The Ambulance Service (Free phone 196) within the Casualty and Emergency Department of Mater Dei Hospital is operated by the Health Department and is located at Mater Dei Hospital, Malta's only public General Hospital.
The fleet of Ambulances consists of several VW Ambulances and Fiat Ducato Ambulances. The Ducato ambulances which have been recently added to the fleet, each containing state-of-the-art equipment for medical care inside the ambulance.
It is now a speciality in its own right and all persons involved in the running of such a service are highly trained. This includes the ambulance personnel, radiographers, nurses and doctors. At a casualty department one must not forget the reception, portering, and cleaning staff whose support, although not so obvious, is essential. With so many people involved, the care of any emergency will have to be a "team event", with all those involved working together to offer the best possible care to a patient.
Besides the long established family practitioner, who today is often very well equipped, Malta is very lucky to have an extremely well structured national health service. Health centres are strategically located around the Island, so that no one is more than a few minutes away from medical care. These health centres are staffed round the clock with nurses and more than three times the number of doctors staffing the casualty department at St. Luke's Hospital. They not only attend to patients arriving at the clinics but also carry out home visits to those who are house bound. The service is free and available to everyone. The health centres have been equipped with many diagnostic facilities like ECG and X-ray machines, and also specialist services.
With the easy availability of such extensive medical care in the community, it stands to reason that the family doctor or the health centres should be the first port of call of most patients when an "emergency" arises. The patient is assessed by the doctor and treated. If necessary, he is then referred to the Casualty Department at St. Luke's for further treatment and/or investigations.
Unfortunately this is not always the case. For various reasons, often best known to the patients themselves, many people present themselves at the Casualty Department as soon as they percieve an ailment. This is not the right thing to do. Such patients cite innumerable excuses as to why they use the casualty department in the first instance. These include living close to the hospital, being at SLH to visit friends or relatives who are in-patients, unaware of the facilities offered at HCs, distrust of HC services, belief that the cause for a long-standing complaint that has not been found by several GPs and specialists will be found in the casualty department...the list is endless. It is obvious that the public must be better educated and informed. But this brings us back to the question of what is an EMERGENCY?
Any incident that is life threatening is an obvious emergency and there is usually no difficulty with these cases. There is a wide spectrum of such cases - from heart attacks to car accidents.
However, with many cases it is not so easy and it is here that the vast experience of the Casualty staff is to be appreciated. Every case attending the casualty department at SLH is first registered and then seen to by a triage nurse.
TRIAGE is an internationally recognised procedure, dating back to Napoleonic times, concerned with sorting out cases in order of urgency. That is prioritising them so that the cases most in need are attended to first. Triage is an ongoing process whereby repeated assessments of patients ensures that the changing condition of a patient is recognised and the patient will get treated appropriately. This ensures that at no time is the waiting period going to affect the management or ultimate out-come of the patient's condition.
The essential role of triage cannot be over-emphasised. In an emergency department, one cannot expect to be treated on a "first come first served basis", but only according to the urgency of the need of care.
Once a patient has been assessed by the triage nurse, he or she is managed accordingly. There are three groups of patients. The first are seen to virtually immediately while a second group may have to wait for treatment. A third group are those that are told that their complaints do not necessitate the use of the Emergency Department, e.g. sprained ankles, cuts and grazes, rash, sore throat or any long standing complaint. These can be easily managed by their general practitioner or at the Health Centres. These last ones, are of course, non-urgent cases but no patient is ever refused treatment at the department. However it is obvious that, should they wish to wait, they will be attended to when all other more urgent cases have been seen.
And this is what some patients find unacceptable. More often than not, the valued advice of the
triage nurse is ignored. A patient will insist:
Meanwhile, the more urgent cases are being treated out of sight in the treatment area. A small number of cases deserve a mention at this stage. Some cases require immediate resuscitation. These cases (such as unconscious or collapsed patients, or cases of drowning or major road traffic accidents) usually bypass reception and are rushed into specially equipped resuscitation rooms for immediate treatment. These are deservedly very demanding on staff and time.
Of course no one case is the same as another and every patient needs adequate time for treatment. One case may need a few minutes of medical and nursing time while another may take up to an hour with various specialists having to be involved. The manpower resources of the Casualty department are not inexhaustible. There are a set number of nurses and doctors manning the Emergency Department 24 hours a day, every day of the year. They have to deal with all the patients who turn up at the Department. These staff work in an extremely stressful environment having to make difficult decisions quickly and correctly. They are faced with patients who are often severely injured or mutilated, tragic accidents and awful diseases, day in day out. However they are often taken for granted by the patients seeking treatment and sometimes even verbally or physically abused.
