I see a lot of half-information and misrepresentation of figures on critical care capacity in Wales.
I was the @WCCTN clinical lead during the first wave so this is first hand info. #thread

In Wales, there are 189 funded and most importantly, staffed critical care beds. Not all can take ventilated patients, but even those can provide other organ support. It’s important as staffing requirements are different for mechanical ventilation and other forms of support.

At the start of the pandemic, we were asked to double the capacity like we would be asked for a natural or man made disaster. The UHBs identified physical resources for ~350 critical care beds, with various, mostly non-sophisticated ventilators attached to these.

In the badly hit areas we went over 250% capacity to look after #COVID19 and “normal” critically ill patients. We could do it as nurses and colleagues from other areas were drafted in to help. As the first wave died down, all that staff went back to work in their original roles.

They are the ones providing elective surgery, routine appointments, follow ups, clinics everything what we call “elective” activity. As this is unlikely to stop as it had in March/April, we will have no extra resources to draw on.

We have highlighted then, that critical CARE means people who can deliver high quality care, 1st and foremost, and NOT equipment/beds/ventilators. If we keep “normal services” running, as we should, we will not be in a position to provide the same high quality care on more beds

Ventilation (invasive or non-invasive) on 200 beds will be a challenge. Ventilation on 350 beds will be only possible if there is an acceptance, that complications will soar and lives otherwise saved could be lost. We have to look after patients with other critical illnesses.

The “increased critical care capacity” is myth, UNLESS there are means to appropriately staff those beds. Critical Care has always been about staff as highlighted in this recent non-COVID19 paper https://link.springer.com/article/10.1007/s00134-020-06234-9

There are always trade offs. I don’t know what are the right answers to those trade offs. But it is important to know about them....