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My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children at home with 24/7 critical care trained nurses, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy with 24/7 critical care trained nurses, where we provide tailor-made solutions at home for adults and children with tracheostomy without ventilation with 24/7 critical care registered nurses, where we provide home ventilation and tracheostomy weaning when medically appropriate. Home cough assist management. Home TPN (Total Parenteral Nutrition), home IV (intravenous) fluids, IV antibiotics, IV potassium, magnesium and other electrolyte infusions. Home central line, PICC (Peripherally Inserted Central Catheter) line, Hickman line and port management at home, nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube, SPC (Suprapubic Catheter) and IDC (Indwelling Catheter) management at home, as well as palliative care management at home. We also provide Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination, as well as TAC (Transport Accident Commission) and WorkSafe case management.

 

In today’s blog post, I want to walk you through a clinical scenario: a seizure in someone on BiPAP at home. It’s an illustrative example, not the story of any individual client, but it reflects the kind of airway emergency that ICU nurses are trained for and that do happen in our clients’ homes. That’s why I can make it so illustrative, because it happens all the time with a variety of clients.

 

And it answers a question I get from families, NDIS support coordinators, NDIS planners and lawyers almost every week. The question is: “Does my loved one on BiPAP really need a critical care registered nurse 24 hours a day, or can a trained support worker do the job?” Let me walk you through it, and then let me explain the scenarios for you.

And you might be wondering what makes me qualified to talk about topics like that on my video blog here. I have worked in critical care nursing for over 25 years in three different countries, where I have worked as a nurse manager for over 5 years in intensive care. I’ve been running Intensive Care at Home here in Australia since 2012, after I had early exposure in my nursing career to Intensive Care at Home in Germany in the early 2000s, before I brought the concept to Australia in 2012. That’s how long we’ve been operating with Intensive Care at Home for.

 

So if your loved one on BiPAP, CPAP or with a tracheostomy is at home or in ICU, and you’re worried about what might happen at 2:00 in the morning, talk to me here at intensivecareathome.com. Call me on one of the numbers on the top of our website at intensivecareathome.com. Click the schedule appointment button and you can book a call with me, or simply send me an email to [email protected]. Also download our free Seizure and Breathing Emergency Readiness Checklist for Families on BiPAP or Tracheostomy at Home.

 

So what could a seizure on BiPAP look like at home? Picture an adult, or a young adult, or even a child living at home who uses BiPAP, bilevel positive airway pressure, while sleeping and has a known seizure disorder. They have a 24/7 critical care registered nurse with them around the clock, and a seizure management plan from the treating doctor that includes prescribed intranasal midazolam. They’re asleep with BiPAP on. Here’s how a seizure might unfold, and what a CCRN (Critical Care Registered Nurse) at the bedside would do.

 

1. The pulse oximeter alarms. The nurse is in the room within seconds, or is at the bedside.

2. Oxygen saturations have dropped into the 70s, and the nurse confirms there’s a good, reliable trace on the monitor. In other words, this is a real desaturation, a real medical emergency, not a loose saturation probe.

3. Pulling back the sheets, the nurse sees stiffly extended arms, deviated eyes and frothing at the mouth, i.e., a seizure.

4. The nurse takes the BiPAP mask off and suctions the mouth to clear the airway. The nurse might have to put a Guedel airway in, or a nasopharyngeal airway, which are both, by the way, skills only for critical care trained nurses.

5. The nurse gives the prescribed intranasal midazolam as per the seizure management plan.

6. High-flow oxygen goes on via a face mask, and saturations start to come back up.

7. The seizure continues, so the nurse escalates to an on-call senior clinician, and the second dose is given if the plan allows.

8. The seizure stops after several minutes.

9. Once it is safe, the nurse weans the oxygen, puts the BiPAP back on, and keeps monitoring very closely.

 

With the right skills at the bedside at home, an emergency like this can, most of the time, be managed at home without an ambulance, an emergency department or an ICU bed. Of course, if the person doesn’t respond, the nurse calls triple zero (000) straight away.

 

Now let me break down why this is so serious, and why a qualification on a piece of paper doesn’t replace an ICU nurse at the bedside 24/7.

Why is a seizure on BiPAP so dangerous? A seizure on its own is a medical emergency once it goes beyond a few minutes. A seizure in someone who already needs help to breathe is a different league. Here’s why.

