There is a problem with the whole chain
Writing | Ji Guangwei
Source | “Medical Community” Public Account
On the morning of May 27, the Shunyi District Government of Beijing announced that the person in charge of the emergency sub-center and the relevant responsibilities were reported to the Shunyi District Hospital and the Shunyi 120 Emergency Sub-center for the problem of delayed treatment and death of patients. Suspended, pending investigation.
Two days later, the official WeChat account “Qingfeng Shunyi” released the “Notice on the Investigation and Accountability of the Delayed Treatment of Shunyi 120 Emergency Sub-center” (hereinafter referred to as the “Notice”, the full text is attached at the end of the article The original text), said that it decided to deal with the four responsible persons as follows: Wang Xinbing, secretary of the Health and Health Work Committee of the Shunyi District Committee, and Zhao Yuehua, president of the Shunyi District Hospital, were punished, and Zhao Xuetian, director of the Shunyi 120 Emergency Branch Center, was dismissed, and the 120 bus was on duty. Group doctor Liu Xiaoyun was fired.
It seems that this is another 120 doctor’s dereliction of duty after a 120 doctor in Shanghai was suspended for not lending a defibrillator to the rescuers. It is another incident that should not have happened during the epidemic. tragedy.
I do not agree with such an investigation and handling decision.
What did the doctor do with the delay of more than 40 minutes?
The author took the “Notice” as the standard, and carefully read the time line after the doctor on duty and his team received the task:
May 11, 2022, 3:38, a young man in the control area called 120 because of chest pain.
3:41, the team doctor Liu Xiaoyun received the task list.
4:25, the on-duty train departs and arrives at the scene 7 minutes later.
From receiving the task to departure, the on-duty team was “delayed” for more than 40 minutes. In the meantime, what did Liu Xiaoyun and the team do?
According to the Bulletin, they called the relevant parties 10 times.
3:44, 3 minutes after receiving the task, contact the patient and ask about the condition.
3:46-3:57, Liu Xiaoyun called Shunyi District Hospital’s fever clinic 4 times, the switchboard was connected, and all extensions were busy.
According to the “Notice”, Shunyi District Hospital is the superior supervisory unit of Shunyi 120 Emergency Sub-center.
3:58, the fever clinic of the district hospital was connected, and it was reported that the person who tested positive for the new coronavirus nucleic acid would be admitted, but it is currently unavailable.
In the next 5 minutes, Liu Xiaoyun called the fever clinic of Shunyi District Maternal and Child Health Hospital twice. After the second connection, the hospital judged and replied that “the treatment ability is weak, and it is recommended to send it to other hospitals for treatment”.
At 4:17, Liu Xiaoyun called the deputy director of Shunyi 120 emergency sub-center, and was asked to get out of the car immediately for treatment.
4:32, the on-duty train arrived at the scene, and the patient was already lying on the side of the road. After emergency treatment, he was transferred to the emergency room of Shunyi District Hospital.
7:24, the patient was declared clinically dead, and the initial diagnosis was sudden death.
Does the doctor have a major responsibility?
Reviewing the survey results, the author believes that Dr. Liu has deficiencies, or even mistakes, and can be criticized for education.
But from the “Notice”, Dr. Liu did not have any major mistakes. She did not lose her job, neglect her duties and grossly misdiagnosed. The whole process has been actively coordinating and contacting, creating conditions for the treatment of patients, and communicating with multiple parties to confirm where the emergency patients in the control area can be admitted. Its communication involves multiple agencies and departments.
Dr. Liu had no major responsibility in the patient’s death.
And from the communication process, if Dr. Liu arrives at the scene immediately without contacting the hospital, it may be difficult to deal with in the follow-up, and may even be dismissed.
Receiving an emergency in the control area, because the receiving hospital is not well contacted, the patient may have to “parade” in the ambulance. During the Wuhan epidemic in 2020 and the Xi’an epidemic at the beginning of this year, there have been many incidents of patients in closed areas being rejected by non-designated hospitals. Therefore, during the epidemic, when an ambulance accepts a patient, it is often necessary to contact the receiving hospital in advance. In the event of an accident, the doctor is also to blame.
There is a problem with the whole chain
The author is a senior surgeon and a practitioner of elderly care and palliative care, and is well aware of the preciousness of medical resources and the importance of maintaining the dignity of life during the epidemic.
Reading through the bulletin, you will find that investigation and handling may seem a bit “over-the-top”.
“Notice” believes that there are four problems in the above incident. In addition to the duty train issue:
Shunyi 120 First Aid Branch Center’s problems include “inadequate implementation of pre-job training” and “failure to report relevant situations as required”. According to the “Notice”, the Shunyi 120 Emergency Sub-center failed to perform the reporting procedure in accordance with the requirements of the “Beijing Administrative Regulations on Pre-hospital Medical Emergency Information Reporting”, and failed to report patient information and treatment to higher authorities process, etc.
Shunyi District Hospital also has problems. Including “inadequate management of Shunyi 120 emergency sub-center” and “improper handling of aftermath”. The Shunyi District Hospital did not attach great importance to Song Mouxin’s death, and did not report the situation to the District Health and Health Committee in a timely manner. In communicating with Song Mouxin’s family members, he was not proactive in his work, and failed to timely and effectively resolve the family’s reasonable demands.
The problem with the Shunyi District Health Commission is that”The supervision and management of hospitals in Shunyi District are not strict” and “they were treated as ordinary medical disputes, and they were not reported to the superiors in a timely manner as a major matter in accordance with relevant regulations.”
Then it is not the first time that Beijing has reported the new crown epidemic, and the response and handling procedures should be relatively mature. Doctors on duty, 120 emergency sub-centers, relevant hospitals in Shunyi District, and Shunyi Health Commission – why didn’t the entire emergency chain have problems detected in advance?
The author believes that the above incident once again shows that under the new crown epidemic, the first aid process is still unclear. This responsibility should not be the primary responsibility of the physician.
Under the epidemic, it is not advisable to “make or break a hero”
In summary, this “Notice” does not get to the heart of the matter. The result was the sacrifice of a doctor’s career to get through a difficult time. It is unfair for doctors to be “scapegoats” for management failures.
In fact, in the event of the above, as long as there is an accident, whatever the ambulance does is wrong. The first to be “wrong” is the on-duty doctor of the crew.
This “make-or-break hero” approach is inappropriate. It is unreasonable and has no legal basis to fire a doctor as soon as something happens. In the long run, the result is likely to be that no one wants to be a 120 emergency doctor.
The author believes that under humanitarian disasters, we should pay more attention to maintaining the dignity of life, and we should earnestly implement the instructions of General Secretary Xie: “We must always uphold the supremacy of the people and the supremacy of life.”
Epidemic prevention and control is currently the top priority of our country’s work. The author has appealed for a long time, and I would like to say it again: dismissal from office whenever there is a problem regardless of the reason is a kind of lazy policy and not worth advocating, which will seriously jeopardize the development of epidemic prevention and control.
