Each patient has the right to immediate he althcare services in the event of a threat to his life or he alth. When to go to the hospital emergency department (AED), and in what situations to use night and holiday he alth care (NEST)? The answers to these questions are provided by Artur Fałek, a doctor and expert from the Rafał Piotr Janiszewski Advisory Office.
Anna Tłustochowicz: When to visit the HED, and when to night and holiday he alth care? This is a dilemma for many patients.
Artur Fałek:It's true. Here we are dealing with a subjective perception of the severity of the disease that is difficult to resolve. Both the emergency department and the ambulance service should be used forsudden and serious eventsthat may have serious consequences for life and he alth, and I am fully aware that without medical preparation, a person very often does not is able to decide whether what she feels is a state of emergency.
Maybe we can explain what exactly means a state of sudden he alth emergency?
A state of sudden he alth threat, it is a condition consisting insudden or anticipated in a short time symptoms of deterioration of he alth , the direct consequence of which may be serious damage to the body's functions or damage to the body, or loss of life. It's a condition that requires immediate medical rescue and treatment.
Yes, but how is the patient to know what the consequences of what he or she is feeling at a given moment may be? We cannot predict the future!
Of course. People generally do not have this knowledge, therefore, I said, they rely on subjective feeling. First of all,we all need to know and remember how our he althcare system is organized . I believe that such knowledge should be provided to children in primary school. We hear from time to time about heroic children who called an ambulance to their mother, father or grandparents, and sometimes they even conducted life support themselves until the ambulance arrived, thus saving lives. Knowing how to behave, most likely learned from school or extracurricular activities,devoted to giving first aid. And that should be commonplace. Children aged few and over should be explained what our system looks like. I saw a few videos on the Internet, listened to songs that talk about emergency services and ambulance service. Also in this way, it is worth passing this knowledge to children.
But let's stick with the adults who don't necessarily have it.
We all need to figure out some things! After all, we choose a family doctor, right? Choosing it, it would be a good idea to determine where to get help when the clinic is closed.Because, as we all know, the family doctor works on weekdays. However, on Saturdays, Sundays and public holidays - no.And now, because our primary care physician, as the name suggests, is a primary care physician, we should find out where we can go when the clinic is closed. This information is available in our clinic!
Hanging in the display case.
Yes, she is available in a prominent place. You can of course ask about it at registration and write down the address and telephone number for night and holiday he alth care.
I have the feeling that many patients are not fully aware that something like night and holiday he alth care (NICC) exists at all and that if the clinic is closed, even with a tick stuck in in the buttock, we go straight to the Emergency Room.
There used to be a sticker in every workplace with emergency numbers on it! And despite the fact that, in theory, all adult people knew that 997 is the police, they still kept this knowledge on entering and leaving work. It is the same now with night and holiday protection!
Every adult should have an address and telephone number for this place!
It is not really difficult, especially sincein 2022 we had a reform: night and holiday he alth care was included in the basic he alth care system based on hospitals . This reform simplified the system and it is now known that if there is a hospital in the poviat, there is also a NICP. Of course, such information can also be found on the Internet, e.g. on the websites of the National He alth Fund.
But let me come back to the question: is it the lack of knowledge that causes patients frightened by the stuck tick to go to the Emergency Room?
For sure. We return to the basic problem: the patient's uncertainty about how he should behave in the system. This is what causes the misuse of this system. And please note that this works both ways:we don't know where to apply,so we use SORexcessively or we call an ambulance too often, but also for the same reason. We do not know where to report, so we do not report at all.
Oh right! And it can be very dangerous.
Therefore, if we believe that the disease is serious, if this is our subjective feeling, then let's go to an emergency room, or call an ambulance. Let's not be afraid of it! If we are so weakened, if we are in such pain, this is what the ambulance service is for, so that the medical emergency team comes to us when we cannot move ourselves. We have made this system quite sensibly! Over 25 years ago I myself drove in the emergency …
Hard work, right?
Hard and tough work were the conditions back then! I drove large Fiats and Polonaises, on which ambulances were created. It was impossible to even connect the drip there, because the difference in levels was so small that there was no flow. And now? Today, taking into account vehicles, equipment, appliances and apparatus, there aresmall treatment rooms and small resuscitation roomsto patients. Such an operating room should definitely not go to the aforementioned tick, which needs to be pulled out of someone's buttock. But what if a person suffers from coronary heart disease and suddenly feels severe pains? She can expect, for example, a heart attack or other disease consequences that are a threat to her he alth and life. In such a situation, there is nothing to hesitate and hesitate, but you have to call an ambulance.
Remember that we will be able totalk to the dispatcher , which is the first line of verification. He will arrange for us an ambulance or even a helicopter. We even have ambulances floating in Masuria!
As I said,the equipment of this system is really decent today.Probably more could be done in terms of the number of ambulances that run in the system, but it is known that you can spend any money, but here you have to calculate so that the system is rationally built.
Speaking of calling an ambulance, some patients may be afraid: "If I call her and it turns out that there was no need, they will charge me again!"
There were such ideas once, actually. It was said and written about it, and something like that could break through to the patients' consciousness, but I deny it. Definitely not! None of the politicians decided to introduce such a solution precisely because the patient does not have the knowledge and competence to accurately assess his he alth condition.
I will repeat again: thissubjective feeling by the patient,based onhis knowledge, his he alth condition, decides whether he will go to night and holiday he alth care or call an ambulance.
Will he report to the Emergency Room?
