Testimony on health management of the recent wildfires in Greece
Press release of the Panhellenic Federation of Employees of Public Hospitals (ΠΟΕΔΗΝ - POEDHN)
Translation: Emmanuel Kosadinos
At the time of this publication, 3 weeks after the disaster, one more person died of his burns (hospitalized at KAT Hospital) while the Greek government is trying to implement palliative measures within the narrow framework of austerity. The controversy does not weaken, sometimes trespassing the limits of decency. The collective trauma is deep, barely veiled by the summer atmosphere. Obviosly, an atmosphere that direct victims can not share. Sadness, anger and disappointment, sometimes resignation, are latent affects, shared by all. A new fire broke out nearly 50 kilometers from the first, fortunately without victims.
The translated text is both a testimony and a union pamphlet and must be read as such. Its translated reproduction, does not imply my adhesion to all the theses, explicit or implicit, which are stated there. I am in no position to verify the veracity of all the assertions of the authors, who sign it assuming responsibility. It is a compilation of testimonies from people who were at the forefront of the struggle to save lives and relieve suffering. That's why they inspire respect and admiration. Sometimes there are interpretations in the text that engage their authors. A judicial investigation should soon start on the responsibilities related to the fires.
However, today like most other times, I fully align myself with the claims of the employees of the Greek Public Hospitals when they ask for more means to carry out their work, when they denounce the austerity policies carried out by all the Greek governments for several years. I am also on their side when they claim to be heard by the authorities. That's why I find the recent statement by Deputy Minister Polakis of Health totally unacceptable and arrogantly misplaced.
Here is the statement of the Deputy Minister: "trade unionists have no opinion to give on the organization of care, neither proclaim themselves emergency medicine or resuscitation specialists, especially if they are former caregivers in psychiatry, without any Higher Education diploma" .
The situations described and the issues raised in this text could concern other European countries as well, in particular the question of the state of material suffering of the hospitals, of the material and moral suffering of health workers, the sensitive issue of the emergencies and of Resuscitation or intensive care units, the struggles of health workers, the arrogance or contempt of the authorities to which they are regularly confronted.
Serious errors and omissions by the Department of Health were noted during the health management of the firestorm crisis, although Minister Polakis claims to have been awake for 36 hours in a row.
An invisibilisation operation for burn victims, hospitalized in ICU (Intensive Care Units / Resuscitation) was organized to minimize the scale of the disaster, the number of deaths and the lack of intensive care beds.
Currently 8 patients are hospitalized in ICU, including 1 at the "Thriasio" Hospital, 2 at the Traumatological Center of Athens (KAT), 5 at the "Evangelismos" Hospital. There are also 6 hospitalized in Unit for burn victims (ΜΑΦ) at the "Thriasio" hospital with very serious burns. A total of 14 patients are in a severe state, irreversible for some of them.
It was initially reported that only 11 patients were hospitalized in ICU. Nearly 10 have been released, but 8 are still there. How to explain this?
The Chronicle of Transfers to Hospitals and Health Centers
Alongside death casualties, dozens of serious burn victims were transferred to the Hospitals on duty in the Capital Region (Attica Region) and to the Health Centers before the government coordination group met.
Reception registers of patients in hospitals and health centers that received the burn patients were concealed or lost during that night. Why that ?
The surgical treatment of burn victims at the Special reinforced care Unit of the "Thriassio" Hospital (ΜΑΦ) was carried out using a manually operated dermatome (special repair surgery instrument).
Australian doctors present were shocked and are preparing to donate a modern electric dermatome.
Chronicle of transfers to Hospitals and Health Centers
The Rafina Health Center evacuated
5:30 p.m : The coordinator of the Health Center was for a long time in communication with the Municipality, the service of the Firemen, the Police, to know if she had to evacuate or not the Health Center. She did not receive any instructions.
6:05 pm : She took the initiative to evacuate the Health Center. Staff and patients were moved to Marathon Road. Her initiative proved to be salutary. The fire reached the Health Center which allegedly burned, if three technical agents of the Center had not taken the initiative, at the risk of their lives, to move towards the Center in flames and extinguish the fire with water hoses. According to the testimony of these technical agents, the first vehicle of firefighters arrived at only 11:30 pm
Nea Makri Health Center
It is the Health Unit closest to the fronts of the fire.
