>> Medicine until the 1970s had been pretty well
divided among the three primary areas of medicine,
surgery and pediatrics,
that was the Holy Trinity of academic medicine.
Pathology, anesthesia, and all of the other fields
generally revolved around the three core departments.
>> No one really paid a lot of attention to the brain issues.
The development of a specialized neurological intensive care unit
was really most important because of
the enormous improvements and what we knew
about the brain and how
the brain function and how important it was.
>> The NCCU needed to be established
because of the needs of
several different departments at Johns Hopkins.
It require the cooperation between neurosurgery, neurology,
anesthesia critical care medicine, and eventually nursing.
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>> The research that began in the NCCU,
began mainly with Dan Handling and came from
the anesthesia department with
their Director of Research, Richard Christian.
They began programs that have been extremely successful.
>> We had to improve the care of patients
and that research was the best way to do it.
There were ongoing projects in plasmapheresis of
Guillain-Barre patients and the NCCU
quickly became a home for those patients.
Working with Professor Jerry Molinsky,
I was part of developing
the first antivirals for human encephalitis,
and those patients came to the NCCU.
Soon after that, Justin McArthur was
bringing people with infections of the brain because of AIDS,
they were both external and internal drivers.
>> As a clinical nurse specialist,
we deal a lot in the translation of evidence.
But when you look at the evidence,
you readily assess that there are gaps.
Knowing that there is a need to find answers to
these gaps in our current knowledge really drives me.
I really find that there's hope in research.
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>> What we have in the NCCU,
I believe it's really a unique brand of
neuroscience nursing and under Ski Lower guidance,
we really elevated the neurologic exam and ensured that we were
speaking the same language as our
neurosurgical and neurology colleagues.
Ski Lower's role in the NCCU really is integral,
she developed the NCCU with Dr.
Henry and colleagues in the early 1980s.
She had come from a critical care nursing background
and she believed in the development of nurses,
so many of us have benefited from that over the years.
>> She taught us all how to be the educators of each other.
Part of the model that we used with
primary nursing also involved shared governance.
What that meant was,
everybody got to participate in so many of
the decisions about how we were to practice nursing.
We all got to come together and
write the rules about how we want it to be as a team.
You weren't a singular person anymore,
you are actually part of a larger
group and everybody had to come to
agreement about what was best for the greater good for the unit.
It's really important to understand that
the neurocritically ill patient can be
a very challenging patient to take care of.
The nurses really dependent on each other for support,
and I do think that that was one of the things that really caused
staff to be bound together by that shared experience.
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>> The training program was also
a very important part in the NCCU that developed very quickly,
this rapidly evolved into requests for fellowships.
>> Our fellowship program is very
selective and is very competitive.
Therefore we always try to train the best out there.
What that means is that there are also charged
with bringing in and developing new ideas.
The graduates of our program,
they have gone out to the world and they have made great things.
We have fellows that have become leaders in many institutions.
I think we're very proud of what we've
done and all the training that we've undertaken.
>> The scientific responsibility of this unit is to
go back to one of the early hopes for neuro protection.
That is to protect
the brain and peripheral nervous system from injury,
to hasten its recovery after injury,
and to know as much as possible about
how to intervene once an injury
occurs to prevent subsequent injury
and reverse that damage that has already occurred.
The difference today is that so much more is known about
the basic physiology of
the brain and the peripheral nervous system,
but it's a more realistic hope today than it's ever been.
>> I think it is possible in particular conditions to bring
neurocritical care into patients homes by way of telemedicine.
I think that that's where the future is going.
There is evidence to suggest that patients may recover
better in their homes than in an institutional environment.
That is something that will be challenging,
but we will be challenged to think about in the future.
>> We now have fellows who were studying patient
well-being a year after
their illness was treated in the neurocritical care unit.
The brain takes a long time to recover from it so.
Having trials that assess the value or
not of interventions and allowing
enough time to assess
the patient long-term is
probably the future of neurocritical care.
I think it's a very bright future because there
are so many things we can do to help
the brain and it's acute injury stages.
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