The chaos of the emergency room has broken out in recent days with a roar that is causing talk of an “emergency case” in Italy. Chaos started from the Cardarelli hospital in Naples, in which the stretchers with the sick, crowded about 30 centimeters from each other, made the relatives scream scandal first. But there is not only Naples. There is also Bologna, where the gateway to healthcare remains a sore point: every day there are reports of patients who wait hours and hours before being examined. “Here the problem – explain the leaders of health in Emilia Romagna – the long waiting times depend mainly on the lack of doctors who work in the emergency-urgency sector and on the consistent number of accesses to the emergency room now close to pre-Covid times .
And then there is Milan, with its emergency rooms hit by a cyber attack on the night of May 1st. This has generated a critical situation that is heavily reverberating on other hospitals: from May 1st, ambulances were forbidden to enter the emergency centers of Sacco, Fatebenefratelli, Macedonio Melloni and Buzzi, except in cases in which patients could not be diverted elsewhere for particular needs.
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Six hundred resigning emergency doctors
It is precisely from the doctors that one must start to understand the malaise of the Italian emergency rooms. Because about 600 emergency and urgent white coats have chosen to resign in 2022, at the rate of about 100 per month. We start with a figure: 4,200, a calculation referring to the last months of last year, which indicates structurally missing doctors in the Italian emergency rooms compared to the real management needs.
“The sum of the factors has implemented the estimated value of the deficiencies bringing it ever closer to 5000 units – explains Simeu (Italian Society of Emergency-Urgency Medicine), of which Dr. Fabio De Iaco -. An increasingly serious problem that continues to not find proportionate attention and interest. A lack of interest that greatly affects the choices of professionals with respect to their own future: if those who leave were grouped into operational teams they would correspond to 4/5 rescue centers that would no longer exist. Canceled, disappeared “.
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A doctor ready to leave in 9 out of 10 facilities
In addition, in 9 out of 10 facilities, at least one doctor expresses an intention to drop out within a year. “We are witnessing the extinction of the emergency rooms – continues Simeu -. The criticality linked to the workforce is amplified by the workload caused by” boarding “, the phenomenon of prolonged stay of patients and overcrowding of stretchers in the department (caused by inability of the wards to welcome the sick due to lack of beds) which alone absorb the time and energy of the professionals, removed from the management of emergencies “.
45% of the Italian emergency rooms are suffering
The reference goes to the case, defined as “extreme” by Simeu, of the Cardarelli hospital, “a dramatic example, but according to the company’s recent estimates, 45% of the Italian operating structures suffer from it”. The Simeu National Congress “Navigating towards the future, aware of one’s past”, organized at the Palacongressi in Riccione from 13 to 15 May, starts from these heavy premises. There will be at least 1,000 professionals: doctors and nurses, but also many young trainees who, despite everything, choose this discipline as uncomfortable as it is fascinating out of passion.
But, going beyond the current problems, the premises will also be laid down to be able to continue looking to the future, instilling confidence in young professionals. “Francesca Mangiatordi will do it, the doctor known for being the author of the symbol photo taken during the first pandemic wave (portrays Elena, nurse, who sleeps exhausted on the computer keyboard at the end of the shift) – underline the organizers -. Mangiatordi will highlight the good reasons for continuing to resist and fight to defend the emergency room from the risk of extinction “.
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“There is a disproportion between health demand and available resources”
The disproportion between healthcare demand and available resources is increasingly evident to De Iaco. What he says: “We hope to be helped by our patients in this fight for the survival of the emergency rooms. Citizens and operators are on the same front of the battle.” And he adds: “A few years ago, in France, a better situation than our current one gave rise to a resounding strike in the emergency room, an option that we do not want and cannot consider. We are already in mass resignation: what else must we do to urge and obtain the necessary actions? How long is it expected that we will still be able to resist on our own strength? “.
“A question of dignity”
For De Iaco it is above all “a question of dignity”. “The problem of the shortage of staff is the most evident – he reiterates -. But the aspect of waiting for a hospitalization in the emergency room is the main element of disaffection with this job. We have become all-round doctors, called to do everything. We also have to manage patients for whom we have no skills. All this is unbearable. At the base of everything we have a moral injury: we continue to do to patients what we do not think is right. And this is very heavy after years “.
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Salaries under accusation
And then there is the economic aspect, which leads De Iaco to this consideration: “We earn less than other hospital doctors; we work at night for 50 euros”. And even with regard to the new specialists, who are also very well prepared, a great unknown remains. It is always the president who speaks: “They would like to carry out both the post of hospital doctor in the emergency room and the pre-hospital one of 118. This would be the only system capable of making things work, but in most Italian regions it is not possible because the two systems are separate “.
“Double the staff needed”
“We have staff that on average are around 9-10 doctors; it would take at least a third, if not double more – concludes De Iaco -. Just make a calculation to realize it: the average number of patients who refer to a doctor in the Medicine department is 10. We, on the other hand, have 25-30, all unknown, often critically ill and in an embarrassing social and human condition. Don’t you think it’s time to intervene? “.