6:45 pm: Four people injured by the fire arrived by private means. Two with respiratory problems and two with severe burns.
8:00 pm: Arrival of a patient in serious condition. He had burns all over his body. The doctors took care of him and he was immediately transferred to a duty hospital. He was hospitalized for a few days in ICU but finally died.
From 6:45 pm to 11:30 pm arrived at the Health Center of Nea Makri , by private means or by the ambulances of the National First Aid Center (ΕΚΑΒ) dozens of patients suffering from serious burns, heart or respiratory problems. Many of them were transferred to the duty hospitals and were hospitalized.
Spata Health Center
From 8:30 pm, heavy burn victims arrived by private means or by ambulances of the National First Aid Center (ΕΚΑΒ). At 10:00 pm dozens were taken care of, or waiting for paraclinical exams. The doctors treated the wounds and several patients were transferred to duty hospitals. Several of them were hospitalized.
From 8:30 pm, burn victims are transferred there. At 10:45 pm was transferred to the hospital the first deceased person (photo transmitted at 11:03 pm). At that moment, the burned people are transferred by three in the ambulances of the National First Aid Center (ΕΚΑΒ).
10:45 pm: An instruction is given to install a mortuary container to accommodate many dead.
Until 11:30 pm were transferred to the hospital more than 30 people burned in severe conditions and many in hypothermia (because of having remained in sea water for several hours). Many of them were hospitalized.
11:45 pm : The second deceased person was transferred there.
At 8:30 pm the first people with severe burns have been transferred from the fire front. Until 11:30 pm, more than fifty people with burn injuries have registered to the emergency departments (ΤΕΠ).
Until 11:00 pm, four people were intubated (two have arrived to Evangelismos already intubated) and were hospitalized at the ICU.
Hospital for Sick Children "Aghia Sophia"
From 8:30 pm, burned young children arrived from the scene of the fires.
At 8:30 pm takes place the first admission in Plastic Surgery of a child with severe burns (registered in the book of the Emergency Department).
At 10:10 pm a six-month-old baby is transferred dead , deceased from its burns (data from the Emergency Department book)
These tragic hours, the Hospitals and the Health Centers of the region were like in zone of war, and even worse.
At the same time, Deputy Minister Polakis spoke of "unconfirmed information" about deaths. But what mention did he make on the dozens of wounded? Information was though available to him since all Health Units were in constant communication with the National Health Operational Center (ΕΚΕΠΥ) and the Ministry of Health.
Mr. Polakis knew that there were deaths and a large number of fire victims who were transferred to the Health Centers and Hospitals, long before the communique of the government coordination group.
They tried hide the reality. This is why the registries of the Health Units were lost during that night.
There were grave errors in the sanitary management of the tragedy.
After such disasters, having left behind dozens of wounded and dead, they must not hide the problems under the carpet. There have been serious management errors and omissions of the government in the management (cardiological, pneumological, etc.) of the victims that fatal night. The state of public health will not improve by the use of false pretenses. It will not improve as long as the policies of the memorandum and high primary fiscal surpluses continue.
Self-gratification by government ministers on how to deal with the situation is just pain and anger. At the same time, we mourn dozens of deaths and where some wounded still give the fight for life.A
After such a disaster, having left behind dozens of wounded and dead, officials must not hide the problems under the carpet. There have been serious management errors and omissions of the government in the management (cardiological, pneumological, etc.) of the cases, that fatal night. The state of public health will not improve by the use of false pretenses. It will not improve as long as the policies of the memorandum and high primary fiscal surpluses continue.
Self-gratification of government ministers on their handling of the situation only creates sorrow and anger. At the very moment when we are mourning dozens of deaths and when some wounded still struggle for their life.
Hospitals on duty, on Monday 07/23/2018
According to the regular schedule of duty for hospitals, hospitals "Sismanoglio", "Evangelismos", KAT Traumatological Center (for specific cases including victims of burns), the Attiko Hospital and, for children, the Aghia Sophia Hospital for Sick Children were on duty in the region of Attica the night of the fire . The military hospitals were requisitioned to be on call for the civilians, however it was a formal watch, since no patient was transferred there and the only effect of the announcement of the Minister of Defense Mr. Kammenos, was to create a chaotic situation.It should also be noted that no fire victim has been transferred to Attiko Hospital although this hospital has a Burn injuries Department.