Yes, but I think it would be necessary to increase the involvement in explaining to the public how hospital emergency departments operate. Well,HEDs are specialized hospital departments that provide services to patients who are in a state of sudden he alth and life threat,who conduct diagnostics and start treatment of patients and are ready to do it in the shortest possible time. time. For SOR to be effective, in military terms, it must have the strength and resources. Whatever his strength and means may be, they may not be enough when a wave of patients suddenly arrives at the HED. This is why a patient evaluation is performed there.
Triage.
Medical segregation, which sounds threatening, and consists in determining the order of providing he alth care services at the HED. A similar system works in the emergency medical system! The general rule is, of course, thatpeople who require immediate assistance will receive this help earlierthan those who, in the opinion of medical professionals, do not require such assistance. In my opinion, this is where the situations arise where patients are indignant that they have waited a long time for help at the Emergency Room …
After a few hours, for example …
It happens, the only fundamental question is: what does it result from? If they came forward with a case that was not as urgent as those reported by other patients, they waited longer. This is normal.This is how this system is constructed. It is based on a five-point scale :a patient marked with a red card must be immediately seen by a doctor. Orange means up to 10 minutes, yellow up to 60 minutes, green up to 120 minutes and blue up to 240 minutes.First contact with your doctor! Patients marked in green and blue may be redirected to other clinics.
Just for night and holiday he alth care?
Often yes. 240 minutes of waiting for the first contact with the doctor …
That's four hours!
Four hours, sir. This means that, in the opinion of a professional medical worker, because it is either a doctor, nurse or paramedic, assigns patients to specific categories - the patient's he alth condition does not require immediate assistance. So to put it bluntly: this patient does not necessarily have to be admitted to the HED. Of course, services are provided at SORalso to those patients who are classified as green and blue. And let's remember that the assessment of patients' he alth is repeated there every 90 minutes.
So it is checked whether the condition has worsened, whether someone does not have to be admitted earlier than originally determined. However, returning to the essence, it is all a matter of our knowledge about the structure of the system, our responsibility and the ability to use this system …
Let's try to solve our he alth problems with our primary care physician, andwhen we suddenly fall ill and the disease is not so serious that it threatens our lives, let's seek help in night and holiday he alth care.There are also travel teams there!
If the patient's mobility is severely restricted, they can report it and the team should reach them.
So an ambulance?
Yes, but not on tone. Normally, an ambulance with a doctor goes to the patient and a home visit takes place.
Let's try to systematize it a bit. The doctor has already said - with a heart attack, of course, we call an ambulance (EMS team), of course also with a stroke. What about a broken leg?
Emergency Department, if the fracture has been treated and we have such a possibility, andif the person is unable to move, even an ambulance should be called , which will come and stabilize the limb so that the fracture did not move and did not cause any major tissue damage. One must have an idea of such treatment for a broken leg. In the past, children were taught such things in defense training. The students were able to put on bandages or just immobilize a limb. If we have a close person who can do it and immobilize the broken limb, then you can take the patient to the emergency department with your own means of transport.
But definitely at SOR?
Yes. A broken leg must be provided. Of course, not every fracture is a life-threatening condition, so if there are such patients at the HED, the patient with a broken leg will wait longer. It all depends on what is happening at the given SOR.
Okay, what about pulling the tick out? We will go to night and holiday he alth care for help in this matter?
Yes. And even if the patient goes to the HED, thenremember that HEDs and night care cooperate with each other, communicate , so if the HED is overloaded, the green and blue patients will be redirected by the staff anyway right over there. It will often be in the same hospital. Sometimes it is just a matter of another entrance, sometimes the HED and night care,they are next door, and sometimes not.
At the end, I want to mention modest people, either afraid of the doctor, or professing the principle: "My father always healed himself, so I do the same."
This is what I was talking about! Thatwe need to build awareness of our own he alth in society.I know stories such as "my grandfather lived 100 years and he did not see a doctor with his eyes, so I do not go to a doctor". It is building a model of your behavior based on casuistry. If grandpa was 100 years old and he did not see a doctor, it was a phenomenon.There are definitely not many such cases.Remember that at the beginning of the 20th century, the average life was just over 40 years! The development of medicine has made people live longer today, but the consequence are chronic diseases and a greater number of cancers in terms of civilization. People are exposed longer to get sick.
Therefore, in order to maintain a decent level of he alth, we needremedial medicine . This is what the system for maintaining he alth is for.
I am not talking about prevention, because it is a large, separate topic, but about family doctors and night and holiday he alth care and ambulances. We have helicopters, hovercraft, boats and even motorbikes with paramedics, and we have SORs that have heliports! It is all linked in thesystem of securing the he alth needs of the populationand you need to be aware of the existence of this system and, more or less, also be aware of how to use this system. Nobody expects a citizen to be an expert on his he alth!It is medical professionals who will decide when we need to receive help.We should have a general knowledge of where to report with which he alth problem. I hope this interview will provide some clue.
Certainly yes!
Expert
Dr. Artur Fałek, doctor
He is an expert of the Rafał Piotr Janiszewski Consulting Office in the field of the organization and operation of the he alth care system, the operation of state administration, legislation in the field of he alth care, and an expert in the field of reimbursement and drug management. He worked in the Ministry of He alth as the Director of the Department of Drug Policy and Pharmacy (2007-2015), previously as the Deputy Director (2007), in the National He alth Fund Headquarters as the Director of the Drug Management Department.
From 2005 he was a member and from November 2007 the Chairman of the Drug Management Team. He is the author, co-author of many organizational solutions and legislation in the field of pharmacy and drugs, he has actedthe function of a Za-cy Member of the Management Board at the European Medicines Agency; Senior Project Officer in the "Transparency of the National He alth System Drug Reimbursement Decisions" project (2007-2008); was a representative of Poland in the work of working groups at the European level.
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