President's Message 2018

Prof. Ross Freebrairn

Welcome to the Asian And Pacific Association of Critical Care Medicine website. The APACCM is an organisation of national societies and individuals with a focus on developing and supporting intensive care practice, infrastructure training and education in the Asia and Pacific region. From its humble beginnings as the Western Pacific Association of Critical Care Medicine in the 1981 with the inaugural congress in Singapore, the Association has developed to incorporate societies from the wider Asia region including societies from India, Sri Lanka, Bangladesh and Nepal.

In the four decades since then much has changed. While the wealth and prosperity in Asia has generally increased, health spending per head of capita in Asian economies is low, at about one fifth the level of OECD countries, amounting to 4.5% of GDP, on average, in the Asian region, compared to over 9.5% in OECD countries. (1)However the growth rate health spending in real terms was 5.6% per year in Asia, higher than the 3.6% observed across OECD countries. The growth rate for China, Myanmar and Viet Nam was even more rapid - almost twice the average rate for the region.(1)Intensive care practice has undergone massive development worldwide with an ongoing increased demand for intensive and critical care services. Within the Asia Pacific region the demand and delivery of intensive care continues to grow, but there is diversity in critical care structure, organization, training, accreditation practice and delivery, related to not only to hospital funding source, size, and country income but also to cultural and religious traditions. (2-5)

The presenting aetiology of critical illness differs in Asia within regions and also significantly from the presenting aetiology in other continents. For example pathogens that cause sepsis within south East Asia differ from markedly those in other areas. (6, 7)With 4.5 billion people Asia comprises nearly 60% of the world's population, yet research publications on problems facing the Asian critical care community are relatively rare. (8, 9)Within Asia, a collaboration within the critical care research community is developing. This should encourage a focus on answering questions relevant to the Asia Pacific critical care community , and consequently improve intensive care delivery.

Assimilation of new information gained from research into clinical practice requires leadership, education and training. Some health systems within Asia have mature education training and credentialing programs, but others are less developed(5, 10). Unprecedented access to information, increasing public expectations and increasing sophistication of treatment make training, education of staff even more important. This increase in information, has not necessarily been matched with increased resource or indeed with the training and education required to deliver the complex interventions health systems where Intensive care. Intensive care poorly delivered is wasteful; while teaching interventions delivered even in resource limited environments with appropriate care can drastically reduce mortality. (11)

Specialized critical care training, not only for intensive care physicians and nurses , but also for other clinical personnel and support staff are essential if the discipline is going to progress.(12) We are fortunate that several initiatives for intensive care training in Asia are currently active. (11-13)A great example is the BASIC collaboration, based out of the Chinese University of Hong Kong, with the compendium of courses including BASIC, Beyond BASIC, Nursing BASIC and BASIC for Developing Health Systems( BASIC DHS) .Other training systems and resources are also available, but the BASIC Courses generailsabilit and absence of a license fee makes them attractive in resource limited systems . Training on specific IC clinical skills is important but creating successful intensive care environment requires attention to infrastructure, attitudes, team building, support, accreditation and standards. Establishing local educational capacity rather than ongoing reliance upon imported trainers is likely to be more cost effective, and appropriate through train-the-trainers programs will be important if the training programs are to be sustained.

How can APACCM help? We know more education is needed, and that some ( often larger, often more affluent ) critical care societies have resources developed that may be of use to smaller, less developed or less affluent intensive care communities. The Asian pacific region is fortunate to have enjoyed the collaboration between the larger societies, in particular the Indian, Nepalese, Maldivian, srilankan, Bangladesh and Pakistan Societies with SAARC meetings , the Japanese and Korean Societies, and ANZICS with the Singapore society in there support for multinational educational meetings. APACCM aims to facilitate collaboration between societies and to support sustainability. Resource-plentiful societies should support training ventures resource-limited countries. Smaller intensive care communities may benefit form the collaborative approach, developing their own infrastructure and systems, without losing their national identify. We hope to develop an Asia wide accreditation program to assist national societies that are struggling to develop their own training pathways. The opportunities to train in overseas training posts jurisdictions are diminishing, and may be counter productive to meeting local clinical demand. Sharing outside resources to bolster local programs increases the ability to train intensive care clinicians locally, and is sustainable. Local trainers add further value through their knowledge of local resources, avoiding the institution of non sustainable or unresourced practices in that are unsuitable in a limited environment.

Last year we ran the changed from a bi annual meeting of APACCM to an Annual meeting. This high quality meeting was ably hosted by Dr Chairat Permpikulin conjunction with the Thai Society in Bangkok. The 2018 APACCM annual Scientific Meeting will be in conjunction with the Hong Kong Society at the Conrad Hotel, Hong Kong on 15-16 December. In 2019 we have a combined meeting with the Indian Society. All promise to be stimulating and worthwhile meetings. APACCM will also be active at the Indian meeting this year in Varanasi, ant the Sri Lankan Critic on meeting on the 15th of July in Colombo , at the Bangladesh society meeting in June in Dacca and at the 25th Asia Pacific Symposium on Critical Care & Emergency Medicine in Bali Indonesia on August 2 - 4. Please come and join us.

The launch of this website marks a step forward for the APACCM. I am grateful to Dr Atul Kulkarnithe, Secretary General of APACCM for his tireless work in initiating, organising and managing the website, and for his encouragement in corraling the APACCM councillors for the meeting in Varanasi. Without his efforts this website would not exist.

contact info
Tata Memorial Hospital, Dr Ernest Borges Road, Parel
Mumbai 400 012, India.
What we do
Critical Care Medicine shall mean that section of health care specifically organized for the management of the critically ill patient.