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“In the absence of these critical resources, we are forced to operate options relative to the possibility of access to care, which are neither clinically nor ethically tolerable. Against our will and, above all, against our human and professional conscience ”. It is a passage from the letter that about fifty between emergency physicians and rescuers of hospitals San carlo me Saint Paul from Milan they gave them health management. Ilfattoquotidiano.it you could read this cry for help that seems to come from blackest page of the pandemic, while the president of the Fontana Region assures that the “peak” of infections has been reached, prophesies the decline, speaks of Christmas and asks that Lombardy “return to the orange zone” as soon as possible.
Among the hospitals that suffer in Milan are also the Saint Paul me Carlo. Emergency rooms, brought together under a single ASST, in recent weeks have been among the most overcrowded in the city, with access peaks of 130 covid patients per day compared to 350 places busy covids. Since February, the management has taken over 22 medici for the emergency and increased the number of nurses by 17 units, but evidently, they were not enough to avoid the collapse that is also witness to the Photo of patients (taken last week) who are stationed in waiting rooms turned into makeshift examination rooms because the fixed ones were full.
From the point of view of those who work in the trenches, the situation has not changed, despite the fact that access to emergency rooms has decreased in recent days. So much so that, they write to the doctors and rescuers who signed the letter, “we are forced to delay access to therapies and potentially curative techniques (orotracheal intubation and non-invasive ventilation) and not being able to treat promptly, with adequate assistance and in a suitable environment, all the patients who could benefit from them ”.
The letter goes straight to the point. “Dear directors, we are professionals committed to managing the Covid emergency (an expected and expected emergency and that, however, sees our structure largely unprepared), we write to express our major concern because of the situation that has arisen at the hospital and our firm disagreement with a policy that prevents us from exercising our profession in science and consciousness, mainly due to the lack of technical and human resources indispensable in the situation in which we find ourselves operating ”.
The rescuers refer “first to the dramatic, and sadly well known, shortage of beds, not only in intensive care, but also in rand ordinary hospital rooms and in departments with the possibility of surveillance, where admitting patients who are candidates for sub-intensive treatments, essential for the care of the majority of Covid patients ”. An emergency that does not actually arise with the Coronavirus. “By providing appropriate technical implementations and the presence of an adequate number of Professionals, trained according to internationally valid and recognized standards, many patients suffering from Covid pneumonia, especially those who are not eligible for intensive care, could be duly treated also in areas of medical hospitalization, as happens in many other hospitals ”.
The reference is forinsufficient staff doctor, nurse and auxiliary, “especially in the critical area, not even remotely occupied by ad hoc hired personnel, introduced in highly specialized departments with an increasingly hasty and summary training”. And it was, according to the complaint, a “very serious shortage known long before the pandemic.”
Here is the most dramatic passage in the text: “Unfortunately, in the absence of these critical resources, we are forced to make decisions regarding the possibility of accessing treatments, which are not well clinically none ethically tolerable. Against our will and, above all, against our human and professional conscience, we are forced to delay access to potentially curative therapies and techniques (orotracheal intubation and non-invasive ventilation) and not be able to treat promptly, adequately and in the environment. . appropriate for all patients who could benefit from it. “
The accusation to the health management is direct. “Of these” options “, even if dictated myopic superior political decisions, we feel the weight; of these moral responsibilities, again, we feel the weight. Choices of those who could have decided, and did not do so in time, is more, with due anticipation, reorganize, attract more trained personnel, open more monitored beds for patients with covid “.
With much effort, continues the complaint, “we try, however, to offer the best treatments to all our patients, whatever their severity, attending to the largest possible number of patients in the emergency room for many days, until we can offer their a bed. And even when we cannot heal, we seek energy and resources to ensure relief and dignity in the final stages of the disease, both in the wards and on the stretchers of the PS “.
The white coats feel “abandoned in the care of our sick and we do not perceive a radical position in its favor, nor any protection against us on the part of the top management. That is why they ask “more attention to need for urgent hospitalization dand critically ill patients and greater protection if we are forced to Make decisions dictated by conditions that transcend the care of the patients themselves.. We also call for an urgent and substantial implementation of emergency personnel and critical area departments, who have been working under constant conditions for too long. overload, further aggravated by the current emergency.
Finally, we request greater attention to the care and hospitalization needs of all the patients we accompany in the final stages of the disease and who have the right to receive even more diligent and dignified assistance in the end of life “.
The last hope: “We hope this letter receives the Due attention and mobilize an in-hospital emergency system that is collapsing And that is causing serious repercussions for patients and operators. For our part, we are not willing to make up for the technical and personnel deficiencies that have been known for a long time and that we have denounced. Each choice dictated not by clinical needs, but by the deficiencies of the system (lack of beds, lack of assistance, lack of patient care due to lack of personnel), and which therefore opposes our will to always operate according to the science and consciousness will not be endorsed in any way. “
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