It perhaps not the nearest hospital, but given the chaotic situation in "Sismanoglio" and "Evangelismos", the treatment of burn victims would have been faster despite the distance.
When the fire broke out, and it became known that there were dozens of dead and wounded, ambulances carrying by three the victims of serious burns to the duty hospitals, to which were added patients transferred by private means, the National Health Operational Center (ΕΚΕΠΥ) and the Ministry of Health did not exercise their role.They did not coordinate the transfer of the burn victims, so they were dispatched to all the duty hospitals and they did not extend the watch to other large hospitals in the Attica region, close to place of disaster and with specialized units. For instance to the "Genimatas" Hospital, which was closer to the fires than the "Evangelismos" Hospital, already overloaded. They did not even decide to immediately extend the watch to the "Thriasio" Hospital, which has a department for burn victims, the "Latsio" department. Finally, the "Latsio" department. began to receive burn patients at 2 o'clock in the morning.
The "Latsio" department for burn injury victims
The "Latsio" department for burn injury victims was created thanks to private donations precisely to deal with such tragic situations. However, at no point so far has it functioned as a National Referral Center for the management of burn victims.
It was planned that there would be a 16-bed Special Reinforced Care Unit (ΜΑΦ) in the basement, and an 8-bed reconstructive surgery unit. It had also been planned that there would be two operating theaters and an Intensive Care Unit (Resuscitation / ΜΕΘ) with 8 beds on the first floor.
Here's how this department functions today:
From the year 2005 began operating the Special Reinforced Care Unit (ΜΑΦ) with 10 beds (6 beds are closed due to lack of staff) and 8 beds for the reconstructive surgery unit.
The two operating theaters do not function for lack of staff.
The Intensive Care Unit (Resuscitation / ΜΕΘ) with 8 beds has been functioning since 2008 as a general Resuscitation service, not to meet the specific needs for which it was originally planned.
In fact, this is happening because there are huge shortages in intensive care beds.
If the "Latsio" Burn Center functionned as originally planned and was adequately staffed, it would have been able to handle most of the victims of the firestorm. Finally, only 12 patients were transferred there, a few hours after the first critical moments of the disaster!
Still, to make this possible, patients already hospitalized at the "Thriasio" Hospital were moved to other departments, to make room for the victims of the fire. The next day, the Special Reinforced Care Unit (ΜΑΦ) opened the 6 beds hitherto closed by redeploying staff from other departments.
Organization of Health Services for the treatment of burn victims
Hospitals "Sismanoglio" and "Evangelismos" have received the load of the wildfire casualties (burns, heart infarction, respiratory problems, etc.). More than 200 medical and surgical cases have been transferred to these two hospitals. There was panic in the Emergency Departments. At the same time, the "Attiko" Hospital, which was on duty and has a specialized burn department, has been forgotten. The rationale that this hospital was made available to accommodate the wounded of the wildfire at Kineta is not holding up because the demand for care from this second wildfire was minimal.
Injured young children transferred to Hospital "Aghia Sophia"
The health staff gave their heart and soul to take care of the victims of the fires in all hospitals, including the hospitals "Sismanoglio", "Evangelismos", Hospital for Sick Children "Aghia Sophia" and "Thriasio". The tragic deficiencies in medical and nursing staff were overwhelmed by the dedication, professionalism and solidarity of the remaining staff who rushed to return from their holidays and rest, and who remained at the hospital, on their own initiative. , for three consecutive rounds of post. What was the coordination by the National Health Operational Center? What was the coordination by the Deputy Minister, Mr. Polakis, who claims to have been awake for 36 hours?
The mass of admissions was carried by the hospitals "Evangelismos" and "Sismanoglio" (80 admissions for both). On the other hand, at the Traumatological Center of Athens (KAT) which was on duty as well, the nearest hospital to "Sismanoglio", more specialized in the treatment of burn injuries, because having a unit of reconstructive surgery and expertise in the field, hosted only 11 patients and performed 8 admissions.
The "Sismanoglio" Hospital does not have a repair surgery department. The surgeon from KAT Hospital was summoned at midnight to "Sismanoglio" to help. However, patients transferred to KAT were very few by decision of the National Sanitary Operational Center.
