Medical emergency system in the metropolitan area of São Paulo

Abstract

The present paper analyzed the emergency medical system in the Metropolitan Area of São Paulo during the year 1999 through the exam of all the pertinent laws, the description of the attendance process of the Regional Controlling Unit (Plantão Controlador Regional - PCR), and the verification of the adequacy of the adopted procedures to the norms that regulate the sector and to an efficient attendance of the patients. Documents were analyzed, interviews were carried out and the functioning of the system was observed in the PCR and in three general hospitals. The paper describes the oral history of the creation of the system and the services routine. It was observed that there was personnel shortage in the PCR and that the doctors did not follow the same routine of procedures. It was also verified that many people, including the doctors on duty, did not know what the PCR was, and that transfers were sometimes impossible due to lack of transportation. Furthermore, the Medical Files and Statistics Services of the researched hospitals are outdated and there is shortage of material and human resources. Although the size of the sample does not allow generalizations, it could be observed that there was lack of beds in the Neonatal ICU, and that the most frequent reasons for the request of resources were lack of beds and equipment, faulty equipment and shortage of personnel. These requests often received a negative answer at first, with the most frequent reasons being lack of beds, unavailable equipment or transport. Most cases arrived at the PCR after the professionals in charge had tried to solve the problem on their own under the justification of delay in solving the case. Based on the rules of the system and on the analysis of international experiences, the paper provides suggestions for the efficacious implementation of a metropolitan emergency system in the metropolitan area of São Paulo.