Copenhagen invented the ICU with 1,500 students and a bag

Copenhagen, 27 August 1952: at Blegdam Hospital, where Vivi Ebert had been admitted the day before, the anaesthetist Bjørn Ibsen opened the twelve-year-old's windpipe, slid in a tube and began squeezing a rubber bag by hand to fill her lungs with air. Vivi had bulbar polio, the form that paralyses the muscles you breathe and swallow with. That bag, squeezed in shifts for months by some fifteen hundred students, is the direct origin of what we now call an ICU.

The city was living through the worst polio epidemic in its history. Between July and December more than 2,700 patients were admitted to Blegdam; 866 were left paralysed and 316 lost the muscles for breathing or swallowing. For those 316 the hospital had a single iron lung — the metal cylinder that works as a bellows from the outside — and six cuirass respirators, rigid shells that pull the chest upwards. By the hospital's own published figures, of every ten patients with the severe form almost nine died.

The head of the hospital, H. C. A. Lassen, was Denmark's leading specialist in infectious diseases and held that these patients were dying of kidney failure caused by the virus itself. Ibsen, an anaesthetist trained in Boston, said no. They were dying of carbon dioxide: the gas released when the chest empties was staying inside them, because they had no muscles left to push it out, and it was acidifying their blood until it killed them. A plumbing problem. And plumbing had a fix, because it was exactly what an anaesthetist does every morning in an operating theatre: open the windpipe, insert a cuffed tube and push the air in.

Lassen let him try it on Vivi, who was dying. Within days the whole hospital had changed method, and that is when the real problem appeared: there were no machines to squeeze the bag: there were students.

Copenhagen called in the city's medical and dental students. Around 250 a day, in six- and eight-hour shifts, sitting on a chair beside a bed, squeezing a bag to the rhythm of somebody else's breathing. Almost every medical and dental student in the city passed through. Each one held an entire life in one hand and could not let their attention drift: if the student stopped, the patient stopped breathing. Many had not yet finished their degree.

Mortality in the severe form fell from 87 per cent to around 40 within a few weeks, and to 11 per cent within a year. Ibsen joined Copenhagen Municipal Hospital on 1 August 1953 and that December opened a ward there where the sickest patients were gathered together instead of being scattered across the floors, under continuous watch and with an anaesthetist in charge. It is considered the world's first intensive care unit.

Vivi Ebert stopped needing continuous ventilation in January 1953, left hospital quadriplegic in 1959 and died in 1971, at thirty-one. The students who relieved one another at her bedside and at the others' put in 165,000 hours of squeezing the bag.