Igor Parfenov: How algorithms for providing emergency assistance will change in the capital
Igor Pavlovich, I have no doubt that even now you are trying to provide assistance to every patient delivered by ambulance to your hospital as quickly and efficiently as possible. Why did you have to prescribe new work algorithms to work in a new hospital, which will soon appear in your country?
Igor Parfenov:First, about the terms. Algorithms in the provision of emergency medical care are a sequence of actions, not only for doctors, but also for nurses and all other employees involved in saving the patient. In the form in which they will operate in the new complexes, it could not be before. In the old buildings, a corridor system was provided in the reception department. A patient, say, with internal bleeding, in order to determine the cause of its occurrence, must first be taken to the surgeon's office, then for an ultrasound, then for an ECG, a blood test, etc. But this is a life-threatening situation, when every minute is precious! In recent years, in order not to roll patients from office to office, we have introduced elements of the modern "doctor to patient" system. But immediately send all those in need of urgent assistance to the "red zone", equipped with the necessary equipment, a patient of moderate severity - to the "yellow zone", and a light patient - to the "green" is not yet possible. The fact is that MRI and CT, for example, are historically located in one wing, and the operating unit is in another. The new ambulance building has a completely different medical logistics. From the ambulance, the patient is immediately transported to the right direction, where there is everything both for a quick diagnosis and for emergency care.
What does this change in the actions of doctors?
Igor Parfenov: Let's go back to our patient with internal bleeding. To determine its cause and intensity, it is necessary that the patient be examined by a surgeon and a therapist, perform an endoscopy, do an ECG, take laboratory tests ... In the "red zone", where such patients will fall in the emergency complex, all this can really be done simultaneously. The patient on the diagnostic bed will be examined by specialists and the necessary studies will be carried out immediately. Need an x-ray? It will be done using a mobile x-ray machine. If necessary, the patient will immediately be connected to artificial lung ventilation, put on a drip with a set of drugs necessary to stabilize his condition, etc.
Patients of the "yellow" and "green" zones do not go to the offices either. Their examination is also carried out on the spot, in diagnostic boxes. The sequence of actions of doctors, nurses and other employees - up to the worker who cleans the premises, was calculated literally with a stopwatch and brought to perfection at the training ground. As a result, the following parameters of being in the emergency department appeared: in the "red zone" the patient should spend no more than half an hour, in the "yellow" - no more than an hour, in the "green" - a maximum of two hours - there is no threat to life. Further, specialized departments take care of it. If resuscitation is required, the patient is transferred to intensive care, those who need the help of a surgeon are taken to the operating room, and so on.
Does this time add up to the minutes allotted for each procedure? Say, 5 minutes are given for an ultrasound scan, 10-12 minutes for a computed tomography scan, and so on?
Igor Parfenov:The timing of each procedure is set, but it is impossible to add up mechanically and get the time to provide assistance for a particular disease. The same disease in each patient proceeds differently, there are different complications. Let's say a person came to us with appendicitis, and he also has a history of diabetes mellitus and hypertension ... There can be a whole bunch of chronic diseases. All this must be taken into account when making a diagnosis. The goal of developing algorithms is not just to reduce time, it is not a race for speed. In the first place is the effectiveness of medical care, which, in turn, is often directly related to the efficiency of its provision. Where, for example, did the "golden hour" rule for patients with a heart attack or stroke come from? To prevent irreversible changes, it is necessary to make a diagnosis and perform an operation in a short period of time. If help is late, the person may become disabled.
Currently, action algorithms have been developed for 87 clinical cases?
Igor Parfenov: Yes. The algorithms cover 96% of cases of emergency care with which patients enter emergency hospitals: these are cerebrovascular accidents, emergency cardiology, severe concomitant injuries, and much more.
What algorithms did you personally develop?
Igor Parfenov: I will say right away: there is not a single algorithm developed by any one person. This is a team work, which involved resuscitators, surgeons, therapists, specialists in radiation, laboratory, ultrasound diagnostics and many other doctors. The doctors of our hospital took an active part in it, and I myself, as a surgeon, a specialist in acute pancreatitis and gastrointestinal bleeding.From the ambulance, the patient is immediately transported in the right direction, where there is everything for a quick diagnosis
Will you have a heliport in the hospital?
Igor Parfyonov: Yes, definitely.
From the helicopter, will the patient also first enter the triage area?
Igor Parfyonov: If a person is delivered by helicopter, it is obvious that he is seriously ill and should be immediately sent to the anti-shock ward. No procedures should be done for the sake of procedures.
Whether taking a patient from a helicopter, or from an ambulance, will you already have some information about him?
Igor Parfyonov: In Moscow, the EMIAS system works, thanks to which doctors know the history of his illness by the time the patient arrives - when he was treated, what operations he underwent, what the latest examinations were. This is important for the doctors in whose hands it falls, and the operator does not need to spend time entering data into the medical history.
With what feelings do you expect the launch of a new emergency complex in your hospital?
Igor Parfyonov: With joy, hope and gratitude to everyone who made the decision to create such complexes. This is truly a breakthrough project of our time.Russian newspaper - Capital issue: No. 236 (8884)