Problem shows no sign of allowing itself to be swept under carpet
In spite of the efforts of defence minister Nuno Melo over the weekend, the shambles affecting emergency medical helicopter transport in Portugal shows no sign of abating. In fact, quite the opposite.
As Nuno Melo upbraided news outlets for daring to point out that the country had only one functioning helicopter during the night, an urgent transfer involving a 49-year-old patient with a traumatic head injury, took “more than five hours”.
As so many criticisms of the workings of the state health service have said in the last few days, ‘this should not be happening in a developed country/ a country that has been part of the European Union for the best part of 40 years’.
But instead of ‘accepting criticism’ and fixing faults pronto, all involved appear simply to be ‘arguing among themselves’ as to who is most responsible (or, as in the case of Nuno Melo, saying a second helicopter will be operational “soon”). Soon doesn’t cut the mustard if your loved one is lying on a hospital stretcher awaiting air evacuation to a neurological unit (see below).
Today, Álvaro Almeida, the ‘executive director of the SNS state health service’ has held INEM (the national institute of emergency medicine) responsible for securing transport. This makes perfect sense, given INEM’s title.
Thus, when Almeida was asked about the shameful hold-up in a simple hospital transfer by CNN Portugal, he said: “This is a question that should be put to INEM”.
What goes without saying that “any transfer” involving patients being referred from one level of hospital care to a more specialised unit “must be made as quickly as possible”, he said.
Álvaro Almeida also referred to the contract signed with Gulf Med Aviation Services – a company which, at the time had no helicopters, and no pilots – saying the SNS executive had absolutely nothing to do with it. He didn’t say as much, but his response suggested that had his entity been involved in the signing of the contract, it would have made the effort to ensure that Gulf Med was ready to swing into action. As it is, the company is unlikely to be able to guarantee the terms of the contact signed in July until September, says Expresso.
A similar position has come from president of the union of pre-hospital emergency technicians, Rui Lázaro, who has blamed this logistical nightmare on the government and INEM: “INEM did not take into account the time of the competition (for companies to bid for the contract) The government and INEM should have started this competition a little earlier, or a little later”, he said, reiterating that Air Force helicopters should be relocated to the interior of the country, where he believes they are most needed.
Waiting five hours for treatment for traumatic brain injury
This is what happened on Saturday, or rather, this is the result of one country having only ONE helicopter available for medical emergencies at night:
The story begins on Saturday afternoon, when the unfortunate 49-year-old man suffered an accident on an electric scooter.
“Firefighters arrived in a few minutes”, writes SIC. The man was rushed to local Covilhã Hospital where the decision was made that he would be better attended (because of his head injury) by neurosurgeons based in Coimbra hospital.
The two hospitals started contacts at 8pm, explains SIC. Firefighters are called two hours later, to help with the transfer, but logistical issues kick in.
“The heavy Air Force helicopter couldn’t land on the hospital’s helipad, so they asked us to transport the patient to Castelo Branco aerodrome. An emergency ambulance was called with a medical team from the hospital who transported the victim to Castelo Branco aerodrome where the Air Force helicopter was already there to transfer the patient to Coimbra,” explains Luís Marques, commander of the Covilhã Fire Brigade.
The Air Force EH101 Merlin helicopter left Montijo military base and flew to Castelo Branco (over 200 kms away) with its own medical team. After the exchange of information between the Covilhã and Air Force medical teams, the patient takes off for Cernache do Bonjardim, in Coimbra.
“Here again, data is passed between the Air Force medical teams and an INEM medical vehicle that has left Covões hospital to transport the patient by land to Coimbra hospital because Air Force doctors have finished their mission when the helicopter leaves”, writes SIC.
It took around five hours from the decision to transfer the patient from Covilhã to Coimbra. The patient ‘met’ six different medical teams (…) “with all the risks associated with passing on information.
“If the emergency medical helicopter service was operational, as required by the contract signed between Gulf Med and the Portuguese state on July 1, everything would have been different. The INEM helicopter to be activated would have been based in Viseu” – much closer to Covilhã. It would have transported the patient directly to Coimbra, potentially even from the scene of the accident, since it is a light helicopter that lands more easily, SIC continues.
In practically, says the news outlet, the whole performance could have been undertaken in one and a half hours, in which the patient would meet a maximum of three medical teams (ie risks in passing on information would have been greatly reduced).
As it is, the 49-year-old remains in intensive care, in a serious condition, and no one has said yet whether his prognosis has been affected by the clear limitations of current medical emergency transport.
Just to end this report, we found a comment online which prompts thought: “The government awards a €77.5 million contract to a company to provide helicopter services to INEM, but… that company doesn’t have enough helicopters or pilots, two aircraft are missing. So the government directly contracts two helicopters from another company and also has the Air Force do the job.
The taxpayer pays three times for the same thing!!! Or am I wrong?” … And that’s before one tackles the nighttime issues.
As this report went up online, Observador online published a story to say that the government was handing this hot potato to INEM to explain.
“An official source for the Ministry of Health said explanations about helicopters should be sought from INEM”, writes the outlet, which also explains that had the journey been done by road, without helicopters involved, it would have taken less time. ND
