The wave of Covid and flu, in the last month, has sent emergency rooms into a tailspin, with thousands of patients waiting and queues of ambulances outside throughout Italy. “The 118 systems are strangled by the now permanent functional amputation of the ambulances, in some cases up to 60% or more of the fleets, which remain queued up for hours and hours on the emergency room ramps. The ambulances are used as 'temporary beds', waiting for hospital admission”. Mario Balzanelli, national president of Sis118, reports this to Adnkronos Salute. “We risk moving from a barellopoli to a barellandia, with ever greater inconvenience and an increase in costs. Yet the remedies are there, they must be implemented.”
In the meantime, a misunderstanding must be cleared away. “It almost seems that the blame for the hyper-influx of calls to 118 and the overcrowding of emergency rooms lies with the citizen. This assumption is, in the vast majority of cases, absolutely inappropriate as well as, essentially, unacceptable”, states Balzanelli. “Those who access the 'two doors' of the emergency system, 118 and emergency room, feel ill, subjectively perceive an acute health problem which alarms them and asks for help. According to those who call the 118 operations centers or those who spontaneously goes to the emergency room, in most cases it is found that everyone is convinced that they have an urgent need to be visited and treated. It is the so-called 'perceived urgency', but – notes Balzanelli – it is not the citizen's task to discriminate between emergencies , emergencies or situations that do not deserve immediate attention because they are not life-threatening at that moment. It is certainly not up to the citizen to make a diagnosis – he points out – while it is certainly up to the citizen, who pays taxes, to demand an effective response from 'health system' for any type of acute problem that suddenly arises”.
In the absence of answers, you end up in the emergency room. For Balzanelli, “at least 85% of the subjects who overcrowd the emergency room on a daily basis must be managed elsewhere, in the context of local medicine, because they suffer from minor acute conditions. It is absurd to expect such an inappropriate amount of performance from colleagues in the emergency room, and moreover exponentially worsening”. To avoid system paralysis, the problem must be resolved upstream. “The 118 first aid points must be reactivated and strengthened where they still exist, such as in Puglia”, is the solution proposed by Balzanelli.
“The multitude of patients with minor acute conditions must be identified upstream, with expert telephone triage carried out by the 118 Operations Centre, which can correctly direct them – he explains – to receive a rapid and appropriate response to their health needs. Among the tasks that the legislator entrusts to the 118 operations center, there is to direct the patient to the 'territorial first aid' points (First intervention points), i.e. the fixed medicalised and nursed stations of the 118 territorial emergency system”.
Data in hand, continues Balzanelli, “these intermediate decompression structures for minor acute cases are able to reduce waiting times and therefore ensure a quick evaluation of the patient, guaranteeing an expert evaluation by the doctors and nurses of 118, but also to administer emergency-urgent therapies, carry out instrumental tests (electrocardiogram) and laboratory tests (blood gas analysis, fundamental blood chemical parameters of primary necessity in emergency-urgency), essential for an initial classification of the patient”. They therefore function as a filter “avoiding that 97% of improper access to the emergency room”.
“These first aid points, which Ministerial Decree 70 sanctioned to be converted into 118 medicalized stations, deserve to be urgently reopened as 'fixed' medicalized stations of the 118 System – he concludes – or, where they have not been closed as in Puglia, to be strengthened in terms of space and equipment. This is the only way to facilitate an immediate and drastic change in the congestion, now close to functional paralysis, of the emergency rooms and 118 systems”.
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