Common sense the key to handling emergencies

PUBLISHED : Tuesday, 06 January, 2009, 12:00am
UPDATED : Tuesday, 06 January, 2009, 12:00am

Caritas Medical Centre's investigation of the death of a man who collapsed outside the hospital has concluded what we suspected: that staff were not proactive enough in offering help. Hospital chief executive Ma Hok-cheung has rightly apologised for the mishandling of the incident. An independent inquiry is looking into whether disciplinary action should be taken; the Hospital Authority has already announced new guidelines to try to prevent a repeat. The response is all well and good, but what is needed most is ensuring that all employees use common sense when confronted with an emergency case.

Why this did not happen on December 20, when the man's son rushed to a front desk receptionist in the hospital's main building and asked for urgent help, is unclear. She told him to dial the 999 general emergency phone number instead of herself calling for an ambulance. A passing doctor saw the stricken man and phoned the hospital's accident and emergency department. Nurses there sent a security guard rather than a medical team. The man arrived at the emergency room 26 minutes after his son got him to the hospital and was certified dead shortly after.

There has understandably been a community outcry over the incident. We expect public hospitals to cater to our health needs, especially emergency situations. The Hospital Authority's stated mission is to 'serve the public with care, dedication and efficiency'. Dr Ma said as much in his report, contending that the centre's staff were 'committed and willing to give their best to the needy'. They would, he said, offer all the necessary help without reservation if confronted by a person with a life-threatening condition.

That obviously did not happen on December 20. If it had, Dr Ma would not have determined that the response of the receptionist and the accident and emergency department were inadequate. Nor would he have questioned the communications skills of the hospital spokesman, who gave a press conference and issued a statement the following day. Educating staff about expectations of hospitals and ensuring an appropriate response needs to be a priority.

There have been calls for Dr Ma to resign and those directly involved to be sacked. But those are not healthy ways to deal with the matter; they would achieve nothing. Some form of discipline may be appropriate, however. It is important that the centre and other hospitals learn from the incident.

A lack of guidelines covering emergencies outside the hospital's doors was initially given as a reason for the delay in getting treatment to the man. Governments and their institutions too often turn to rules to resolve problems. But guidelines cannot deal with every possible contingency. In hospitals, staff need to exercise common sense while having a proactive attitude towards patients. This should apply to all employees, regardless of whether or not they are frontline medical workers.

There are also matters quite specific to the centre that need to be dealt with. The hospital's emergency section is poorly sign-posted; circumstances might have been quite different if the man's son had initially been directed to the department. Such may also have been the case if the emergency unit had been equipped with a portable defibrillator to help the patient. Outdated equipment meant a wait for an ambulance with the apparatus, rather than sending one immediately with medical staff. In response, the Hospital Authority will buy 200 portable defibrillators for its institutions.

We do not know whether such measures would have saved the man's life. A common-sense attitude by staff would certainly have given less cause for criticism. Ensuring that this thrives in our hospitals, rather than staff being directed solely by guidelines, is essential. The lesson should have been well learnt. We need to educate hospital employees in the right mindset.