as in most other developing nations , critical care medicine as a specialty has developed very slowly and only recently in india . the coronary care units were developed in the early to mid-1970s .
perhaps the main pioneer of the field of critical care in india was farokh e udwadia , a brilliant physician with international training in pulmonology . in the mid 1970s , udwadia developed the first respiratory care units in the country in two hospitals in mumbai  a community hospital and a private one .
the most major achievement of these units was not only to bring down the mortality of tetanus , but also to open the eyes of society to the need for critical care services .
organized critical care training or programmes did not materialize , however , and it was left to individual interested trainees to go abroad and receive training . although the speciality was being practiced in isolated foci of hospital practices , the first few ripples in this field were created by consultants returning to india after training abroad in the united kingdom , in the united states , and in australia .
the initial centres of such activity were mumbai , pune and chennai , and they still remain the centres of academic creativity and administrative ability .
these few enthusiastic , trained consultants came together in 1992 to discuss critical care on a common platform , and they formed the national indian society of critical care medicine ( isccm ) .
the society had its teething troubles and has now established itself very firmly as a representative body of critical care consultants in india .
the current practice of critical care in india is a matter of as much diversity as the country itself .
there are three types of hospitals in india that are delivering patient care in india .
community hospitals are mostly run by the government and essentially result in no cost to the patients .
critical care is a branch that involves a lot of technology and therefore is dependent on finances .
hence , there have been limitations to the growth of this branch in community hospitals .
additionally , there are more than 1000 district hospitals . only a small proportion ( < 10% ) of all these hospitals , however ,
patients are levied a charge for these services that is proportional to their income ; there are also a small percentage of beds that are provided for free . as per the current estimation ,
icus in private tertiary care hospitals are usually very well equipped and thus form the most major contributor to the critical care facilities in the country , albeit at a higher cost to the patient .
finally , an interesting segment of health care facilities in india consists of small hospitals or nursing homes . modestly equipped , and managed mostly by medical professionals themselves , these are realities representing the vast middle and lower classes , and they contribute about 40% of available beds for the country .
the need and the viability of facilities for critical care are being acknowledged by this segment , and currently the facilities are on the upswing .
the certificate course in critical care , the first organized training activity in critical care medicine , was started 4 years ago by the isccm and has been evolving well .
a number of hospitals have developed training modules , and more students are coming out of this training programme regularly .
the isccm has also been very active in interacting with various medical councils in india . as a result ,
the postdoctoral fellowship in critical care medicine conducted by the national board of examinations has recently been announced . with this , the first steps for training in critical care on a national level curriculum are now being taken .
the training of nurses , technicians , and therapists has begun in some isolated foci but has not evolved into a meaningful training activity .
the patterns of medical problems seen in indian icus are dissimilar to those seen elsewhere .
a number of tropical infections such as malaria , leptospirosis , tuberculosis , salmonellosis , etc . form a significant proportion of the patients .
playing its part in the development of this new speciality , the isccm has taken the lead in the development of a number of other related issues .
the cpr training project and the development of an independent , dedicated organization like the resuscitation council of india has been felt by many who have been working in this field . along with other like - minded societies ,
development of guidelines for the working of icus has been another important issue that the isccm has taken up .
the guidelines are currently being formulated . for a country that has it own set of problems
the indian journal of critical care medicine is the official journal of the society and is the only mouthpiece of the organization .
the society has redesigned and activated its website ( ) , so one can now have access to all the latest news on isccm activities the annual national conference in critical care , conducted by the isccm , has been the high point of academic activities in this field .
held in different important cities , this event has been attracting not only the who - is - who in critical care in india , but also many international stalwarts over the past 8 years .
good quality original work has now started emerging , and is being accepted for publication by the prestigious international journals . at the recently held world congress , a multicentre study on scoring systems was presented on behalf of the isccm , and indian icus are now being included in the upcoming international simplified acute physiology score ( saps)iii study .
for the first time , india will be represented on the executive committee of the world federation of societies of intensive and critical care medicine .
one hopes that all the efforts will lead to a humane , scientific and meaningful service for the multitude of critically ill patients .
the ' icus worldwide ' series is created in collaboration with the world federation of societies of intensive and critical care medicine ( wfsiccm ) .
 critical care practices in india have evolved significantly over the past decade . 
 critical care initially began as a service in major hospitals , but with the formation of the indian society of critical care medicine the development of this speciality has been very rapid . 
 regular conferences , updates , continuing medical education programmes and workshops have emerged , and postdoctoral training programmes have been developed . 
 scientific publications have begun to appear and in spite of the diverse problems and standards , meaningful speciality - related activities have begun . 
 future challenges include the development of guidelines , the consolidation of training activities and research on the outcome of critical tropical problems . 
Introduction
Competing interests
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Acknowledgement