Medical emergency teams

Ken Hillman first developed medical emergency teams (METs) in Sydney, Australia as an alternative to the cardiac arrest team. The MET was alerted to any critical changes in A, B, C or D and parameters were provided for guidance. The MET included an ICU doctor and an ICU nurse. At its disposal was a critical care facility larger than in most UK hospitals.

In Liverpool, UK, there has been a rise in the number of MET calls (up to 44% occurring at night) since it was formed and a decline in the number of cardiac arrests. This is due to an increase in "Do not attempt CPR" orders as well as prevention of cardiac arrests: 25% patients seen by the MET were deemed to be unsuitable for CPR, although that decision had not yet been made by the referring team. General wards in the UK are increasingly likely to be filled with patients at risk of physiological decline. Most patients admitted to ICU have obvious physiological derangements (Figure 1.1). They are recognised by general ward staff as being at risk, yet there is often a lack of effective intervention.

Up to 30% patients admitted to ICUs in the UK have had a cardiac or respiratory arrest in the preceding 24 hours. Most of these are already hospital in-patients. Half die immediately and mortality for the rest on ICU is at least 70%. The purpose of a medical emergency team instead of a cardiac arrest team is simple - early action saves lives. As Peter Safar, a pioneer of resuscitation, has commented, "the most sophisticated intensive care often becomes unnecessarily expensive terminal care when the pre-ICU system fails".

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