So why do they do it? The answer is simple: DEDICATION! Many of the staff have been in the department by choice for several years. Their wealth of experience is invaluable and should be better appreciated. Many of the doctors, at great personal and financial sacrifice, have undergone post-graduate training to enable them to offer better patient care from which every patient benefits. The doctors and nurses continue to undergo in-house training and education regularly as the speciality of Accident & Emergency is so dynamic and all are keen to keep up to date with knowledge and skills. This continuing education occurs both during working hours as well as on days off!
One must mention the ambulance service. The Health Department offers a 24-hours emergency ambulance service, which can be reached by phoning 196. These calls are received at the Casualty Department by experienced nursing staff who will decide on the staffing and equipment needed for the various calls. A call out for a patient wqith a suspected heart attack will require different things from a patient who has fallen off scaffolding. This is where the co-operation of the public is required and asked for when an ambulance call is received. Correct details regarding the condition of the patient are very important and not a waste of time.
Unknown to many, both staff and equipment come from the casualty department so that when an ambulance goes out with a nurse on board, that nurse depletes the nursing complement on duty in the Casualty Department. It is not unusual to have four or five ambulances out at the same time. Judicious use of the ambulance service is essential. It is there solely for the transport to or from casualty of patients who are unfit to travel by other means. As in all things free of charge, the service is abused and misused. Again, this is not an inexhaustible resource and a futile ambulance trip may mean that a more urgent case may be endangered by having to wait for an ambulance to be available.
One must not forget the possible occurance of a major incident at any time, with a large number of casualties at the same time making it very difficult for the service to cope. One example was the explosion at the drydocks in February, 1995. These, thankfully rare, incidents cause great stress and stretch resources to the limit, both in the sense of manpower as well as equipment. Casualty staff are trained and committed to deal with these events.
For an efficient emergency service it is important to let the people, trained in emergency work, do just that: MANAGE EMERGENCIES. Greater public awareness is needed for better use of the Casualty Department. In the end, it is this same public who will benefit from the service in an unexpected "emergency".
So next time you think of using the Casualty Department, please stop and think: "Do I really have an emergency? Can my GP or well staffed Health Centre deal with this problem first? Am I abusing of the Doctor's or nurse's time and stealing it from more deserving cases?"
And in the unfortunate event that you DO HAVE to attend the Casualty Department, you will find CARING and COMMITTED STAFF to take care of you, but please BE a "patient" PATIENT.
Hearing about people on the brink of death admitted to the Emergency and Admitting Department (EAD) at St Luke's Hospital is one thing - witnessing their suffering, and the frantic efforts to save their life by the staff working at the EAD, is another.
As I wait to speak to the nursing officer in charge in the main corridor of the EAD, a young boy in a wheel chair is pushed past me. He is barely 10 years old, his eyes are closed and his face scaly from first degree burns he suffered after a petard exploded in his face.
Many others continue to walk past me, some crouching in pain. There are a number of elderly people who seem to have suffered a fall accompanied by their relatives. Doctors and nurses are breathlessly walking up and down the corridors, in and out of cubicles treating patients who have gone past the triage area.
Unfortunately few understand the concept of triage. As a result some of those in the waiting room of the triage area become verbally and sometimes physically abusive with the staff. They would not react in this manner if they just read the posters stuck on the walls, indicating which are and which are not emergency cases.
Triage is a dynamic of rapidly classifying patients on the basis of the urgency of treatment needed. At EAD patients are prioritised as Priority One, Two and Three. One being the more urgent cases.
"In the triage area, a nurse is assigned to assess all the walk-in patients," Ms Mary Bezzina, nursing officer in charge at the EAD told The Malta Independent on Sunday.
"According to the guidelines provided, the nurse assigned to the triage area decides which priority the patient fits into and then proceeds accordingly. If the nurse considers the patient to be a priority one case, the patient is seen to immediately," she explained.
Ms Bezzina said there are times when there are many urgent cases and even then priority is given to the most urgent case out of all the urgent ones.
"Some people do not understand what the EAD is for," she continued. "We see many cases which can easily be treated at health centres or by a general practitioner. Unfortunately even the medical staff at health centres do not cooperate at times."
The less urgent cases - Ms Bezzina said - are categorised into priority two and three. People in this category are the ones who many times have to wait for long hours before they are seen to, because the medical staff will be busy seeing to life-threatening cases.
When dealing with urgent cases, the patient is taken to the acute area of the EAD. The prioritising of medical care is based on the nature and severity of the illness or complaint, history, signs and symptoms, general appearance, vital signs, and a brief physical assessment. Through experience a triage nurse often detects subtle signs that can lead to diagnosis of a serious health problem.
On that day Nurse (Mrs Giovanna) Debono was assigned to the triage area of the EAD. In the course of her studies, Mrs Debono, who has been working in the EAD for six years, carried out an intense research of this area. She took the initiative of putting up self explanatory posters in the triage area to educate the public.
