We have computed tomography directly in the emergency room, including a mobile, very sensitive ultrasound, says MUDr. Drummer. What does a modern ER look like?

09/08/2022

Photo: Lenka Hatlapatková (same as pictures in the article)

Description: These are not the famous actors from the famous series Emergency, but the real ones: MUDr. Boris Bubeník (on the right in the first row) with a team of colleagues from the Central Emergency Service.

CONVERSATIONS ON THE EDGE In no other hospital department is there such a buzz every day as in the “Emergency Room”. MUDr knows about this too. Boris Bubeník Jr., head physician of the Central Emergency Department (CUP) at the hospital in Frýdek-Místek, whom we asked to introduce us to this workplace, which is the catchment area for an incredible 150 thousand people.

How many patients do you treat here on average?

In a year – from June 2021 to May this year – we treated 43,789 patients here, which is an average of 3,649 patients per month and 121 per day, if I count 30 days in a month. And that’s really a lot. Out of these, 10,803 patients were brought by emergency medical service teams, i.e. an average of 900 patients per month, 31 are brought by ambulances per day. The remaining patients come to us or come alone. The 121 patients per day have to be treated here by five to six doctors who are on duty, sometimes other doctors who are called in help. In addition, around 45 nurses and paramedics work here on a round-the-clock basis.

Boris Bubeník III.

The catchment area of ​​the Frydek-Místě hospital is large, from which places do patients come to you?

Our hospital is specific in this regard. We include, for example, Brušperk, but on the other hand, Hamry, Bílá and a large part of the border with Slovakia. In addition to the fact that our catchment area includes approximately 150,000 inhabitants and is one of the largest, some patients come to us from relatively long distances.

In some cases, we are also an intermediate stop for outgoing groups of emergency medical services. Every paramedic respects the rule that a seriously ill patient must be brought to the nearest hospital. So, from time to time, traumas from major accidents are also brought to us, which do not fall under the district hospitals, but the patient needs immediate help. As soon as we stabilize him, these patients are then transferred to the university hospital or to specialized workplaces.

The central emergency reception was recently completely renovated and equipped with modern equipment.

The CUP workplace underwent a relatively large renovation…

It is a very modern workplace located in the surgical pavilion in building H on the ground floor. The indisputable advantage is that we have all the necessary workplaces literally together, and doctors from various fields such as surgeons, traumatologists, neurologists, internists and radiologists can in many cases work together very intensively. On one side there are three internal outpatient clinics and an ultrasonography examination room, on the other side there is one surgical and one trauma outpatient clinic and a smaller operating room. In the middle we have waiting beds with monitors and all technical equipment. In addition, there are four surgical beds, four internal beds and one so-called crash box for patients on the verge of vital functions who need facilities for the anesthesiology-resuscitation team. An integral part of CUP is the immediate availability of imaging methods such as X-ray, ultrasound or computer tomography, which also have their facilities here and are used 24 hours a day, 7 days a week. So we don’t have to transport patients anywhere. Of course, there is a large waiting room with two entrances and a reception.

Upon arrival at the Central Emergency Department, patients report to the reception desk.

People often lament that when they arrive at CUP, they have to wait a long time. Why?

The first point of contact for each patient is always the reception desk, where an erudite nurse registers them immediately upon arrival and triages the sick – sorting them according to the urgency of their health condition. Priority is given to so-called A patients who require immediate treatment, followed by B patients who must be treated within an hour at the latest, C patients and so on. And even though it sometimes seems that the waiting room is empty and nothing is happening, we are constantly buzzing in the ambulances. Emergency medical service vehicles bring patients to us through the back entrance, who in many cases have to be treated as a matter of priority. The heliport is part of the CUP and it has priority over all others. And we can’t influence that.

In addition, every patient, whether brought by an ambulance or comes alone, undergoes a comprehensive examination with us. For example, if he falls into the internal ambulance, we will perform an EKG, measure the pressure, take blood samples, possibly even an X-ray or ultrasound if the situation requires it, and more. And we can do all this in about 20 minutes. However, if we need complex biochemistry, the patient waits for 1.5 hours in our bed. In many cases, patients in surgical, trauma and neurological outpatient clinics do not need blood sampling, but even their examination takes time.

