As both National Minority Health Month and Celebrate Diversity Month, April served as a timely reminder that inclusion is not just a box to check, but a principle to live by. In neurocritical care, our mission to “awaken” consciousness must extend beyond the clinical realm. It is a call to sharpen our ethical awareness, elevate our moral consciousness, and refuse the deceptive comfort of silence.

The Neurocritical Care Society (NCS) reminds us that inclusion is at the heart of who we are. Yet inclusion doesn't happen by inertia—it requires intention. To awaken fully means to remain alert to disparities in access, representation, and treatment. It also means calling out the structures and habits that preserve those inequities. And it means acknowledging that silence—especially from those in positions of influence—is never neutral.

Silence is both a symptom and an insidious disease. Like hypoxia or hypotension, it may appear deceptively calm at first. But its cancerous and degenerative nature is profoundly dangerous. When we fail to speak out about inequity in our field, we allow it to deepen. When we fail to advocate for patients whose voices are marginalized—because of race, language, socioeconomic status, or geography—we become complicit.

We must not be the clinicians Niemöller warned us about:

First they came for the vulnerable, and I said nothing…

In today's ICU, the vulnerable are not only the critically ill but also those who have long been underserved and unseen by our health care system.

The Henderson Equity and Research on Disparities (HEARD) Center emerged from a stark reality: neurocritical care, like many specialties, harbors profound inequities. Studies consistently demonstrate disparities in stroke care, traumatic brain injury outcomes, and access to specialized neurocritical care units based on race, ethnicity, socioeconomic status, and geography. These are not abstract concerns but life-and-death realities for our patients.

Consider the evidence: Black patients are less likely to receive tPA for acute ischemic stroke even when eligible. Rural patients face delays in transfer to specialized neuro ICUs. Language barriers contribute to misdiagnosis and inadequate informed consent. And implicit bias affects clinical decision-making in ways that many of us remain uncomfortable acknowledging.

The HEARD Center represents our field's commitment to confront these uncomfortable truths. Its mission—to eliminate disparities through research, education, and advocacy—requires more than passive support. It demands active engagement from every NCS member—because while the Center can identify problems and propose solutions, implementation requires collective consciousness.

The HEARD Center represents a tremendous opportunity for NCS to advance its core mission of excellence in patient care. Together, NCS members and leadership have the unique ability to amplify and accelerate this important work through collaborative engagement.

This partnership begins by celebrating how equity work enhances our field's scientific foundation. NCS has already demonstrated leadership by establishing the INCC committee, section, and keynote, recognizing that understanding disparities strengthens the evidence base that informs our clinical practice.

The society's commitment to inclusion can be further enhanced by weaving equity perspectives throughout educational curricula, journal publications, and quality improvement initiatives—creating rich opportunities for members to contribute to this vital dimension of care.

As the HEARD Center develops its research and education agenda, the NCS community provides crucial support through membership engagement, mentorship networks, and collaborative funding initiatives that reflect our profession's dedication to equitable care. These strategic alignments of resources with our shared priorities will accelerate progress toward eliminating disparities in neurocritical care.

Equally important is embracing opportunities for collective growth and learning. By creating safe spaces for honest dialogue about healthcare disparities, NCS fosters an environment where all members should feel empowered to examine assumptions and expand clinical perspectives—ultimately enhancing patient care for all those we serve.

It also means fostering inclusive communities within our own teams. Neurocritical care is a collaborative discipline, and true collaboration thrives on diversity of background, thought, and experience. Engaging in NCS initiatives like the Inclusion in Neurocritical Care (INCC) section or supporting the annual INCC keynote are not side efforts—they are central to the future of our field.

To be clear, this work isn't going above and beyond—it is essential to our practice. Inclusion, equity, and anti-bias efforts are not distractions from patient care, but core components of it—because we cannot provide excellent care unless it is also just.

The awakening we seek for our patients must mirror our own. Just as we strive to restore consciousness in the neurologically impaired, we must elevate consciousness in our profession. It means showing up—not just in scrubs, but in spirit. It means calling out what's wrong, standing up for what's right, and refusing to let comfort or complacency guide our practice.

Inclusion is who we are, but only if we actively choose it. So speak up, show up, and awaken fully. And most importantly, enroll in this vital work. The HEARD Center needs more than our approval—it needs our conscious action.