Mrs Debono explains that to work in the triage area, a nurse has to have at least two years experience and even then she needs supervision. This is a specialised area, she explained. Not just any nurse can take the responsibility of assessing the patients at the triage stage.
"At this stage patients give you limited information. It is a fast process. You have to be quick and alert enough to assess the situation and decide whether it is an urgent case or not. You have to take down a brief medical history of the patient. You also have to be able to read in-between the lines of what the patient is telling you, assess it and then pass the patient on to the doctors concerned."
Triage is probably the most stressful area in the EAD. Emergency: understanding what Urgent cases are.
As I sit with Nurse Debono in the triage area, people are continuously knocking at her door. They complain they have been waiting for far too long. Little do they know that some of those seated in the waiting area should not be there in the first place.
"While patients complaining about the long waiting hours have their own reasons for doing so," continued Mrs Debono, "they are not justified, when they become verbally abusive and aggressive towards the EAD staff."
Many of the walk-in cases at EAD being assessed are non-urgent cases. One woman complained about a back pain after she had been carrying heavy bags. She said she decided to call at the EAD because she was visiting a relative at St Luke's. Another complained about a stomach ache.
Among those in the waiting area are the urgent cases, one man was kicked by a cow in the foot while he was working at the abattoir in Marsa. A woman complained of chest pain - this is treated as an urgent case. Another man came in after he was involved in a fight the night before and was badly bitten by his attacker. Others had severe fractures and some had symptoms of a heart attack.
Dr Robert Camilleri, principle medical officer at EAD said the triage system goes against the Maltese culture, which is why many complain.
"As Maltese we are used to a culture of a first come first served basis. We are always careful to note who is being served before us….therefore the triage system goes against the psychological make up of the Maltese culture," said Dr Camilleri.
"Ironically enough it is usually those who have the least urgent cases who become aggressive and shout at the staff," he added.
Nurse Lucienne Brincat said she suffered verbal abuse from some patients. She also suffered physical abuse and was once bitten aggressively by a person waiting at the EAD.
All nurses and doctors working at the EAD have been through some form of physical or verbal abuse by patients. Nurses have reportedly been punched and assaulted on ambulances on their way to hospital.
Malta was unfortunately the place where one of the worst hijack disasters in history occured. On 23 November 1985, when an Egyptian task-force stormed the hijacked Egypt airplane at Luqa airport, resulting in more than 60 passengers being killed. Ms Bezzina was working at the EAD at the time.
She was head of shift and worked day and night when the injured passengers were thrown out of the plane and taken to St Luke's Hospital.
On that day the hijackers threatened to kill a passenger every 10 minutes, after they were refused fuel at Luqa International Airport. Following the hijackers' threat, Egyptian President Hosni Mubarak sent his commandos to Malta, to save the passengers involved in the hijack.
In fact after the plane was bombed and in flames, Ms Bezzina accompanied one of the three hijackers in an ambulance to the EAD with a bullet wound in his leg.
"I remember the hijack disaster clearly," recounted Ms Bezzina. "the day before it happened, the EAD was unusually quiet. Whenever there is a day like that at EAD, we somehow always expect a disaster to happen the following day."
"I had left work at 8 p.m., the night before and when I came to work the following morning at 7.00 a.m. they told me there was a hijacked plane, that had landed in Malta during the night," she continued. "They warned me not to go into one room at the EAD, because there was an American woman, a passenger on the hijacked plane, lying dead."
All the staff at EAD immediately started preparing for what could happen in the ensuing hours of the day. "We were lucky that we had a whole day to prepare. In the meantime several wounded passengers were coming into the EAD regularly, because the hijackers were shooting frequently and throwing people out of the plane."
In fact, medical staff were on standby at the airport, "I was awake for 24 hours. At one point they called me and a few others to go and relieve those who has been on standby at the airport. That is when disaster struck. I remember that when I got to the airport, the plane was already on fire."
"All the passengers were coming down, most of them were dead and the rest were being rushed to hospital in ambulances," she said.
"I had one of the hijackers and an Egyptian commando in my ambulance," said Ms Bezzina. That day Ms Bezzina and all the staff from the EAD stayed at Luqa International Airport till 4.00 a.m.
Ms Bezzina, who has worked at the EAD for 20 years, was appointed nursing officer in charge six years ago. She was also in the ambulance which went to the aid of 34-year-old father of three, Police Constable Roger Debattista who was shot dead at Ta' Farsina branch of Bank of Valletta in Qormi last November. "Mr Debattista lived for two hours before he died, here in the EAD," Ms Bezzina said.
One fine day, you may find yourself face to face with an emergency in which you are either the victim or a witness. What are you to do in such circumstances? Remain a passive spectator or try to be of help to any victims who may urgently need your assistance, even by making a little phone call to the EMERGENCY SERVICES? Do you know the Emergency Numbers?
