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Michael Christian

Michael Christian
British Columbia Emergency Health Services

MD, MSc (Public Health), FRCPC DRCPSC, CCPE

About

129
Publications
55,577
Reads
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5,624
Citations
Additional affiliations
October 2018 - February 2021
Barts Health NHS Trust
Position
  • Resarch & Clinical Effectiveness Lead / Senior HEMS Doctor
Description
  • Appointed to join the senior team to lead on the delivery of key objectives within LAA's research strategy. The primary objective of the role is to transform LAA's research programme to address the key challenges of: 1. Understanding the human response to trauma in the first minutes after injury; 2. Delivering precision prehospital resuscitation through novel diagnostics, stratification and decision support tools; 3. Improving survival and long-term outcomes through novel and targeted prehospit
January 2015 - present
Department of National Defence and the Canadian Armed Forces
Position
  • Consultant, Critical Care & ID, Flight Surgeon
Description
  • Reserves
July 2009 - January 2015
Department of National Defence and the Canadian Armed Forces
Position
  • Consultant Critical Care & ID, Flight Surgeon
Description
  • Regular Forces

Publications

Publications (129)
Article
Full-text available
Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all of those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, pr...
Article
Full-text available
Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequate...
Article
Full-text available
Despite pandemic influenza's long reign atop the list of potential medical catastrophes, the first protocol designed to support critical care triage in a pandemic was published only in 2006. InFACT (the International Forum of Acute Care Trialists) was formed in 2009 and provided a platform for international critical care research collaboration duri...
Article
Full-text available
The first cases of severe acute respiratory syndrome (SARS) occurred in China in November 2002. The agent causing this illness has been identified as a novel coronavirus, SARS-coronavirus. Since its introduction <1 year ago, this virus has infected 8098 people in 26 countries, killing 774 of them. We present an overview of the epidemiology, clinica...
Article
Full-text available
The recent outbreaks of avian influenza (H5N1) have placed a renewed emphasis on preparing for an influenza pandemic in humans. Of particular concern in this planning is the allocation of resources, such as ventilators and antiviral medications, which will likely become scarce during a pandemic. We applied a collaborative process using best evidenc...
Article
Full-text available
Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood prod...
Article
Full-text available
word count: 250 Manuscript word count: 3402 Abbreviated running title: Severe COVID-19 Cohort. Potential Conflict of interest: Attached. Take home message: Countries and hospitals need to identify strategies to increase their ICU capacity (i.e., trained personnel, ICU beds and monitoring systems) to treat patients presenting to the hospital with se...
Article
Full-text available
Due to the large number of patients with severe COVID-19, many were treated outside of the traditional walls of the ICU, and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside of the ICU is unknown. This was a multinational, multicent...
Article
Full-text available
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °...
Article
Full-text available
Background Following the publication of 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic.¹ Gaps in prior pandemic planning were identified and require modification in the midst of ongoing s...
Article
Full-text available
Background: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey. Method: A survey about the use of POCUS in HEMS was conducted by a multinational steering expe...
Preprint
Full-text available
Background: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS. Methods: A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carr...
Preprint
Full-text available
Background: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS. Methods: A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carr...
Article
Background This study aimed to determine the rate of scalpel cricothyroidotomy conducted by a physician–paramedic prehospital trauma service over 20 years and to identify indications for, and factors associated with the intervention. Methods A retrospective observational study was conducted from 1 January 2000 to 31 December 2019 using clinical da...
Research Proposal
Full-text available
This document details the initial analysis plan for the publication of the cohort of LAA patients from Jan 1, 1999, to Dec 31, 2019, who underwent a pre-hospital thoracotomy. Study Registered: researchregistry6529 (www.researchregistry.com)
Article
Full-text available
An amendment to this paper has been published and can be accessed via the original article.
Article
Introduction: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic. Methods: We rapidly de...
Article
Full-text available
Background Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method We conducted an international survey to evaluate mechanical ventilation...
Article
Full-text available
Objective Helicopter emergency medical services play an important role in the prehospital care of critically ill and injured patients, providing enhanced interventions and direct transfer to specialist centers. Essex & Herts Air Ambulance (EHAAT) delivers prehospital critical care to patients in Essex, Hertfordshire, and the surrounding areas. Hist...
Article
PurposeTo describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19.Methods Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Ca...
Article
Full-text available
Background Early in a pandemic, outcomes are biased towards patients with shorter durations of critical illness. We describe 60-day outcomes for patients critically ill with confirmed COVID-19 and explore the potential bias in the weekly reported data by ICNARC. Methods First 200 consecutive patients with confirmed COVID-19, admitted for critical...
Chapter
Full-text available
In this chapter: ● Forming teams ● Shared cognition in teamwork ● Tools and techniques that can be adopted in pre-hospital teams
Article
Full-text available
Background: Early in the COVID-19 pandemic, there was serious concern that the United States (US) would encounter a short fall of mechanical ventilators. In response, the US government, utilizing the Defense Production Act ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities...
Article
The World Health Organization (WHO) designates access to essential drugs as a critical concern due to persistent shortages and escalating costs. Drug shortages are a function of demand and supply mismatches that can be affected by manufacturing, distribution, as well as regulatory, economic, or political considerations. Prior to the 2019 coronaviru...
Preprint
Full-text available
Purpose: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians towards triaging scarce critical care resources in the COVID-19 pandemic. Methods: We rapidly deployed...
Article
Full-text available
Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management...
Preprint
Full-text available
Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method: We conducted an international survey to evaluate mechanical ventilatio...
Preprint
Full-text available
Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method: We conducted an international survey to evaluate mechanical ventilatio...
Preprint
Full-text available
Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method: We conducted an international survey to evaluate mechanical ventilatio...
Article
Objectives: Coronavirus disease 2019 patients are currently overwhelming the world's healthcare systems. This article provides practical guidance to front-line physicians forced to make critical rationing decisions. Data sources: PubMed and Medline search for scientific literature, reviews, and guidance documents related to epidemic ICU triage i...
Article
Full-text available
The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmati...
Article
Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical car...
Article
Full-text available
A global health emergency has been declared by the World Health Organization as the 2019-nCoV outbreak spreads across the world, with confirmed patients in Canada. Patients infected with 2019-nCoV are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, care...
Article
Full-text available
There's a therapeutic vacuum in the "hot zone" of a terror attack. Claire Park and colleagues describe efforts in the UK and beyond to deliver expert medical care to casualties trapped at the centre of an attack Claire L Park medical adviser 1 2 3 , Matthieu Langlois medical director 4 , E Reed Smith operational medical director 5 6 , Matt Pepper p...
Article
This review provides an overview of triaging critically ill or injured patients during mass casualty incidents due to events such as disasters, pandemics, or terrorist incidents. Questions clinicians commonly have, including "what is triage?," "when to triage?," "what are the types of disaster triage?," "how to triage?," "what are the ethics of tri...
Article
Full-text available
Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional pea...
Article
Full-text available
Purpose . The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods . Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Resul...
Article
Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission, while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those mos...
Data
The supplemental material contains ICU survival rates for each ventilation strategy observed (Supplemental Table 1), bivariate analyses comparing standard laboratory test values (from the first 24 hours of ICU admission) of ICU survivors and non-survivors (Supplemental Table 2) and bivariate analysis on potential influence of leukemic subtype on IC...
Article
Full-text available
In the setting of international disaster response, an important challenge is determining when it is appropriate to withdraw deployed assets as the acute disaster response transitions to recovery and rebuilding. We describe our experience with realtime data collection during our medical response to Typhoon Haiyan as a means to guide military aid mis...
Article
To provide clinicians with practical considerations for care of children with Ebola virus disease in resource-rich settings. Review of the published medical literature, World Health Organization and government documents, and expert opinion. There are limited data regarding Ebola virus disease in children; however, reported case-fatality proportions...
Technical Report
Full-text available
http://www.canadiancriticalcare.org/_assets/Ebola%20Clinical%20Care%20Guidelines_ENG.pdf
Technical Report
Full-text available
http://www.canadiancriticalcare.org/_assets/Ebola%20Clinical%20Care%20Guidelines_FR.pdf
Article
Full-text available
Background: Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics...
Article
Full-text available
BACKGROUND: Past disasters have highlighted the need to prepare for subsets of critically ill, medically fragile patients. These special patient populations require focused disaster planning that will address their medical needs throughout the event to prevent clinical deterioration. The suggestions in this article are important for all who are inv...
Article
Full-text available
BACKGROUND Past disasters have highlighted the need to prepare for subsets of critically ill, medically fragile patients. These special patient populations require focused disaster planning that will address their medical needs throughout the event to prevent clinical deterioration. The suggestions in this article are important for all who are invo...
Article
Full-text available
Introduction No standard exists for provision of care following catastrophic natural disasters. Host nations, funders, and overseeing agencies need a method to identify the most effective interventions when allocating finite resources. Measures of effectiveness are real-time indicators that can be used to link early action with downstream impact.Hy...
Article
Full-text available
Background: Despite the high risk for patient harm during unanticipated ICU evacuations, critical care providers receive little to no training on how to perform safe and effective ICU evacuations. We reviewed the pertinent published literature and offer suggestions for the critical care provider regarding ICU evacuation. The suggestions in this ar...
Article
Full-text available
Background: This article provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disasters or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion article addresses surge logistics, th...
Article
Full-text available
Background: Successful management of a pandemic or disaster requires implementation of preexisting plans to minimize loss of life and maintain control. Managing the expected surges in intensive care capacity requires strategic planning from a systems perspective and includes focused intensive care abilities and requirements as well as all individu...
Article
Full-text available
Background: Pandemics and disasters can result in large numbers of critically ill or injured patients who may overwhelm available resources despite implementing surge-response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. The suggestions in thi...
Article
Full-text available
Background: Planning for mass critical care (MCC) in resource-poor or constrained settings has been largely ignored, despite their large populations that are prone to suffer disproportionately from natural disasters. Addressing MCC in these settings has the potential to help vast numbers of people and also to inform planning for better-resourced a...
Article
Full-text available
Background: Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administ...
Article
Full-text available
Background: Planning for mass critical care in resource-poor and constrained settings has been largely ignored, despite large, densely crowded populations who are prone to suffer disproportionately from natural disasters. As a result, disaster response has been suboptimal and in many instances hampered by lack of planning, education and training,...
Article
Full-text available
Background: During disasters, supply chain vulnerabilities, such as power, transportation, and communication, may affect the delivery of medications and medical supplies and hamper the ability to deliver critical care services. Disasters also have the potential to disrupt information technology (IT) in health-care systems, resulting in interruptio...