As the United States braces for the peak of the coronavirus pandemic, not knowing exactly when it will come, how severe it will be, or how short hospitals will be on intensive-care-unit beds and ventilators, the story of the Danish physician Bjørn Ibsen and his many helpers could not be more timely. Patients in dire condition survived because he innovated during an emergency, because agile hospital administrators recognized the value of an insight and scaled up its application in real time, and because hundreds of people volunteered their labor to provide care.
The story begins in 1952, when Copenhagen suffered a polio outbreak. Within a few weeks, Blegdam Hospital admitted more than 300 patients who were suffering from temporary paralysis that prevented them from breathing properly. At first, doctors didn’t fully understand their condition.
The fatality rate exceeded 85 percent.
Ibsen was a Danish-born anesthesiologist who had spent time at Massachusetts General Hospital before returning to his home country. He hadn’t been involved in treating the initial cases in the outbreak. But he attended an emergency meeting of physicians at the hospital, where, according to historical accounts, Ibsen hypothesized that insufficient oxygen and a buildup of carbon dioxide was killing patients.
Vivi, a 12-year-old girl, was sweating, gasping for air, and on the verge of death when he recommended that she be treated in a different way: As was sometimes done in the operating room, they should perform a tracheotomy and force oxygen into her lungs using “manual intermittent positive pressure ventilation”––in other words, pump oxygen by hand for every breath she needed. While this was a radical new approach, the dearth of other options overcame resistance to the idea. A surgeon performed the tracheotomy. At first, Ibsen was unable to force air into the patient’s lungs, but after administering a general anesthetic he did so successfully.
Soon Vivi regained consciousness and her fever fell. It seemed that the radical new approach actually worked. But how to apply it to a sudden influx of patients when each required someone sitting at their bedside 24 hours a day, hand-squeezing oxygen into their lungs as often as they needed to breathe?
Enter the helpers. The hospital soon organized shifts of perhaps 1,500 volunteer medical students, later augmented by dental students. They worked under hundreds of nurses, some semiretired. “The medical students worked 6 or 8 hour shifts so that three or four shifts were needed,” the respiratory physiologist John B. West recounted in a 2006 journal article. “It is daunting to think of the responsibility of these students who were essentially ventilating blind with only the patient’s appearance to guide them, at least in the initial stages.”
This went on for months. So many severe cases arrived that polio patients needing ventilation took up three floors of the hospital. Once the new methods were adopted, the mortality rate fell to 26 percent. Ibsen’s innovative treatment would be used in other hospitals, and it soon spurred advances in mechanical ventilators. The approach had broader consequences, too. Ibsen saw the general usefulness of putting dire cases that required care by multidisciplinary medical teams in one place.
“After the polio outbreak had subsided, Ibsen was offered a job at Copenhagen's Kommunehospital, where he was asked to supervise surgical patients in the recovery room and the wards,” the science journalist Stephen Pincock recounted in The Lancet. “Ibsen turned the surgical recovery ward into a unit where all types of patients could receive critical care … This was the world's first dedicated intensive care unit.”
Practitioners of intensive-care medicine credit him as a founding father. R. V. Trubuhovich of Auckland Hospital in New Zealand credited Ibsen with being “foremost in advocating a separate location to be established in hospitals where intensive care management could be supplied to the critically ill.”
The COVID-19 pandemic will generate many more patients over a longer time horizon, and differ from the 1953 polio epidemic in many ways besides. Still, Ibsen’s example is inspiring. Few at that Copenhagen hospital could have known at the time that their deeds would echo down through the decades as their collective success inspired imitators and advances that transformed medicine. May any of us put in a position to serve similarly in this pandemic succeed as admirably.
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