Do you know what to do when you come face to face with an emergency situation at your office, during your recreation or at home? What will you do when you witness a car crash, when your kitchen catches fire, or when your child chokes on some food?
The sites which appear hereunder, link to some professional information which may be of help to you to BE PREPARED for such an eventuality. Go through them and try to gain some benefit from other people's know-how. If you are really interested click on any one of these wonderful and beneficial sites: You may one day need their advice!
From the 19th July 1997, the life saving service which started in 1996 at Ghadira Bay, Ghajn Tuffieha Bay and Birzebbugia will be in operation during the weekends. This service is sponsored by the Office of the Prime Minister (Department of Civil Protection) and will last till the 18th September 1997.
This service is being organised by the Malta Red Cross Society, the St. John Ambulance Brigade, St. John Rescue Corps and the Special Assignment Group of the Malta Police.
This service will see prompt assistance in case of emergencies, until the proper services arrive on the scene of accidents. Dinghies for Coastal life saving will also be available to the rescuers.
Moreover, it is planned that a Maritime Unit within the Department of Civil Protection will be set up so that these life saving operations will be better co-ordinated for the benefit of the citizen.
Fil-jiem shan tas-sajf, id-Dipartiment tas-Sahha Pubblika jappella
lill-pubbliku biex jevita temperaturi gholja. Id-Dipartiment jissugerixxi
dawn il-mizuri :
1. Evita x-xemx diretta bejn l-10 ta' filghodu u l-4 ta' wara
nofs in-nhar. Sports u attivita' fizika fit-tul u fis-shana tista'
tgholli t-temperatura tal-gisem b'mod perikoluz u twassal ghal
2. Meta espost ghax-xemx uza kapell jew umbrella tad-dell.
3. Thallix tfal jew pets f'karozza maghluqa, lanqas ghal
perjodu qasir. Shana zejda jkollha effetti aktar qawwija fl-anzjani,
tfal u nies li jbatu b'certu mard kroniku.
4. Uza fan u ivventila tajjeb il-kmamar biex tbaxxi t-temperatura
5. Ixrob hafna ilma; mal- 1.5 sa 2 litri kuljum, sakemm ma jkollokx
problemi medici. Ilma b'tahlita ta' melh u zokkor apposta (oral
rehydration salts) jghin jirkupra l-gharaq mitluf.
6. Ilbes hwejjeg hfief, komdi u li ma jkunux issikati mieghek.
7. Sintomi tal-effetti hziena tas-shana jinkludu telqa, nixfa
fil-halq, ugigh ta' ras u dardir. Jekk xi hadd ihossu hazin minhabba
s-shana, ressqu f'post fid-dell sakemm jistejqer. It-temperatura
tista' tnizzilha permezz ta' fan u billi xxarrab il-gilda
b'bicciet imxarrba. Jekk il-persuna tkun tiflah ghandha tinghata
tixrob. Ghandu jigi kkonsultat tabib mill-aktar fis.
Is-sajf huwa zmien ta' mistrieh u hafna Maltin u anki barranin jerhulha lejn il-bajjiet taghna ghal mistrieh taghhom. Huwa wkoll iz-zmien meta ghandna noqghodu ferm attenti biex jigu evitati incidenti kemm fuq il-bahar kif ukoll fix-xtut taghna, bhalma huma kazi ta' "bends", kazi ta' gharqa, kollizjonijiet fuq il-bahar, u incidenti simili li jkunu jenhtiegu interventi ta' malajr kemm mis-servizzi medici kif ukoll tas-servizz tal-ordni pubbliku.
Ghall-konvenjenza tal-pubbliku, qeghdin inxandru n-numri tat-telefon ta' xi servizzi ta' emergenza li huma ghas-servizz tal-pubbliku matul il-gurnata kollha:
|Pulizija - 112 or 191||Ambulanza - 112 or 196|
|Tifi tan-Nar - 112 or 199||Rescue Team - 2168 3443|
|AFM Patrol Boats - 2123 8797||Helicopter Rescue - 2180 9279|
|St. Luke's Hospital - 2123 4101||Mosta Polyclinic - 2143 3256|
|Paola Polyclinic - 2169 1314||Mosta Police - 2143 3800|
|Paola Police - 2123 7542||Valletta Police - 2122 5496|
Il-pubbliku huwa mitlub biex jikkopera billi ma jabbuzax minn dawn is-servizzi essenzjali u meta juzahom jaghti dettalji ezatti u precizi lil operators sabiex l-ghajnuna mehtiega tasal malajr u bla dewmien.
Dawn huma s-servizzi b'risq ic-cittadin u ghalhekk ghandhom jintuzaw bil-ghaqal.
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last modified: January 2010