The Crisis in the Portuguese Emergency Services in 2015: A Combination of New and Old Problems Leading to Terrible Outcomes

Abstract

The chaos in the emergency services (ES) occurs anytime the
demand exceeds the implemented capacity, which is never
enough when a hospital receives everyday during the winter
more than double the usual number of patients. As long as
the primary care services continue not to offer reasonable
alternatives for the treatment of severe diseases, people will
keep on flowing by the hundreds to the hospital emergency
services, even if aware of the multiple hours of waiting ahead
of them. They do not know whether the grievance they suffer from is something mild or if it is the indicator of a serious
malady. They come to the emergency services because it is
the only trustworthy door open, and because they fear for their
lives. Another long-standing problem is the rapid exhaustion of
hospitals’ capacity for hospitalisation, in connection to the rise
of the needs of the ES. The specialisation of the health care
teams is not the solution for the overloaded ES, although it
has been suggested by believers of this system as if it were. In
Portugal, as long as the patients arrive by the hundreds at the
ES without any medical triage whatsoever, and more than 93%
of the hospitalisations are conducted through the emergency
services, it becomes essential that the doctor takes on a holistic approach, guaranteed by the internist. Only then can the
quality of assistance and the institutional unity be assured, and
the inadequate discharges avoided. This year, a combination
of factors emerged, which resulted in the terrible outcome we
have witnessed. The vaccine for the influenza was not as effective. The patients were older, they carried more diseases and
presented many more social deficiencies, leading to a substantial increase in the need of hospitalisation. Economic austerity
caused the reduction of the health care staff in terms of doctors
and nurses, and robed them both of any rational motivation. It
was only natural that a storm would begin to take form out of
the first winds.