[ad_1]
The regions change from one color to another based on the 21 parameters developed by the Government’s scientific-technical committee. “My region has changed color despite the number of ICU admissions has increased”. Antonio Giarratano, President-designate of the Italian Society of Anesthesia, Resuscitation and Intensive Care and professor at the University of Palermo, is concerned with the maintenance of intensive care and ask the Cts take into account a “parameter 22”, essential to contain the evolution of the pandemic and the stability of the health system. But the specialist not only asks to consider the use of “fourth and fifth postgraduate degrees that have more than 5000 hours of activity” because “it means having in intensive care people with a competence not comparable to that of a recently graduated doctor or with different specialization and means fewer deaths“.
President Domenico Arcuri said, on November 16, that “There is no pressure on intensive care. We have about 10 thousand seats, we will reach 11,300 ”. Why do you think it is necessary to change the point of view?
Because having 11 thousand seats, assuming that they are all structural and therefore with all the parameters including safety and not just technology, and not having dedicated and specialized personnel means, although Arcuri I am convinced that it does so in good faith, feeding the false expectation of tightness. on the intensive care front of regional health systems. And perhaps persuade the policy to reopen considering an increase in intensive care hospitalizations.
It is essential that the intensive care system is maintained. Is there a “new” parameter that you would like to propose to the CTS?
We believe that in this pandemic phase the availability and resource of intensive and ordinary care beds dedicated to Covid must be integrated, if we want to have real data on the stability of regional health services, with that of dedicated and specialized personnel. If I have 12 resuscitation anesthetists in intensive care it is a certainty, if I have 5 resuscitation anesthetists and 7 free emergency professional contracts without specialization or with other specialties, I do not have the same capacity and quality of health. We want to call this parameter 22.
The National Agency for Regional Health Services (Agenas) has published the number of beds in intensive care, currently there are 8,802. But are these the real numbers? Do they correspond to individual intensive units with dedicated staff?
To the best of our knowledge and belief, this data is not combined with the data of the personnel dedicated by specialization and competence.
Can “intensive units” be declared available to the health system even if they do not have all the necessary parameters, including personnel?
In maxi emergencies and disaster medicine, personnel and structural technological parameters are exempt. In any case, the question, excuse me, is: do we want to repeal and reach a precisely “catastrophic” condition where the obvious medical care does not offer the same treatment possibilities?
To reach these 8,802 places, have other intensive units, dedicated for example to diseases such as stroke, been converted into intensive Covid? Intensive beds dedicated to ischemia and stroke are reduced to increase the availability of Covid places
Absolutely yes and this represents the greatest criticality. We count deaths from Covid but do not have a system to monitor deaths from other diseases that necessarily suffer a “slowdown” in their management. Among other things, in addition to the strong inheritance of increased mortality in the critical area, the risk is, once again, that complaints and disputes over alleged delays will then be directed to health personnel who are facing the Covid al same time in many situations. and the front not Covid.
Are there some regions that, in order to change color, may have provided beds in their intensive units that are different from those strictly adhered to the actual availability?
That is why clarity in the data is required. If you declare 2000 places, you must declare how many are structural and with dedicated specialized personnel and how many are additional in the operating rooms or in the ICUs (intensive care units) or in the medical sub-intensive and how many of these have dedicated specialized personnel. This is necessary in order not to distort, perhaps unconsciously, the real capacity of the health system.
What is the current perspective? While the contagion curve decreases, intensive care and deaths go in another direction, what should we expect?
Now the trend is known. First, infections increase, then emergency services are blocked and hospitalizations in ordinary and sub-intensive care increase, then intensive hospitalizations and then deaths increase. When the peak is reached, the decline occurs from infections but the peak of intense and deaths are the last to decrease. Therefore, we must hope that the reopens do not intercept, in a possible resurgence of contagion, the sub-intensive and intensive zones that are still full.
After Christmas, there will be other months in which it will be necessary to maintain high care and precautionary measures, what should be the health policies to avoid a third wave and repercussions in the intensive ones?
Without generalizing in Italy, let’s say that, partly even during the few Covid-free summer months, we haven’t done what it takes. The failure of territorial medicine, not because of its own fault but because of the system, the lack of updating of the laboratories, the monitoring system immediately went into crisis. If intensive therapies work, it is because the previous system did not work and that is why we believe that in this “hospital” phase, among the 21 parameters there are two, or rather three, if we consider 22, which are essential and are the ones that should clarify the real capacity in terms of beds and specialized personnel.
Do you want to add something that I have not asked you but consider important?
Yes. If we don’t use the time we have to correct mistakes, the third wave will be worse. On the personal, wanting to limit my competence to my sector, this national government in the last two years has done a lot to increase the number of scholarships for specialization in anesthesia and resuscitation and both have the regions, regardless of their political color. We will have the benefits in three years. Meanwhile, and this time my Sicily region is not the last, resorting to recruitment in accordance with the fourth and fifth year postgraduate universities that have more than 5000 hours of activity in the sector means having in intensive care figures of a competition incomparable to that of a newly qualified doctor or with a different specialization. It means, excuse the rawness, less dead.
[ad_2]
