During these weeks of empty and silent streets, the sirens remember every few minutes the reason for the confinement. In Madrid, ambulances come to the aid of dozens of people with breathing problems that can end in cardiac arrest. The way of working of these emergency toilets has been radically changed by the pandemic. They get into the vehicle and leave for the home with the first indications given by their coordinating center, which it executes quickly: “Woman, 49 years old, unconscious”, is read on the tablet. In some cases it is accompanied by a red code for “covid” (because the patient has already been diagnosed and is passing the disease at home) or with the message “suspected covid”, but, in many other cases, no.
Sometimes the ambulance starts walking without knowing what is going to be found. If that unconsciousness is due to a cardiorespiratory arrest by the covid or a heart attack. “When the family member has asked for the ambulance, sometimes he is so nervous that the coordinating center has not been able to find out if he is suspected of covid or not. He has not been able to clarify if he had a fever or cough the previous days,” explains Rthat Merlo, from the Community of Madrid Medical Emergency System (Summa 112) and member of the Spanish Society of Emergency Medicine (SEMES). “You have to understand it, the person is nervous, wants someone to come to attend to their family member and it is thought that, when the doctor asks so many questions, the ambulance is not activated. But we are already going. The questions serve to let’s get ready and know how to act and, in this pandemic, know if I’m going to have to put on personal protective equipment (PPE) or not, “he adds, didactics.
Upon arrival, what three weeks ago was done in just a minute, takes much longer. Now Merlo calls the intercom and does a “second triage” if he considers that he does not have enough information to know if you waste time putting on the PPE.
First ask if the patient has had a fever and cough. Also ask if there is a working thermometer and sphygmomanometer in the house. “I have to be clear if the entire team is necessary; if not, I always protect my face well with glasses, I put on a robe and double gloves“explains the doctor. Why do you ask for a thermometer and a sphygmomanometer?” Because I prefer to use the one they have in the house so that later I do not have to disinfect it and I ask that they take the temperature while I go up. “
If it is necessary to use the PPE, in principle only the doctor and the nurse will put it on, who will be the two people who will enter the home. The two health technicians who complete the mobile ICU act as a “mirror“and they make sure that everything is in place. One of them will never enter the house or put on the special suit, because he has to be kept ‘clean’ of viruses and must be able to maintain contact with the coordinating center and the hospital , open and close the ambulance and help his colleagues to remove the PPE, a very delicate moment to avoid infections.
When the doctor is dressed, she calls the intercom again and says: “I am going to go upstairs, I want everyone confined in a room except the sick person.” “It is very difficult to move and work in the suit and, since you don’t know how the relatives are, you cannot risk that they are coughing around you. Our protection is very important to continue working against the virus. And we hump more that the process is not enhanced for anyone, “he adds. “You think: ‘I’m taking too long and it could be a heart attack!’ That hurts us“he confesses.
The lace of reality
“It is very hard. Everything is dehumanized. They don’t see you,” he says. Yolanda Barrios, also a nurse at Summa 112 and an affiliate of the Independent Trade Union and Official Central (CSIF). “But, despite being like this, the familiars they respect you. They understand it, because they don’t bother you and they are very respectful with what we ask them “, he affirms before sighing:”They are giving us a lesson in this crisis“
Barrios believes that, for fear of going to hospitals, the sick “are holding on too long at home” and, when services arrive, it is sometimes late. “The covid triggers crisis unexpectedly and they get sick very quickly”, he laments, remembering the last guards. If the person has already died, now, with the pandemic, the coroner and the police are not notified. The certificate is issued directly. “It’s terrible. You leave the house leaving the family devastated and asking them not to come close, “he continues.
Light in the tunnel
Merlo finished the guard last Sunday believing that the situation is already beginning to be controlled. “It had nothing to do with what I experienced the weekend of March 14 and 15. There the calls of strokes, heart attacks, the emergencies that are normally the ones we attend to, were left hanging on the collapsed phones. It was that sad, “he regrets. Now, with the reinforcements of Summa 112, with a special telephone number (900-102-112) for queries about the coronavirus, the lines and services have been released, says the doctor, Y “they filter better “, so that the most urgent cases are not left unattended. In any case, ask not to let your guard down because of the risk of a second wave of infections.
At the end of each service, the PPE ends in a double-twist bag, the boots sprayed with a spray of water and bleach, and the ambulance disinfected. “We end up infinitely more tired by the rush of the suits, but, above all, because of the emotional burden of working in these circumstances“Barrios says goodbye.