 

1. The airway is under a mask. BiPAP pushes air through the mask over the nose and mouth. During a seizure, saliva, froth and sometimes vomit build up in the mouth. With the mask on, that material can be pushed into the lungs. That’s aspiration. And aspiration pneumonia is one of the biggest reasons BiPAP clients end up in ICU.

2. Oxygen saturations in the 70s mean the brain is short of oxygen. Every minute at that level matters. Prolonged hypoxia can cause permanent brain injury, cardiac arrhythmias or cardiac arrest.

3. The client can’t protect themselves. Most of our BiPAP clients can’t take their own mask off or turn onto their side. They are completely dependent on the person in the room.

4. The seizure medication slows breathing. Midazolam is the right drug to stop a prolonged seizure, but it is a sedative after all. In someone whose breathing is already weak enough to need BiPAP, it can tip them into respiratory depression or respiratory arrest. Someone has to watch for that minute by minute.

5. High-flow oxygen is not risk-free in these clients either. Many BiPAP clients retain carbon dioxide, or CO2. Giving lots of oxygen without putting ventilation back in place at the right time can let CO2 rise. Knowing when to wean oxygen and when to go back to BiPAP is a clinical judgment that only critical care registered nurses have.

So what did the critical care nurse do, and why did every second count? Think of it like a pilot in the cockpit. When an engine fails, you don’t want someone reading the manual for the first time. You want a pilot who has handled emergencies hundreds of times and acts on instinct. That’s what an ICU-trained nurse brings into the home with Intensive Care at Home. In a scenario like this, the CCRN does in a matter of seconds and minutes what we’d expect in an ICU.

1. Recognizes the problem immediately. The nurse is awake, close by, responds to the alarm straight away, checks the trace quality, and knows whether it’s real or not.

2. Recognizes the seizure. Eye deviation and limb posturing under the sheets are signs that can easily be missed or misread by someone without clinical training.

3. Secures the airway first. Mask off, mouth suctioned, oxygen on. Airway, breathing, circulation, in that order.

4. Gives the right medication, by the right route, at the right time, as per the doctor’s seizure management plan.

5. Escalates appropriately to a senior clinician and makes a shared decision about a second midazolam dose.

6. Assesses breathing after the midazolam, weans the oxygen and puts the BiPAP back on at the right moment to manage CO2 and keep the client ventilated.

7. Keeps monitoring and documents everything, so the treating team can review the seizure management plan.

That combination of recognition, airway skills, pharmacology and clinical judgment is exactly what ICU nurses do every day. It isn’t something you can learn in a half-day training module.

 

So what would have happened under a delegated model of care? Under a delegated model of care, a support worker looks after the client day to day, and a registered nurse trains them, delegates certain tasks to them, and supervises from a distance, usually by phone or with occasional visits. The nurse is not in the room.

Let me be fair here. Many support workers are caring, dedicated people. And with the right training, a disability support worker can be delegated to give emergency seizure medication under a seizure management plan. That’s not the issue. The issue is what happens around that medication.

 

In my professional opinion, based on over 25 years in intensive care, here’s how this scenario would most likely play out without a CCRN at the bedside.

 

1.Delays in recognition. Would a support worker know the low reading was real? Would they spot the eye deviation and stiff arms under the bedding straight away? Every minute of delay is a minute of hypoxia.

2. Airway decisions beyond the scope of a support worker. Taking off the BiPAP, suctioning a seizing client, applying high-flow oxygen, and deciding when to put BiPAP back on are clinical decisions. Disability support workers generally aren’t trained or delegated to make them in real time.

3. The ambulance call is almost guaranteed. Typical seizure management plans for support workers say to call triple zero if a seizure lasts longer than about 5 minutes, if a second dose of medication is needed, or if breathing is compromised. This scenario ticks all three boxes. That means an ambulance, an emergency department, and quite possibly an ICU admission for a client who could otherwise have stayed at home.

4. Waiting for help with dangerously low oxygen. Even with excellent paramedics, the person would be waiting for an ambulance with recent midazolam on board and an unprotected airway.

5. No one to watch for respiratory depression. After midazolam, a BiPAP-dependent client needs constant, skilled assessment of their breathing. A phone call to a nurse who can’t see the client is not the same.

