The criteria for admitting patients to trauma centers under the ordinance already signed by the Minister of Health will prevent a large group of patients from qualifying for treatment in the centers until it is too late, doctors believe.
This is one of the concerns raised during the Thursday meeting of specialists from thirteen Polish hospitals, in which, in accordance with the amendment to the act on emergency medical services of July 2009, the so-called trauma centers. A meeting during which, among others, on the financing of medical procedures performed in centers, was held in Sosnowiec.
The talks also focused on the ordinance on trauma centers signed in recent days by Minister of Health Ewa Kopacz, which has already been published and will come into force two weeks after its publication. Doctors said that there were shortcomings in the document, they were also planning to establish a National Association of Employers of Injury Centers.
Head of the Hospital Emergency Department at St. Barbara in Sosnowiec, Dr. Czarosław Kijonka warned, inter alia, that the criteria for admission to trauma centers included in the ordinance would prevent patients in serious condition, although conscious and with circulatory and respiratory efficiency, not being eligible for treatment there.
Will only patients in shock, respiratory distress and unconscious be qualified for the trauma center? () The entire group of salvageable multiple organ injuries, multiple organ trauma, multi-site and severe isolated trauma, will not be eligible for treatment at the center until it is too late. We are very afraid of it, the more that we have such sick people today and it happens that they die – he pointed out.
Kijonka assessed that the criterion of treatment in a trauma center should be the serious mechanism of the patient’s trauma as a factor predisposing to multiple injuries, not only his clinical condition. Quick delivery of the emergency medical team to the scene of the accident may result in a good condition of the patient soon after the accident and a critical condition an hour later – explained the expert.
The head of the hospital emergency department in Sosnowiec also added that the definition of the so-called a traumatic patient does not cover all the cases in which the patient should be admitted to a trauma center.
The statutory definition cited by the head of the clinic indicates that a traumatized patient is a person in a state of sudden health threat caused by an external factor, resulting in severe, multiple or multi-organ injuries.
According to Kijonka, the trauma center should also go to, among others, a patient with severe isolated injuries, i.e. injuries affecting one organ, e.g. a ruptured liver, a broken pelvis or a severe craniocerebral trauma, despite the fact that he will be circulatory, respiratory and conscious.
Referring to the staffing requirements in trauma centers and pointing to the shortage of emergency medicine specialists, Dr. Kijonka suggested that doctors should be able to enter it after two years of this specialization – who already specialize in the main areas of surgery. In our opinion, a good solution is to build a + trauma team + center based on hospital emergency department doctors – he pointed out.
Dr. Kijonka also asked who would cover the costs of treatment in the centers of uninsured patients – pointing out that his emergency department in Sosnowiec, due to underestimated NHF valuations, generates a significant debt for the hospital.
Silesian voivodeship general surgery consultant prof. Jacek Starzewski, who presented solutions for similar trauma centers in the United States, assessed, inter alia, that the new ordinance of the Ministry of Health on trauma centers gives hope for an improvement in the situation, despite the already visible shortcomings in its content.
Provincial emergency medicine consultant from the province Lesser Poland prof. Leszek Brongel said on Thursday that currently only three out of thirteen selected hospitals meet the criteria for the functioning of trauma centers. He emphasized that hospitals that decided to open the centers made a commitment to treat patients with severe injuries, not being sure that they would be paid for it.
Brongel also assessed that these hospitals probably rightly set up an employers’ union to defend themselves against the fatal consequences that the opening of the centers may have on them. He pointed out that hospital emergency departments often treat regrown nails, while the National Health Fund punishes for sending patients away – hence the strict criteria for admitting patients to trauma centers.
The representatives of the health ministry present in Sosnowiec on Thursday signaled that the doctors’ comments were valuable, while the regulations on trauma centers – the first regarding this matter – could be changed or supplemented. The ministry also praises the plans to establish a union of employers of centers as a body that can provide valuable opinions. (PAP)