Why couldn’t the CMA save a nurse who died of a cerebral hemorrhage?

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The recent death of an Asan Medical Center (AMC) nurse who suffered a cerebral hemorrhage while on duty has deeply shaken the medical community. AMC is considered one of the best among the top five hospitals in Korea.


Health industry officials wonder why the AMC, with state-of-the-art medical facilities and elite doctors, could not treat the nurse immediately and had to transport her to the University Hospital. National Seoul (SNUH).


According to Blind, a mobile app for an anonymous forum among verified employees, the nurse complained of headaches and collapsed while working at AMC in the early morning of July 24. He was diagnosed with a cerebral hemorrhage after an examination at the hospital emergency room.


AMC said it provided emergency treatment, including embolization to stop the bleeding, but the nurse’s condition was critical. An AMC surgeon was absent and it was quicker to move her to SNUH for quick surgery than to wait for the surgeon to arrive at AMC, the hospital said.


However, the nurse died after arriving at SNUH.


A nurse from Asan Medical Center (AMC) died while being transported to Seoul National University Hospital (SNUH) after suffering a cerebral hemorrhage while on duty on July 24.


The death of the CMA nurse sent shock waves not only through the medical community but also in political circles.


Some lawmakers have argued that the government should investigate the incident. Civic groups have urged the government to punish AMC under the Serious Accident Suppression Act.


Representative Seo Young-seok of the Democratic Party of Korea said he could not believe AMC, the largest tertiary hospital, had such a ‘poor medical environment’ which failed to save the nurse , during the meeting of the National Health and Health Assembly. Social Committee Tuesday.


He asked the Ministry of Health and Social Care to carry out a factual investigation. In response, Second Deputy Health and Welfare Minister Lee Ki-il said the ministry would do so.


A civic group, Civic Action Changing Nursing and Care, said AMC should face legal penalties for an alleged violation of the Serious Accident Prevention Act.


He asked the government to form an investigation team to punish those responsible for the death of the nurse and to prepare measures to prevent such an incident.


The Serious Accident Prevention Act came into force in January to punish an employer who violated the obligation to establish a safety and health management system, in the event of a serious accident such as the death of an employee. ‘an employee. Such an employer could face a prison term of one year or more or a fine of up to 1 billion won ($761,594).


“Chronic shortage of intensive care beds, specialists have made the problem worse”


Insiders in the medical community were cautious as to why AMC transferred the critically ill nurse to SNUH, but cited shortages of intensive care unit (ICU) beds and specialists as the main limitation of the system. Korean health.


They speculated that AMC must have decided to transport the nurse because she did not have enough beds in the ICU.


ICU beds in most Korean tertiary hospitals are 90% full, and this problem occurs not only in AMCs but in all tertiary hospitals.


Korean Stroke Society (KSS) President Bae Hee-joon (from the Department of Neurology at SNU Bundang Hospital) said the most crucial factors in urgent surgery were operating rooms, intensive care and surgeons.


“Tertiary hospitals don’t have much room in these three cases,” Bae said.


When 90% of intensive care beds are occupied, the hospital has no room for an urgent patient, he continued.


“Hospitals should have enough operating theatres, beds and human resources to provide care for critical serious illnesses, but they are not doing so. This problem was already predicted,” he said.


Another expert said AMC must have struggled to prioritize its nurse and ignore another patient who was waiting for ICU entry before the nurse.


An urgent care professor said intensive care units at Big Five hospitals, including AMC, are still full.


“A lot of people are waiting in the emergency room, but if you treat the employee first and transport the other patient to another hospital or delay the hospitalization of the patient, you have to ask yourself if it is ethically acceptable,” a- he declared.


Can Koreans accept a situation where a hospital first treats its employee and refuses to receive other patients, he asked.


A third observer raised the possibility that a specialist who could perform demanding surgery to stop a subarachnoid hemorrhage had to be absent from the AMC, given the sudden worsening of the nurse’s condition.


“If angiography had been enough, AMC would have done it,” said an emergency medicine specialist. “But if the aneurysm was ruptured, it would require very difficult surgery that takes six to 10 hours.”


She added that such surgery is not something any surgeon could do.


“There are only a handful of brain surgeons who can perform such an operation in a hospital.”


Even if AMC had such a neurosurgeon, the surgeon cannot operate on two or three patients at the same time, she continued.


People think AMC is the biggest hospital in Korea, but they should know that situations may vary, she added.


“The medical safety net is essential to secure the golden hour”


Following the death of the CMA nurse, some have raised the need to build a safety net to treat major serious illnesses such as strokes or cerebral hemorrhages at the right time.


Hospitals need enough beds, operating theaters and human resources with government support, they said.


KSS Chairman Bae said the prognosis of a stroke or cerebral hemorrhage could change by just one hour.


He pointed out that a stroke patient should receive treatment at the first hospital and should arrive at the hospital within the golden hour.


“To do this, there should be a system for sharing information about beds and surgeons. But we don’t have such a system,” he said.


A patient with cardiovascular disease should receive treatment immediately after arriving at the hospital, Bae noted.


“As golden time is important for cardiovascular treatment, we need a separate emergency medical delivery system,” he said.

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