 

So realistically, the best-case outcome under a delegated model would have been an ambulance call and a hospital admission. The worst case, with prolonged hypoxia, aspiration or respiratory arrest, could have been catastrophic, including hypoxic brain injury or death. I’m not saying that to scare anyone. I’m saying it because families deserve honesty when they ask what’s at stake.

 

And what does the Noah Johnston case teach us? Many of you will know that I often talk about the late Noah Johnston. Noah had a tracheostomy, and in December 2025, his tracheostomy tube became displaced at a time when no registered nurse was with him, because the NDIS cut his 24/7 registered nurses. So the NDIS is directly responsible for Noah’s death.

 

Noah’s story is different from this scenario, but the lesson is the same. Airway emergencies in clients on BiPAP, CPAP or with a tracheostomy don’t make an appointment. They happen at 2:00 in the afternoon or 3:00 in the morning, and they’re over in minutes. The person standing in the room in those minutes decides the outcome. In the scenario above, that person is an ICU-trained nurse. In Noah’s case, there was no registered nurse there. That’s the difference I’m asking decision makers to think about.

Also, what does the evidence say? At Intensive Care at Home, we follow our evidence-based Mechanical Home Ventilation Guidelines, which draw on the German Respiratory Society’s guideline for non-invasive and invasive ventilation, as well as international literature and Australian literature. Germany has been ventilating people at home with critical care trained nurses 24/7 for around 30 years now. So the proof is in the pudding, the proof is in the concept, and the proof is also Intensive Care at Home. We’ve been operating under the evidence-based mechanical home ventilation guidelines since 2012, and the evidence is clear that these are best practice and evidence-based standards.

 

A few key points from our guidelines:

1. Home ventilation should be delivered by 24/7 critical care trained staff, and service delivery without them puts the ventilated adult or child at risk of death.

2. Nurses on the team should have at least 18 months ICU or critical care nursing experience. Our nurses have at least two years ICU or critical care nursing experience.

3. The designated specialist nurse needs at least 3 years, plus a postgraduate critical care qualification. As a matter of fact, we’re employing hundreds of years of ICU nursing experience combined. And because of that, we bring the highest nursing skill levels into the community in Australia, hands down.

4. Nurses need to understand gas exchange, the difference between hypoxic and hypercapnic respiratory failure, and oxygen use in combination with ventilation. That’s exactly what’s needed in a scenario like this.

5. Clients who can’t remove their own mask in an emergency need someone who can act immediately.

 

You can read the full mechanical home ventilation guidelines on our website at intensivecareathome.com.

 

Next, why does accreditation matter when you choose a home nursing provider? When you’re choosing who comes into your home at 2:00 in the morning or 2:00 in the afternoon, you want to know that the service has been independently checked. Intensive Care at Home holds third-party ISO (International Organization for Standardization) 9001:2015 certification, with a scope specifically covering the delivery of intensive care nursing services at home, including services to ventilated patients. To our knowledge, in 2026, and since 2012, we have been the only third-party accredited Intensive Care at Home nursing service in Australia. We’re also NDIS registered, and approved by TAC, WorkSafe and DVA (Department of Veterans’ Affairs). See our accreditation and certificates at intensivecareathome.com/accreditation-quality.

So to summarize, how can you get the best outcomes for your family member?

 

Get the medical records. Ask for incident reports, nursing notes, seizure charts and hospital discharge summaries. Real incident reports from your loved one’s care are powerful evidence in NDIS or other funding body reviews, or an ART (Administrative Review Tribunal) appeal.

Ask the treating doctors to put it in writing. A letter from the neurologist or respiratory physician explaining why the client needs 24/7 ICU-level nursing carries a lot of weight.

Get a specialist nursing assessment. We provide clinical nursing assessments that explain, in plain language, the risks and why a delegated model of care is not appropriate for a specific client.

 

Next, don’t accept the downgrade without challenging it. If your NDIS plan, any other funding body or insurer proposes moving from nurses to disability support workers, ask for their clinical reason in writing, because you probably won’t get a good one. It’s all based on trying to save money and letting people die, because that’s what we’ve seen with the NDIS in the meantime.

 

How can Intensive Care at Home help your family? We provide 24/7 critical care registered nurses in the home for adults and children on BiPAP, CPAP, tracheostomy and ventilation, all around Australia, in all states and territories. Like I said, we’re registered with NDIS, TAC, WorkSafe and DVA. We also work with private health funds and families funding care privately. For many clients, ICU-level care at home is significantly cheaper than an ICU bed, roughly 50%, and it keeps people out of hospital with their families, permanently and predictably.