Emergency medicine has literally taken leaps and bounds in recent years. In what area has she moved the most?

Definitely available. Today, everyone can have relatively quick medical treatment. In addition, thanks to the availability of high-quality imaging methods and modern equipment, diagnosis and subsequent treatment are also faster. In the past, a person with a heart attack lay in the hospital for two to three weeks, received medication and waited to see how the body could handle everything. Today, a patient with this diagnosis is taken straight to a specialized cardiac center, where he has all the initial examinations within 1.5 hours at the latest, on the basis of which the doctors decide which method to treat the patient. In the past, many hospitals didn’t even have CT scans, so when a patient had a head injury, for example, the only way they could tell if they had bleeding in the brain was by drilling into the head. Today, we have computed tomography directly in the emergency room, including a mobile, very sensitive ultrasound, thanks to which we can literally find out in a few minutes whether the patient has more serious internal injuries.

Availability is one thing, abuse is another. With which injuries should people definitely go to the Central Emergency Department and in which cases should they not go?

The very word urgent calls for people to come to us with problems that they are unable to solve with their general practitioner. The latter should primarily determine whether the problem is serious enough to require a hospital examination. In the past, no one would go to the hospital with diarrhea, vomiting, or back pain. If it is not a serious, life-threatening condition, patients should first go to a general practitioner, who will either prescribe medication or refer the patient to a specialist for examination. Unfortunately, in recent years, people rush into everything and come here without any prior consultation with a general practitioner, often with chronic problems. Sometimes they even call an ambulance, like one young woman who had a single bout of diarrhea after her own dietary mistake and had an ambulance brought to us. Unfortunately, the waiting time of patients increases because of these people, and the treatment time also increases for patients in very acute conditions. On the other hand, we encounter cases, especially among the older generation, when the patient has symptoms of a heart attack or stroke, comes to us on his own, and sits in the waiting room to wait. That is the other extreme. In these cases, people should not hesitate to call an ambulance immediately.

Today, there are also various call centers providing advice in the field of health. If people have a health problem and do not know who to turn to, for example, they can call 800 888 155, where they will be advised and directed. Some health insurance companies provide similar services.

An integral part of this workplace is the immediate availability of imaging methods such as X-ray, ultrasound or computed tomography.

You come from a family in which the profession is passed down from father to son. Was medicine an obvious choice for you? And why intern?

My grandfather, Boris Bubeník, was born in 1920 in Harbin, from where he and his parents fled to Boskovice after the capture of Subcarpathian Rus by the Hungarians. In 1949, my grandfather graduated from the Faculty of Medicine in Brno and in the same year joined the hospital in Frýdek-Místek. In 1960, he was appointed the head of the internal department and at the same time the director of this hospital. It is 50 years since he had a park built in front of the hospital, filled it with pines and ornamental trees and built a lake here, which is still in the middle of the park today. My father, Boris Bubeník, was already born in Frýdek-Místek, and after graduating from the medical faculty in Olomouc, he joined an intern, but changed his field and in 1984 was appointed head of the hematology-transfusion department, where he worked until 1994. He then built the Blood Center, where he still works as a director today. And after graduating from the Faculty of Medicine in Olomouc in 2014, I joined the internal department here and have been working here for the eighth year. And why intern? She is colorful. It deals with prevention, diagnostic and non-surgical treatment of the patient. Internal medicine is a multi-faceted battle, where the doctor does not always have to be able to do everything perfectly from his subspecialties in detail, but he must be able to make a decision, establish a diagnosis and, subsequently, a treatment procedure for any patient who comes to him with any problem. And that’s what I like about the intern.

Lenka Hatlapatková

Posted by: Anička Vančová


The article is in Czech

Tags: computed tomography emergency room including mobile sensitive ultrasound MUDr Drummer modern

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