Italy, position paper on Covid-19 and emergency: "rethinking the out-of-hospital emergency system

In Italy the Covid-19 pandemic has pushed emergency departments and intensive care units to the limit, and with them the whole world of ambulance transport.

Rethinking the out-of-hospital emergency system is now a priority in Italy: the proposals made by Siaarti, Aaroi-Emac and Cpar have been set out in a position paper.

The Position Paper ‘The Non-Hospital Emergency Health Care System’, a document developed by the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), the Association of Italian Hospital Anaesthetists and Resuscitators – Critical Area Emergency (AAROI-EMAC) and the College of Anaesthesia and Resuscitation Professors (CPAR), was published today.

Position Paper ‘The Non-Hospital Emergency Health Care System’: the presentation

The document was drafted and signed by Flavia Petrini (SIAARTI President), Alessandro Vergallo (AAROI-EMAC President), Paolo Pelosi (CPAR President), Emiliano Cingolani (SIAARTI Head of Critical Care Emergency Medicine).

The Position Paper starts from the consideration that “thirty years after the establishment of the 118 emergency number as a single number for health emergency calls and the decree establishing the territorial response, a reorganisation of the system is necessary, taking into account the changes that have taken place in this period and the progress recorded in the scientific-professional field”.

The reorganisation, the document specifies, must take into account the fact that “the Italian situation is not homogeneous with regard to the development and implementation of organisational models that really ensure a system response with full integration with the hospital emergency and intensive care networks”.

The rethinking of the out-of-hospital emergency health care system must be guided by minimum standards based on the principles of: appropriateness and managerial and clinical-assistance innovation; timeliness of the emergency response in the territory and in the hospital; equity of organisation and emergency response throughout the country, based on the clinical needs of the patient; efficiency and optimisation in the use of available resources.

Given these premises, the Position Paper presents some clear and synthetic proposals:

1 – Definition and launch of a unitary GOVERNANCE of the emergency-urgency system;

2 – Involvement of healthcare and technical personnel in the planning of the organisational MODEL and its management;

3 – Definition and launch of a new organisational model based on appropriate COMPETENCES and on the rejection of occasionality;

4 – Adequate TRAINING and specific training in the area of critical emergency medicine;

5 – Specific training courses for NURSEs, given their fundamental role (both in the 118-112 Operations Centre and on emergency vehicles);

6 – Integrated training courses and “team building” with the involvement of technical SUPPORT figures (drivers, rescuers, driver-rescue workers).

The heart of the position paper? “trying to rebuild the 118-112 system”.

We believe that, after so many years, it is appropriate to try to rebuild the 118-112 system,” states Flavia Petrini (SIAARTI), “by finally integrating it completely with the hospital Emergency and Intensive Care networks.

To date, we continue to record a profound structural inhomogeneity, which increases the difficulty of providing coordinated and efficient responses to emergencies throughout the country, even in the case of maxi-emergencies – as the current pandemic demonstrates – which require close cooperation between the various territorial systems differently organised in the different Regions and Autonomous Provinces.

Today’s document is therefore an important reference text proposed by those with the greatest expertise in the sector.

We would like to hand it over to the institutions, decision-makers and the National Health Service as a concrete stimulus for change: it is no longer possible, and indeed dangerous for citizens, to wait any longer to achieve this renewal”.

Alessandro Vergallo (AAROI-EMAC) explains: “The need to express this Position Paper arises from the desire to collaborate with all the interested parties so that SET118 can finally be reformed on the basis of certain fundamental concepts: the Service has nothing to do with Family Medicine, whereas in too many Regions it is carried out ‘in agreement’ through a special sector of the ACN of General Medicine; it is a System that was created to be ‘pre-hospital’, as it is intended to manage emergencies and emergencies ‘by bringing the Hospital, understood as technologies and medical and nursing skills, to the home’; It is not a Service where ‘one Doctor is worth another’, nor where an expert nurse with expertise in the hospital emergency and resuscitation sectors is worth less than a doctor without specific expertise and experience, and therefore it is a Service in which Advanced Rescue must be entrusted first and foremost to Doctors and Nurses trained in hospital emergency and resuscitation”.

The position paper focuses on an urgent need: that of putting continuous, quality training back at the centre

“The great importance given in this Position Paper to training aspects shows how urgent it is to respond to the need for continuous, quality training – stresses Paolo Pelosi (CPAR) – at the various institutional levels, starting with degree courses, specialisation schools and theoretical and practical refresher courses for specialist medical managers.

This training process must also pay increasing attention to the nursing and healthcare personnel, as well as to the technical personnel involved at various levels and functions in the emergency system, in order to allow a high level of competence to be maintained”.

The Position Paper ends by launching an appeal for all those involved in the system to accept the Document and to start a reform programme “that brings together Scientific Societies, Professional Organisations and Trade Unions pertaining to the Discipline of Anaesthesia, Resuscitation, Intensive Care and Pain, “as a fundamental element for the improvement of the response to the territorial emergency and for professional, didactic and scientific growth with a close interdisciplinary and multi-professional relationship”.

On this basis, SIAARTI, AAROI-EMAC and CPAR are convinced that it is possible to develop a serious reflection and reorganisation of the overall system, to the benefit of Italian citizens and their daily health needs.

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