 

Just to summarize, some frequently asked questions.

 

What should happen if someone on BiPAP has a seizure? Follow the treating doctor’s seizure management plan. In general, the airway must be cleared and protected, oxygen levels supported, prescribed medications given, and breathing closely monitored afterwards. If you don’t have a nurse present, call triple zero. This blog is general information, not medical advice for an individual.

 

Does the NDIS fund 24/7 nursing at home? It can. It definitely can, otherwise we wouldn’t exist, where it is reasonable and necessary. Strong clinical evidence, including incident reports and specialist letters, makes all the difference.

 

Why are oxygen levels in the 70s dangerous? Normal saturations are usually above 94% in most people. Saturations in the 70s mean the body and brain are seriously short of oxygen. It’s a medical emergency, and medical emergencies in a hospital, for example, trigger the appearance of the ICU team. And it’s the same at home. Every minute counts. You need 24/7 critical care registered nurses.

 

Is Intensive Care at Home accredited for what we are doing? Yes, absolutely. Like I said, to my knowledge, in 2026, we are the only third-party accredited Intensive Care at Home nursing service, because we’ve built the policies, the procedures and the intellectual property from scratch, for the delivery of Intensive Care at Home nursing, including ventilation, tracheostomy, etc. And we are a registered NDIS provider as well.

 

The bottom line is this. A seizure on BiPAP at home can go from asleep and comfortable to dangerously low oxygen and frothing at the mouth in seconds. With a critical care registered nurse at the bedside, a potentially life-threatening emergency like this can often be managed at home. Under a delegated model of care, it would most likely mean an ambulance, a hospital admission, and potentially death. It could be much, much worse.

 

Contact us at intensivecareathome.com. Call me on one of the numbers on the top of our website, or simply click the schedule appointment button, or send me an email to [email protected]. With Intensive Care at Home, we’re currently operating all around Australia, in all states and territories. If you’re watching this and you’re in the US, UK, Canada, India, anywhere around the world, and you’re interested in Intensive Care at Home, please reach out to us as well. My mobile phone number is 041 094 2230. Take care for now.

 

With all of that said, with Intensive Care at Home, we are currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to long-term stay in intensive care for:

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure) (https://intensivecareathome.com/quality-life-nursing-services-adults-children-requiring-non-invasive-mask-ventilation-cpap-bipap-andor-high-flow-oxygen-therapy/) ventilation without tracheostomy
• Tracheostomy care without ventilation
• Home TPN (https://intensivecareathome.com/tpntotal-parenteral-nutrition-administration-picc-line-central-line-care-community/)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

We’re providing:

• Cough assist management at home
• Ventilation weaning management at home
• Central line (http://intensivecarehotline.com/central-venous-lines/), PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• Nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) (https://intensivecarehotline.com/your-loved-ones-treatment/peg-percutaneous-endoscopic-gastrostomy/), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services at home

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders.

 

Our Coverage and Accreditation

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

We’re also ISO 9001:2015 accredited. Our clients and we as a service provider have also received funding through public hospitals, private health funds as well as departments of health.

 

We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home level of accreditation in the community and has created more intellectual property when it comes to Intensive Care at Home nursing than we have.

 

This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

 

If You Need Help

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.

This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

 

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

 

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

 

Our Support Coordination Services

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

 

If you’re an NDIS support coordinator or a case manager or a social worker from another organization or a hospital watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. We will help you with the right level of funding and with the right level of advocacy.

 

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

 

Join Our Team

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, successful, and high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined.

 

If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

 

I have a disclaimer though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff.

 

If you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re looking for consistency and our clients are looking for consistency. So please only apply with us if you can give us regular and consistent availabilities for shifts and you’re really keen on building relationships with us and with our clients. Reliability is also a must.

 

For Medical Professionals and Healthcare Executives

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well.

We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help to take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

 

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

 

International Support

If you’re in the U.S. or in the UK and you’re watching this and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses privately.

 

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

If you like my videos, click the like button, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

Thank you so much for watching.

 

This is Patrik Hutzel from intensivecareathome.com and I’ll talk to you in a few days.

 

Take care for now.