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All Wales Critical Care Escalation Guidance for the Management of All Large Unplanned Increases in Demand

Date of expiry / review:

Until replaced.

Action by:


Required by:

Health Boards and NHS Trust in Wales    


Professor Pushpinder Singh Mangat, Deputy Chief Medical Officer (Health Services), Welsh Government

Welsh Government contacts:

Clinical Pathways and Major Conditions,
Quality and Nursing,
Health Social Care and Early Years,
Welsh Government,
Cathays Park,
CF10 3NQ.


All Wales Critical Care Escalation Guidance for the Management of All Large Unplanned Increases in Demand


Publication of the revised All Wales Critical Care Escalation Guidance on the NHS Wales Executive website. These guidelines replace all previous versions of escalation and emergency planning guidance for critical care services issued by the Welsh Government.


There are times when critical care services become over-stretched due to a major incident, infectious disease outbreak, or other sustained increase in demand. This document provides guidance on how to respond on such occasions to optimise services and maintain equity of care.

The guidance aims to:

  1. prevent avoidable mortality and morbidity as a result of patients who require critical care not being able to access an appropriate level of care in time
  2. maximise capacity in the critical care system in a range of scenarios through a coordinated escalation and de-escalation approach across geographical areas
  3. avoid triage by resource (as opposed to triage by clinical need) until all potential escalation options have been exhausted

The guidance should be read alongside local escalation plans, regional and network plans, and appropriate national emergency planning guidance.


Health boards and NHS trusts, as appropriate, are expected to work with other health boards, NHS trusts in England and the National Strategic Clinical Network for Critical Care, Trauma and Emergency Medicine to ensure their arrangements for critical care escalation meet the requirements of this guidance.

Health boards and NHS trusts, as appropriate, should assure themselves they have plans in place to manage unplanned or sustained increases in demand for adult, children, and neonatal critical care.

Health boards must ensure they have a robust plan for the resuscitation or stabilisation of critically ill children and the provision of ongoing paediatric critical care whilst awaiting the arrival of specialised transport services or when a paediatric intensive care unit (PICU) bed is unavailable for a prolonged period.