The ambulances from the Local Health Units of São João (Porto), Coimbra, Santa Maria (Lisbon) and Faro (Algarve) are those chosen to advance until March with the pilot phase of the new model of transporting critical patients between hospitals.
According to the order published this Monday in Diário da República, the new transport model defines that the critically ill patient should ideally be accompanied by an “experienced and trained” doctor and nurse, who must hold the advanced life support and transport of critically ill patients.
The diploma also defines that the destination service must be contacted in advance, not only to guarantee the existence of a vacancy, but also to ensure that it is prepared to receive the patient at the expected arrival time, and this contact must be personalized and the transport team be informed of the name of the person responsible for accepting and receiving the user at the destination service.
This new model, which is one of the priority measures defined in the Emergency and Health Transformation Plan, also defines that the doctor on the transport team should ideally have the specialty of urgent and emergency medicine or intensive medicine or anesthesiology or internal medicine.
The nurse who is part of the transport team should, ideally, be a specialist in medical-surgical nursing in the area of the person in a critical situation and have increased competence in extra-hospital emergencies.
In the order, the government recalls that the transport of critical patients is “a complex care process”, which requires “clinical and technical differentiation” from the teams.
The main indication for transferring a critically ill patient between two hospital units is the lack of resources (human or technical) in the hospital of origin that would allow definitive treatment or continuation of the treatment started, but it can also be motivated by non-clinical situations, such as the absence of space at the hospital of origin.
The Government recognizes that, although the transport of critical patients between hospitals is the responsibility of the health operator where the user is located, “there are some weaknesses in this process”, which is why it considers it necessary to define “a uniform secondary transport model in the entities that make up the National Health Service”, to guarantee the quality of the entire process.
The transport decision, being a medical act, is up to the doctor responsible for the patient, but the diploma considers that “a clinical discussion between the doctor proposing the transport and the doctor at the destination unit can allow for better planning in the management of care for patients. health and faster treatment of patients”.
The doctor responsible for the Integrated Medical Emergency System Coordination Center must also be included in the decision, as well as in technical and clinical support regarding the best type of transport for the patient in question.
The diploma defines that a critical patient is one “with time-dependent pathology, with potential or established organ failure, in Emergency Services or Intensive Medicine Services (SMI) with the need for emergent transport to a definitive treatment location”.
It also indicates that the National Institute of Medical Emergency (INEM) must define, create and establish a training program for selected doctors and nurses to “guarantee the quality of the teams that will integrate the future model and the critical patient transport teams”.
INEM is also responsible for ensuring coordination between the hospital of origin and destination, through the Coordination Center of the Integrated Medical Emergency System, in a specific contact line, as well as defining the most appropriate means of transport, in conjunction with the person responsible. ULS critical patient transport clinic.
INEM must also appoint the clinical responsible for the national Integrated Critical Patient Transport (TIDC) and respective regional coordinators and is equally responsible for quality control of critical patient transport and for defining performance indicators.
The pilot project defined in the diploma must be on the ground by the end of March, to be fully used during the second quarter of the year, when the detected flaws will be identified and corrected.
The extension of the model to the entire country should take place in the second half of the year, to become fully operational at the end of the year.
The diploma also states that a fixed annual subsidy will be allocated to ULS that carry out transport, the value of which will be defined by the member of the Government responsible for the health area.
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