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The Federation of Public Health Associations (Fedasap) was the first union to make the complaint. Almost at 23.00 yesterday, they published on Twitter that a 36-year-old patient who had arrived at the Hospital San José Emergency Department had died. “For not having the hospital with mechanical ventilators available”.
The fact was immediately disclosed and today, in the early hours, was the director of the hospital, Luis Escobar, who came out to deny the accusation: “That is not effective, there were mechanical fans available.” The same was commented by the Undersecretary of Assistance Networks, Arturo Zúñiga, during today’s report. When asked about this situation, Zúñiga said that he had contacted Escobar directly to ask for an explanation. “I spoke with the director of the hospital, Luis Escobar, and he informed me that the patient arrived in a very serious situation … We ruled out that there has been a lack of ventilators,” said the undersecretary.
However, the version delivered by Escobar differs from what the hospital officials themselves say. “Yesterday, a 36-year-old patient required to be intubated, he arrived with a major respiratory failure. That patient was awaiting an invasive mechanical ventilator. In the meantime, while waiting, the patient fell unemployed and an attempt was made to resuscitate for 30-35 minutes, but it was not enough. He finally died and the cause of the arrest was hypoxia, that is, due to lack of oxygen and lack of ventilatory support, “says the anesthesiologist and capitular of the Medical College of that establishment, Manuel Lorca.
Lorca’s version is backed by another doctor from the San José Hospital. This doctor, who asked for the protection of his identity for fear of reprisals, is categorical in his diagnosis: “The patients are effectively dying because there are no ventilators.”
This is the drama that the Hospital San José lives, one that you already have all your critical beds occupied and that it is the only one of high complexity of the North Metropolitan Health Service.
That in the winter campaign the Emergency of the San José Hospital collapses is not a novelty. It happens every year. For this reason, the workers at the compound still do not understand why the appropriate preventive measures were not taken, knowing that the pandemic was coming and that the forecasts of the Ministry of Health set the peak of infections for May. Whatever the reason, what was not done is already having its effects.
At the start of the pandemic, The hospital asked the Army for help to comply with the separation of the flows of patients arriving at the Emergency Department, so as not to mix the respiratory with the non-respiratory. This is how two field tents were installed in the ambulance yard. But that solution involved having a place only for basic outpatient care.
The same doctor who asks for his name is told that the situation is overwhelmed. Says the establishment He has come to have problems with the bodies of the deceased who have had to pile up because some families have been unable to remove them because they are in quarantine and that they are even planning to have a refrigerated container.
The wait in the ambulances —which can go from 30 minutes to 12 hours—, says the same professional, is due to the lack of space in the emergency room. The boxes are all occupied therefore patients cannot enter to be evaluated. This has caused them to be referred to the extra system per day, that is, to other hospital facilities, between 8 to 15 patients. Making each referral is a job that further increases the workload and makes the staff less. This involves introducing the patient, making a report, and transferring him to the ambulance. A doctor can spend between half an hour to 60 minutes alone in these tasks, while the emergency boxes are full of patients waiting to be seen.
One of the most serious points, say the same sources, is that the Emergency “It has no mechanical fan assigned.” Currently they only have two of these invasive machines that were “borrowed” by other hospital units. They also do not have transport fans.
The drama is lived daily and the weekend had a very specific example, the same one that was denounced by Fedasap on Sunday night. At 5:00 p.m. a patient arrived at the emergency room. As the Third PM was able to rebuild, this person entered “drowned”, so he was initially treated with a non-invasive ventilator while the team on duty tried to obtain an invasive mechanical ventilator. At that time there was one available, but the problem was that there were no circuits to install it and make it work.
Circuits are the ventilator devices that connect to the patient tube. It is a kind of hose. That input, basic to make it work, was not available. The complex thing about these machines is that the circuits are not universal and are not sterilizable, that is, when used, they are discarded. The health personnel who were at that time searched for two hours for a circuit to install the ventilator, which they were only able to do around 7:00 p.m. However, the patient was waiting all that time and was not able to tolerate the non-invasive ventilator. As soon as the circuit arrived, he proceeded to perform the intubation, but at that point he was already exhausted, in a serious condition and ended up dying of cardiorespiratory arrest. “If there are no supplies for the ventilator, there is no ventilator,” says the same hospital source..
The description of the events fits, in part, with the communiqué published by the venue to explain this situation: “The patient was admitted on Sunday, May 10, around 5:00 p.m., with severe respiratory failure, he is directed directly to the resuscitation room, it was possible to partially compensate where he was hospitalized with a diagnosis of suspected Covid-19 medical medication, remaining under mechanical ventilation. Despite the efforts and the resuscitation maneuvers, the patient suffered a cardiorespiratory arrest, after which he died. It should be emphasized that it is not effective that invasive mechanical ventilation equipment was not available at the time of patient care. “
The reality of emergency boxes is very precarious. None of these spaces has negative pressure. That is what allows to completely isolate a patient with Covid-19 since it implies having a mechanism that extracts the air, purifies it and takes it outside. How do they do the isolation? “We can only close the door of the box,” says the same doctor. In recent weeks, patients have died waiting in the box. This has happened at least twice.
Urgent consultations doubled last week. The two tents are receiving between 150 and 270 patients daily. Several of them for PCR sampling. Others, who meet severity criteria, must be transferred to the central emergency, which is also collapsed. This sector receives, daily, about 300 patients, almost all for respiratory problems.
There the clogging occurs. The Army tents until a few weeks ago had no oxygen, which could be recently enabled. But it was not enough. On Saturday, for example, the tents ran out of oxygen for about two hours. Those on duty had to look everywhere for a spare, until they could install a large ball to recharge.
“The anguish is felt, we no longer give more. We don’t even have time to go to the bathroom because of the level of collapse we’re having. To see patients die knowing that we have the knowledge to give them treatment, but we cannot because we lack supplies is something, really, very distressing ”, says the same hospital doctor.
The situation is reaching its limit. Ho And early an emergency meeting was called to address the contingency for the death of the 36-year-old patient. At the meeting, called by the director, the main staff of the compound, the department heads, the coordinating nurses and the administrative staff who see the supplies part were present. At that appointment, according to what this medium could know, the responsibility for the death was transferred to the emergency unit, something that was not well received by the doctors. In fact, the director has reiterated on several occasions that the Emergency Department should not have invasive ventilators because it should not have hospitalized patients. Something that, they say, works well in theory, but has no basis in reality.
After the meeting, it was commented that within a week they will increase the intensive beds and that they will bring more mechanical fans, but without giving details of how many, on what date, nor indicating which unit they will be assigned to.
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