The victims of burns admitted to the Hospital "Sismanoglio" were dispatched in various services (not in reconstructive surgery), just as those admitted to "Evangelismos" since the beds of repair surgery had been saturated.
Burn victims should be cared for in Reparative Surgery Services, Special Reinforced Care Units (ΜΑΦ) or Intensive Care Units (Resuscitation / ΜΕΘ) because of the high risk of infections to which their wounds are exposed and all the more so because many of them were transfused.
And yet, they were hospitalized in departments of Urology, Internal Medicine and General Surgery. Anywhere there was room.
The means of the big hospitals (KAT, Attiko, Genimatas, Center "Latsio" for burn victims) have remained unused.
Intensive Care Units (Resuscitation / ΜΕΘ)
To deal with such deadly fires, with dozens of wounded and dead, the first necessity in a health system is the operation of a sufficient number of intensive care beds. In the Greek National Health System (ΕΣΥ), taking into account the total number of hospital beds officially reported, 3,000 intensive care beds are expected to operate.However only 420 intensive care beds are functional and another 150 beds are technically equipped but are closed due to shortages of medical and nursing staff.
The minister's claims that there are 570 intensive care beds are untrue. Where did he see it? We expect from him the communication of figures by hospital.
During summers, due to the disinfection of the ICUs, only 370 intensive care beds are operational on average across all Greek hospitals. That is why waiting lists exist, even if needs decrease during summer.
On Monday 07/23/2018, when the fire was devastating and there were already had seriously injured and dead people, the waiting list for intensive care admission was already 35 people, waiting for other serious health problems. This list is managed by the National First Aid Center (ΕΚΑΒ). As a result, there was no bed available in any intensive care unit to accommodate the victims of the firestorm.
The management of burn victims requiring intensive care hospitalization has not been coordinated by the National First Aid Center (ΕΚΑΒ) as required. The injured were not on the same intensive care waiting list as other patients in serious condition. In this way, the lack of availability in intensive care beds was concealed. The coordination was organized by the hospitals (managers, Emergency Departments, treating physicians), by the National Health Operational Center and by the Ministry of Health. Obviously, this was done in such a way as to hide the fact that more patients, suffering from burns and requiring hospitalization in intensive care, could not be accommodated.
Burnt and intubated patients requiring ICU hospitalization waited for 24 hours before finally finding a bed. Two patients were hospitalized in the Special Reinforced Care Unit (ΜΑΦ) of "Thriasio", then in the Intensive Care Unit (Resuscitation / ΜΕΘ), where eventually they died.
Burn victims were hospitalized at the ICU (Resuscitation unit) of the Evangelismos Hospital, which had been closed for disinfection. It was reopened that night, which was a good decision since there were no ICU beds available in any other hospitals.
Exceptional priority was given to fire victims by bypassing other intubated patients waiting for an ICU bed, 35 in total. Every day there are, in Greece, on the waiting list for ICU beds more than 30 patients in serious condition.
So, even if more than a dozen more people who perished in the flames would have been recovered faster and would require a place in intensive care, where would they find it?
How do we know, even today, if burn patients who need to be hospitalized in intensive care will be well cared for? How to know since the Ministry of Health does not provide official data on the management of ICU beds, or even conceals them.
Several burned patients (at least 10) have come out of Intensive Care, either by death or because their condition has stabilized. In spite of this, there are 8 patients still hospitalized in Intensive Care Units (Resuscitation), including 5 at the Hospital "Evangelismos", 2 at the Hospital KAT, 1 at the Hospital "Thriasio".
The Ministry of Health puts forward the number of 6 patients still in ICU. It is necessary to add to these 6 persons hospitalized in the Special Reinforced Care Unit (ΜΑΦ) of the Burn Center of the "Thriasio" Hospital, still in serious condition.
The ministry is practicing piecemeal communication to mask the scale of the disaster, the number of deaths, and the lack of intensive care beds. By blocking the waiting list for access to ICU beds, in order to prioritize access for the victims of the fire, it is possible that the deaths of other patients in serious condition at the top of the list at the moment of the disaster, were precipitated.
For the Executive Board of the Panhellenic Federation of Employees of Public Hospitals (ΠΟΕΔΗΝ)
Mikhalis YANNAKOS, Chairperson
Christos PAPANASTASIS, General Secretary
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