Samu de São Paulo forces teams to take patients without stretchers in ambulances

The Samu (Mobile Emergency Care Service) teams in São Paulo are having to provide care and transport patients to the hospital in ambulances without a stretcher, in case the equipment is missing or is stranded in hospitals and emergency rooms. The situation was reported by officials to the Sheet.

According to the Ministry of Health, the articulated stretcher with wheels is a mandatory item in Samu ambulances, and moving without it is a type of irregularity.

In the absence of a stretcher, patients are being taken to the emergency department on a long board – made of plastic or wood, made for treating trauma – or sitting on a bench.

The ambulance has nowhere to fix the board correctly, and the equipment needs to be placed on the ground, according to officials. With a sudden braking, the patient can slip and hit some part of the body.

Sought, the Municipal Health Department says that “in specific cases of absence of a stretcher, professionals are instructed to accommodate the patient on a long board affixed to the bench and not on the floor”.

Officials point out, however, that in the seat there is a risk of falling if the seat belt is released. In addition, this is the location of the health professional who must assist the patient during the journey.

Samu is a federal program that follows rules and criteria established by the Ministry of Health. It is managed by prefectures or states. In São Paulo, the service is the responsibility of the municipal secretariat, currently managed by Mayor Ricardo Nunes (MDB).

In a reserved character, the report heard doctors and nursing professionals who provide pre-hospital care at Samu. They claim that they are being forced by the administration to adopt an irregular practice and are threatened with suspension, exoneration and even denunciation in the class council for failure to help if they fail to comply with the order. Management did not comment.

The problem of retained litter is old, difficult to solve and impacts service production. When Samu leaves a patient in the emergency room and the place has nowhere to accommodate him, the health unit stretches him until the person is attended to, at least. The equipment gets stuck for hours. There are cases where the hospital retains more than one stretcher.

Prior to the new rule, the team could not return to base or be called for another occurrence without the stretcher. Now, according to reports from doctors and nursing professionals, the center passes the call and says to “take it anyway”.

“An impact at 40 km per hour increases the chance that you will have a severe abdominal contusion and injuries to the face and eyes. Sometimes the person is on IV, unconscious. How do you hold a patient on the ambulance floor?” , asks Domingos Costa Hernandez Júnior, a physician specializing in the management of public health services at Fundação Getulio Vargas.

For him, the solution would be to increase hospital turnover to avoid the retention of the stretcher.

“The city and state hospitals have overcrowded emergency rooms and empty wards. The patient with 24 hours in the emergency room needs to have a definition: internal or discharged”, he says.

According to officials, daily, the service needs to put 122 ambulances on the streets for 24 hours, but that is not what happens. According to the prefecture, an average of 85 vehicles circulate.

Professionals still complain about doctors who work in the regulation of Samu. They assess the priority of the event and determine the resources available for urgent care.

According to reports, this screening is not done. Thus, street teams are obliged to answer simple calls such as toothache and stuffy nose, for example.

It is up to the doctors to guide the citizen by telephone when the situation does not require the dispatch of an ambulance.

Secretariat says it tries to speed up the release of stretchers

Through the Municipal Health Department, Samu de São Paulo says that it is monitoring the release of stretchers with hospitals so that it occurs as soon as possible, without prejudice to the rescued.

The folder states that, in addition to the stretcher, ambulances have other life-saving equipment, such as oxygen, respirator and defibrillator, and that transport techniques are part of the regular training of professionals who must ensure the safety of the patient and the team itself.

The folder also states that more professionals should be hired to increase the number of teams on the street. Since 2020, 518 new employees have been hired, according to the secretariat.

In addition, says the agency, the Service Regulation Center was restructured. As of October, Samu plans refresher courses for high school and higher education professionals in order to qualify the assistance provided to the population.