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There can be no European Health Union without intensive care medicine | View

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By Maurizio Cecconi & Elie Azoulay
Opinions expressed in View articles are solely those of the authors.
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Since January 2020, when the first COVID-19 patient stepped into a European Intensive Care Unit (ICU), starting an unprecedented influx of hospitalisations, critical healthcare workers have been on the frontline.

After a year and a half of relentless fighting against the disease, it is showing tenacity while a fourth wave of contamination has started and is expected to make European ICUs very busy again in the fall. That is why preparedness is key to protect our patients. We can’t afford to go back to the terrible situation experienced during the first three waves.

We now know what we are facing and we need to use the lessons learned to avoid repeating mistakes from the past. It is not acceptable anymore to reschedule surgeries and to prioritize hospital and ICU admissions. We cannot accept an ICU bed being confused with a piece of furniture, disregarding the professionalism, experience, humanity, humility and self-sacrifice that each healthcare professional brings.

We urgently need initiatives and programs at EU level to build our resilience such as training and upgrading of skills for European critical healthcare workers. This training should not only address physical complications of COVID-19, but also mental ones. Clinicians should be trained to take better care of patients, family members and themselves.

For many years now, the European Society of Intensive Care Medicine (ESICM) has been representing the Intensive Care Medicine (ICM) community to European policymakers, working towards the goal of raising the global standards of care to be able to provide the best treatment for all Intensive Care patients.

This can only be achieved by deepening the fundamental value of solidarity highlighted with this pandemic. It is in the name of solidarity that we need to further promote the dialogue with policymakers, to continue sharing knowledge and best practice, and to allow intensivists to move freely across the EU in order to provide help where it is most needed.

We cannot accept an ICU bed being confused with a piece of furniture, disregarding the professionalism, experience, humanity, humility and self-sacrifice that each healthcare professional brings.
Professors Maurizio Cecconi & Elie Azoulay

This solidarity will translate into more COVID-19 lives saved, less burn outs of professionals and more non-coronavirus patients benefiting from the best care – instead of an altered care plan that can only result in suboptimal outcomes.

European citizens are now expecting a strong EU engagement in healthcare such as delivering a fully functional European Health Union. It is only by taking the demands of the frontline workers into account, and by making ICM a central pillar of European health policies, that we will strengthen EU’s resilience to this and future pandemics.

We need to tear down any bureaucratic barrier that currently prevents intensivists from working across member states and learning from one another. The obstacles to the free movement of intensivists, especially in times of cross-border health threats, prevent the exchange of practices, hinder solidarity among EU countries and affect the quality of care to patients.

During the peak of the crisis, it proved easier to move critically ill persons across countries than to send intensivists in another member state to support their peers. This is a paradox that should be urgently addressed for the benefit of all people at stake.

As such, we need to create a framework at European level to allow – without changing national healthcare or educational systems – the mutual recognition of Intensive Care qualifications so we can create a network of excellence, knowledge, shared research and best practices. By creating such a network in times of “peace”, we can considerably raise the EU’s healthcare resilience in times of crisis.

Wave after wave of COVID-19, Europe’s ICUs have proven to be the last line of defense in public health. Now, they need greater support from policymakers to guarantee the necessary physical resources and flexibility. We need to take very concrete steps in the direction of mutual recognition of qualifications and the free movement of intensivists, the first of such being the inclusion of Intensive Care Medicine in the Directive on the Mutual Recognition of Professional Qualifications.

ESICM and its members stand ready to contribute to this long-awaited development in European healthcare policy and to promote the paramount role of Intensive Care Medicine in building the future European Health Union.

Together, we are intensive care.

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Professor Maurizio Cecconi, is the current president, and Professor Elie Azoulay is the president-elect of European Society of Intensive Care Medicine (ESICM).