Even the emergency room has to wait its turn.

Emergency care doesn't mean that whoever arrives first gets treated first. In emergency departments, the triage process is a matter of life and death, based on risk factors and fairness in healthcare.

The Emergency Department of Cho Ray Hospital was full of beds on the afternoon of September 5, 2022.

An 18-year-old man was rushed to the emergency room after a traffic accident. While waiting for the test results, his family burst into the room shouting, "Why is it taking so long? Emergency room, why the wait?"

The incident occurred in early March, when a man took his younger brother to a top-tier hospital in Hanoi for emergency treatment. The brother had just been involved in a car accident, falling and hitting his head on the ground, sustaining scrapes and bruises, and bleeding profusely, but he remained conscious.

At the emergency room entrance, medical staff collect information, complete admission procedures, measure vital signs, attach a triage chart, and transfer the patient into the ward.

After being ordered to undergo imaging tests, the patient continued to wait in the emergency room. At this point, the family urgently explained the critical condition, requesting a doctor to examine the patient because they "feared a head injury." The family questioned, "Many patients who arrived later received priority care, why does my sibling have to wait their turn?"

This scene is not uncommon in tertiary hospitals. At Gia Dinh Hospital ( Ho Chi Minh City), a man stormed into the emergency room, repeatedly cursing and assaulting doctors and nurses for making his family members "wait for several hours without examination," demanding that someone be assigned to watch over and care for the patient 24/7.

Meanwhile, according to the medical team on duty that day, the time from when this patient was admitted to the hospital until the completion of medication, blood tests, X-rays, the immobilization of the shoulder in a cast, and the examination by an orthopedic specialist was only 24 minutes.

Recently, at Nam Dinh Provincial General Hospital, a family member stormed in and punched a male nurse in the face and neck. The man claimed he lost his temper because he didn't see any medical staff assisting his father, whose health was deteriorating.

In medicine, saving lives is the ultimate priority, and emergency care for patients is always a priority, even if they have no family members accompanying them or their identity is unknown at the time of admission, according to Associate Professor Dr. Nguyen Lan Hieu, Director of Hanoi Medical University Hospital.

Minister of Health Dao Hong Lan also emphasized that "saving lives is the top priority, without any other considerations." In the emergency department, every life is carefully considered.

According to the 2023 Law on Medical Examination and Treatment of the Ministry of Health, an emergency is a sudden onset of a person's health condition or behavior which, if not monitored and treated promptly, could lead to impaired bodily function, serious and long-term damage to organs or body parts, or death, or pose a serious threat to the health and life of others.

However, "The process of admitting and treating emergency patients is categorized by severity, not by waiting time, yet many family members still feel that their loved ones are being neglected or abandoned," said Dr. Ha Anh Duc, Director of the Department of Medical Examination and Treatment (Ministry of Health), adding that patients and their families want to be served quickly and thoroughly, while medical resources are limited.

"Expectations exceeding the hospital's capacity to meet them are the root cause of the conflict," Mr. Duc observed.

Mr. Pham Van Hoc, Chairman of the Board of Members and General Director of Hung Vuong Healthcare System, noted that the emergency environment always requires rapid assessment and decision-making with limited information. This is a challenge because each decision is life-or-death.

However, emergency departments are inherently high-pressure, with time constraints, workspaces often located near hospital entrances, frequently connecting to the outside, and high foot traffic, leading to chaos, noise, and difficulty in control.

"To avoid missing any patients, doctors must categorize them and make quick and accurate decisions, otherwise the system will collapse," he said.

Dr. Tran Quang Thang, Head of the Emergency and Stroke Department at the National Geriatric Hospital in Hanoi, said that most people going to the emergency room assume they "will receive immediate treatment." Therefore, when they witness their loved ones waiting, anxiety quickly turns into anger and suspicion, leading many to resent and even assault medical staff. In reality, emergency care doesn't mean "first come, first served." In the emergency department, triage is a vital principle, based on life-or-death risk and fairness in healthcare.

"Emergency triage isn't about leaving anyone out, but about saving as many people as possible, with the right people, at the right time," the doctor said.

