all relevant individuals via the bleep system. The team would normally be assembled prior to a patient’s arrival.
Severely/potentially injured patients were normally met by a consultant trauma surgeon, a consultant anaesthetist, medical and nursing team. A radiographer was included in the initial alert and porters were on standby. Consultants were present for almost all admissions and were on-call with their team 24/7. The admitting medical team-maintained responsibility for the care of the patient from arrival until discharge from outpatients.
Nursing staff were experienced in intensive care. They were able to use highly technical equipment and monitor patients continuously both during and after initial resuscitation. A patient requiring ongoing intensive care was looked after by the same nursing team as that involved in resuscitation. The ward area was part of the overall unit.
These ongoing medical and nursing responsibilities reduced communication breakdown and increased expertise.
The MIU also acted as the intensive care unit for the whole hospital. Patients from Burns Unit or the general trauma wards were admitted if their condition warranted high dependency or intensive care.
All potentially necessary equipment was immediately available, some of it as sterilised sets for procedures such as insertion of drains, traction pins or cervical traction. This included the requirements for treating and documenting multiple casualties during a major incident. The unit normally had 4/5 ITU beds and 2 resuscitation beds. The total could be raised to 6 resuscitation beds if necessary. There was also an empty ward in the hospital which could be opened at short notice for the reception of multiple casualties. Each ward in the hospital, including MIU had a list of equipment to be provided to that area in the event of a major incident.
There was no delay in initiating investigations. A radiographer was included in the initial resuscitation team and the porters on standby took blood specimens to the laboratory. Laboratory staff were available at all times. The unit was the first in the UK to have a remotely monitored blood gas analyser.
Detailed records were kept for all patients including those unidentified. A medical records clerk arrived with a set of hospital notes immediately on admission and sets were available in the unit for major incidents. This meant that all notes/laboratory investigations etc were recorded under a single hospital number rather than on initial “Casualty Cards” thus reducing the possibility of mistaken identity. The unit also documented detailed resuscitation records in real time. These were available at a later date if required by police/coroner/audit/research. TRISS scoring was introduced and audit showed that outcomes were on a par with those in North America
Relatives were an integral part of a patient’s care and were involved in rehabilitation from the start.
The unit was at the forefront of the introduction to the West Midlands of innovative techniques in resuscitation and intensive care such as extra-dural intracranial pressure monitoring, haemofiltration and the treatment of multiple rib fractures with high thoracic epidural analgesia. Nursing staff took part in many research projects and initiated several. The most significant of these latter was the development of a detailed scoring system for head injured patients. Nurses had long felt that the universally recognised Glasgow Coma Score was not sensitive enough to document minor but important changes in the responses of patients with significant injury. For instance, the GCS only recorded whether a patient opened their eyes spontaneously or to stimulus. It did not record that the patient opened his eyes but did or did not focus on anything. Nurses felt that this was an important issue. A meeting with Mr David Clark from Pinderfields hospital resulted in the introduction of a 36- point scoring system for adults developed in that hospital’s neurosurgical unit. MIU nurses went on to develop a variation of this scoring system specifically designed for children. The development was led by Sister Julie Williams who had a paediatric qualification as well as one in Intensive Care.
The work of the MIU continued without interruption during upgrading of the permanent unit. The empty Ward A was set up for resuscitation and intensive care and patients were admitted directly as normal
