when the cell phone is the only method of coordination between doctors

There was a few weeks ago a complicated medical situation, which fortunately ended well thanks to the initiative and great professionalism of health workers from three different communities. It was approx Pablo, a two-year-old boy with lung involvement, admitted to the Pediatric Intensive Care Unit of Burgos General Hospital in a very unstable situation which he needed to continue living from the connection to an ECMO, acronym in English for the system designed to oxygenate the blood through an extracorporeal membrane. This apparatus allows the function of the diseased lung to be replaced as it recovers, extracting the blood through an external circuit where it is oxygenated, cleaned of carbon dioxide and returned to the patient. Although it is not a new technique, the truth is that it is being used more and more and not only in the treatment of lung diseases, but for example in the extraction and preservation of organs for transplantation. During the pandemic, he managed to save hundreds of lives in highly compromised patients.

1,000 km to save a child with an ECMO: why are these machines in short supply in Spain?

Jose Pichel

The indications in children are fortunately limited to a few dozen a year, a figure which makes the availability of this technique impracticable with the consequent team formed in all hospitals. In Spain there are 15 centers with this technologybut only three of them inside Malaga, Madrid and Barcelona have the team ready to move remotely and transfer the patient. In Pablo’s case, the Doce de Octubre hospital in Madrid answered the call asking for help via WhatsApp to the Burgos hospital, which had the necessary car, but not the staff to travel, which instead was available in the Maternal and Child Center of Rum raisin.

It all started thanks to this chain of professionals from three hospitals, united by WhatsApp, who met in Burgos (and in the case of the Malagasy, advancing the money for the plane tickets to Madrid and the return taxi), connected the ECMO to the child and transferred him to two ambulances together with six toilets and escorted by the civil guard in Madrid to continue his recovery.

Of course It’s not the first time such a device has been produced, nor will it be the last. in both children and adults. Indeed, during the pandemic, these professional WhatsApp connections between intensive care workers served to connect hospitals and save many lives of critically ill patients who could thus receive adequate care wherever it was available. What it really attracts attention is that, in the 21st century, All this coordination must depend on the initiative of the doctors and there is no formal set of protocols and coordination mechanisms established between hospitals and between communities that transform the heroic and the exceptional into something normal and routine.

It is surprising that there is no set of official coordination protocols and mechanisms established between hospitals and autonomous communities

The unanimous request of the doctors involved in these transfers is that the Ministry of Health create protocols and a coordination mechanism similar to that of the National Transplant Organization (ONT) which makes it possible effective coordination of intensive care units adults and children and the transfer of patients and/or professionals when necessary. Because, in fact, what we have just described does not differ too much from a device for organ donation and transplantation (indeed, it is simpler), which can involve up to 100 people and which is repeated every day in Spain on average 6-7 times a day, perfectly coordinated by the ONT.

The situation, almost forty years latereg quite similar to that of transplants in the eighties (and it’s been a while). In those years, only the initiative of transplant coordinators and teams with the limited technological support of landline telephones and pagers and the support of a small office of the Catalan health administration created on the initiative of the Doctor Roser Deulofeu They have made it possible to make the most of the few donations that existed before the start of the ONT. Were precisely the complaints from doctors, patients and even the ombudsman who forced the ministry to create this institution in 1989. Again, in the late 1990s and faced with a similar situation of lack of coordination in the face of limb amputations requiring urgent reimplantation by a plastic surgery team, the ONT assumed this role of coordination, allowing the transfer of the patient and the sectioned member to the reference centers until the autonomous reference circuits were established years later.

Similarly, the Ministry of Health, devoid of managerial powers, transferred to the communities for many years, should instead assume the coordination role recognized and required by the law, without once again looking the other way when there is a clear need for someone to take on this role. Perhaps the State Agency for Public Health, so often invoked and for now poorly defined, one of whose founding purposes included in the bill is the reduction of social inequalities in health, could meet this responsibility and give a satisfactory answer to these new needs. are emerging in our healthcare system

Meanwhile, trust WhatsAppalthough the transmission of personal health data through this tool, certainly very useful, it is more than doubtfully legal.

There was a few weeks ago a complicated medical situation, which fortunately ended well thanks to the initiative and great professionalism of health workers from three different communities. It was approx Pablo, a two-year-old boy with lung involvement, admitted to the Pediatric Intensive Care Unit of Burgos General Hospital in a very unstable situation which he needed to continue living from the connection to an ECMO, acronym in English for the system designed to oxygenate the blood through an extracorporeal membrane. This apparatus allows the function of the diseased lung to be replaced as it recovers, extracting the blood through an external circuit where it is oxygenated, cleaned of carbon dioxide and returned to the patient. Although it is not a new technique, the truth is that it is being used more and more and not only in the treatment of lung diseases, but for example in the extraction and preservation of organs for transplantation. During the pandemic, he managed to save hundreds of lives in highly compromised patients.