Transcript Caso clinico: divorziata ansiosa

STATUS OF EMERGENCY
MEDICINE IN ITALY
Ivo Casagranda
The Second Mediterranean Emergency Medicine Congress
SITGES/Barcelona, Spain
September 13 – 17, 2003
Country Information
Population
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57 million
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Density 500 people per square mile
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14.4% < 15yrs
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18% > 65 yrs
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Median age: 41,6 yrs
Socio – economics
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Overall poverty level
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Absolute poverty
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Unemployment rate
11%
4.2%
11.4%
Country Information
State of Health
- Life expectancy: 77yrs for men and 83 yrs for women
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Major causes of morbidity
- Arthrosis
(18,4%)
- Hypertension (11,9%)
- Allergy
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(9,9%)
Major causes of mortality
- Cardiocirculatory diseases
- Neoplasms
- Respiratory diseases
Country Information
Health care system
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Organisation: public and private
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Public: SSN: The Italian National Health Service
- Financed by the Italian government through taxes
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- Largely socialized:It provides free medical care to all citizens
- Citizens are responsible for various co-payments
- Policies established both nationally and regionally (national and regional
health care program)
Private
- Indirectly subsidized by the government if accredited
- Financed in small part by private insurances
Country Information
Health care system
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Hospital organisation
- Private and public
- 4.7 beds every 1000 inhabitants
- Physicians are allowed to practice either in the public or in the private hospitals
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Three types of hospitals
- Hospital with high level specialties and a second level ED
- Hospital with basic specialties and a first level ED
- Country hospital with a daytime first aid service
Country Information
Medical education
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Italians enter medical school directly after high school
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The medical school has a closed admission after an examination
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The medical school curriculum is six years long
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specialty schools are university based and usually five years long.
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Curricula meet European Community standards
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Examination and a thesis discussion to get Medical Specialty Board
certification
EM Specialty Status
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Emergency medicine is recognized as disciplina but there is not
an independent specialty in Italy
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There is a training program in some specialities
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specialty in Internal Medicine
- Branch in Emergency Medicine:last two years of attendance in the ED
- List of skills and procedures to be learned
EM Specialty Status
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specialty in Anaesthesiology and Intensive Care
-Trained in anaesthesia,critical care, analgesia, hyperbaric therapy
- No specific training in emergency medicine
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specialty in General Surgery
- Training in surgical emergencies but no training in the medical ones
EM Specialty Status
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Professional organisations that serve the needs of Italian EPs include:
- SIMEU ( Italian Society of Emergency Physicians )
- SIARTI ( Italian Society of Anaesthesiology and Intensive Care )
- SICUT
Italian Society of Urgent Surgery and Trauma )
EM System Information
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Pre-hospital emergency care
-All regions have developed an advanced out of hospital system
funded with fixed budget
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In the field:
- Helicopters staffed with an anaesthesist (generally) and a trained nurse
- Ambulance type A (advanced) staffed with a trained physician and a
trained nurse
-Ambulance type B (basic) staffed with volunteers with minimal first-aid training
Helicopters
in Piedmont
Casale Monferrato
Valenza
Ambulances
Type A
ALESSANDRIA
Tortona
Novi Ligure
Acqui Terme
Ovada
Province of Alessandria
Arquata Sc.
EM System Information
Pre-hospital emergency care
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Dispatch mechanism:
- A 24-hour dispatch center in every province inside or outside the hospital
- A nationally common toll-freee access number ( 118)
- There is a Medical Director
- The dispatcher is a trained nurse with a physician supervisor
EM System Information
In -hospital emergency care
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In the emergency department the care provided to the patient is:
- Resuscitation and stabilisation
- Diagnosis and first disease treatment
- Observation of the patients who need it up to 24 hours
EM System Information
In -hospital emergency care
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Care providers
- Medical care is usually provided by physicians with specialty training
in internal medicine and in some hospitals in surgery
- In some ED there is also an orthopedic surgeon
- Anaesthesiologist normally on call for some critical patients
- Consultation is provided by other specialists on call
EM System Information
In -hospital emergency care
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Care providers
- Triage is performed by nurses
- Nurses are assigned full time to the ED
- In larger hospitals physicians are assigned full-time to the ED
- In smaller institutions physicians may rotate ED duty along with other
clinical responsabilities
EM System information
In -hospital emergency care
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Type of training of EM providers
- Specialist in internal medicine : the competency is variable.
Good if trained in ED . Generally they take ATLS,ACLS courses
and other courses organized by SIMEU.
- Specialist in Anesthesiology: his competence is good for some critical
patients
Challenges and Strategies
The two top challenges that SIMEU is facing are:
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The establishment of the specialty in Emergency Medicine
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ED staffed only with full time physicians trained in emergency medicine
Challenges and Strategies
The institution of the specialty in emergency medicine
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Is necessary to achieve the competency in facing emergencies and to get the
same standard training throughout the country
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The board – certification is important because we need to have the same
dignity as other specialists in the other branches of medicine
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This specialty could be a great and interesting
physicians
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opportunity for young
Challenges and Strategies
To institute the specialty in E M the proposals were and are
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A “super specialty” to do after another specialty such as internal medicine
or anaesthesia or surgery: too long
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A specialty like the US model
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A subspecialty in the area of internal medicine (SIMEU proposal)
Challenges and Strategies
ED staffed only with full time physicians trained in emergency medicine
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This should be the effect of the specialty
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In the meantime SIMEU is pressuring the regional governments to establish
it by law and to institute training courses to give the same standard training
to all physicans working in the ED
SUMMARY
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In the last few years emergency medicine in Italy has come a long way
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The foundation of Italian Society of Emergency Medicine (SIMEU)
was the right way to face the numerous problems
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What we need now is the specialty in emergency medicine