The National Geriatric Hospital is the highest-level facility for treating and caring for the elderly, and it continuously receives severe cases. The emergency classification and management process is divided into five levels. Level 5 is the immediate emergency for life-threatening situations such as cardiac arrest, respiratory arrest, deep coma, seizures, intravenous drug poisoning with altered consciousness, and dangerous behavioral disorders such as suicide or causing injury to others.

The yellow level is for emergency care within 10 minutes in life-threatening situations or situations requiring urgent treatment, such as severe pain. Specifically, this includes patients with respiratory failure, circulatory failure, acute stroke, fever accompanied by lethargy, multiple trauma with severe blood loss, chest pain suspected to be cardiovascular, mental disorders, etc.

The remaining three levels are: emergency care within 30 minutes for potentially life-threatening situations or adverse events within 30 minutes; emergency care within 60 minutes for situations that may worsen if not treated within 60 minutes or require testing, hospitalization, or treatment; and finally, emergency care within 120 minutes for mild or chronic illnesses, follow-up visits, review of old wounds, etc.

Doctors at the Emergency Center of Bach Mai Hospital provided emergency care to the patient.

Bach Mai Hospital is at the forefront of the medical landscape, with its Intensive Care Unit facing the most intense pressure in the country. This unit has over 160 doctors, nurses, and medical staff, working in two shifts daily. On average, they receive over 300 emergency cases a day, with approximately 70% being critically ill patients. Upon receiving a patient, doctors classify them based on their condition and then determine the appropriate course of treatment.

Specifically, the red category represents the top priority, requiring immediate resuscitation. These are patients with severe respiratory failure, altered consciousness, cardiac arrest, or psychiatric symptoms that pose a danger to themselves and others. The orange category is the second priority, requiring resuscitation within 10 minutes. The yellow category is the third priority, requiring resuscitation within 30 minutes, and the green category allows for monitoring and treatment within 1 hour.

Viet Duc Hospital receives approximately 2,000 inpatients and around 2,000 outpatients, each patient usually accompanied by one or two family members. The hospital has about 2,000 medical staff. Therefore, approximately 10,000 people are around the hospital each day. The unit has established emergency procedures and admission protocols for critically ill patients in accordance with the regulations of the Ministry of Health.

In hospitals in Ho Chi Minh City, the average length of stay for patients in the emergency department is typically no more than 4-6 hours, adhering to the "4-hour rule" and "6-hour rule" set by the city's Department of Health. Therefore, during initial treatment, medical staff must decide whether to transfer the patient to another hospital, discharge them, or transfer them to an appropriate inpatient ward to avoid prolonged stays in the emergency department. The priority of intervention depends on the severity of the patient's condition.

Hospitals are strengthening communication with patients' relatives during their stay in the emergency department, helping to create a sense of reassurance and reduce unnecessary anxiety and distress. In situations where the number of patients suddenly increases, such as mass poisonings or injuries, hospitals will coordinate to increase emergency support staff.

According to the Law on Medical Examination and Treatment, patients have the right to emergency care, and it is the responsibility of medical staff and doctors to ensure this right is fulfilled. However, doctors also have the right to refuse examination and treatment in certain cases.

For example, prognosticating a patient's condition beyond their capabilities or within their scope of practice; conducting medical examinations or treatments contrary to legal regulations or professional ethics; or a patient or their relatives engaging in acts that infringe upon the physical integrity, health, or life of a medical professional while they are performing their duties, except in cases where the professional suffers from a mental illness or other condition that renders them incapable of understanding or controlling their actions.

Associate Professor Nguyen Lan Hieu emphasized that the key issue is building a high-quality emergency and resuscitation system. Hospitals need to gradually improve procedures to suit their specific conditions, and he proposed establishing a "loss-subsidizing" mechanism for emergency and resuscitation departments, so that these units do not have to balance their own revenue and expenses, reducing financial pressure and maintaining the priority of saving lives.

In addition, he emphasized that the emergency environment also needs to be protected from violent acts. The procedures must be based on the general standards of the Ministry of Health but flexibly adjusted according to the specific characteristics of each level, especially at district hospitals.

"Professionalism and transparency are the goals the healthcare industry strives for. In the face of unscrupulous behavior, the medical community is ready to unite to defend what is right," the doctor said.

TB (according to VnExpress)

Source: https://baohaiduong.vn/cap-cuu-cung-phai-cho-den-luot-411324.html