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  • Health. Catalonia advises against admitting patients "with a poor prognosis"

The recommendations of the Generalitat of Catalonia to restrict hospitalization of sick patients with severe preexisting pathologies in Catalonia have circulated among health personnel. Two professionals from emergency teams rule out this means of following the suggestions to the letter, on which the Government denies that they imply limiting therapies or that they lack resources for all those infected by coronavirus.

"I am not going to let a person of 30, 50, 70 or 80 years die badly because there is no respirator. I will take the patient to the ambulance if necessary, I will transfer him to a health center and there they will decide. They can call me irresponsible and that I will saturate the system, but I am not going to leave anyone at home who could die, "responds an employee of a medical transport company hired by the Department of Health .

The worker clarifies that "normally" he is hospitalized, often by consensus with an optional coordination center. "My decision is always going to be to move, unless I am 98 years old and the time has come for the poor. To die in a hospital without anyone taking his hand, I put on a mask and gloves and I stay at his side until he dies. With good sedation you don't have to suffer, "he says.

"Assistance is being limited because they are collapsed. If there is total collapse in an area, it is much more limited and they send primary care doctors," says a nurse, who states that "the protocols are to guide but also to skip them when necessary "

"If a person in a residence exceeds the established age but their conditions are good, we will not leave it there. The ethical code is generated by each one," he maintains, while stressing that "no one is left unattended."

"What happens is that the aggressiveness of the attention is one or the other because, with 200 respirators and 400 patients, you have to decide who to put them on," he says.

"Death at home is the best option"

"There is no limitation, the health system is increasing the number of beds. It is intended that each patient receive the most appropriate therapeutic option according to technical and ethical criteria, and taking into account the opinion of the patient and his environment," defends Xavier Jiménez , medical director of the Emergency Medical Service , which has written the indications.

He denies that it is due to hospital saturation that the document postulates that "death at home is, at this time, the best option." "Even if we had seven million beds, terminally ill people would not benefit from being admitted to the ICU. Many would only be agonized."

Workers concede in cases where hospitalization is inadvisable. They point out the danger that a fragile base person with no confirmed positive in Covid-19 will end up getting infected when entering. "If primary care were reinforced, treatments could be done at home and risks and saturations could be avoided," says the doctor.

"Grandparents are better at the residence than in the hospital. They are in chairs or armchairs because the bunk beds have run out and, with a lot of patients, you cannot attend to them as they need," observes the nurse.

Jiménez claims that medical judgment prevails over advice. He notes that the guidelines do not differ from those prior to the pandemic, although they have been updated "due to the increase in the number of patients in whom decisions must be made."

He adds that emergency teams are asked not to mention the lack of beds for lacking "tools to decide whether to enter the ICU" and "transmit confidence or hope instead of fear."

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