Wednesday, May 23, 2007

Zagreb ER

Today we visited the hospital in Zagreb. It is the only major hospital in the city, and also receives patients from all over Croatia, as it is the only hospital in the country with a trauma center and a burn unit. The hospital also specializes in spine and pelvis surgery. The first thing that we noticed upon arrival was that it was hot and small. The air conditioner was under-used, but this seems to be a tendency throughout the entire country, which may be due to lack of funding as opposed to the desire to save energy. Our group spoke directly to the director of the hospital, and then we were divided into two groups. One group went to view the ambulance bay and ER, and one group went to the outpatient part of the hospital to view some minor wound care. I personally was in the group to witness the wound care, and there were several things that I noticed. We were required to don scrubs and face masks before entering the room, and there was a nurse present at all times, according to strict policy. The doctor was very thorough about cleaning the wounds, using four different types of antiseptic solutions. They were also very fast with their work. We witnessed the doctor stitch up a cut finger on one man, and then drain a hematoma on another in about 15 minutes. We also noticed that their records are all computerized, which is very advanced technology, as the United States has only recently switced to this.

Next we viewed the intensive care unit and the burn unit (both groups got to do this). The equipment in the ICU was state of the art and our professor remarked that they use the same machines in the United States. There seemed to be a lack of privacy, however, as the beds were not separated by curtains and were placed very close to each other. There also seemed to be a problem with space, as there were only about 12 beds, and the room was filled to capacity. In this room we learned the importance of time and place in relation to the likelihood of survival in an accident. There was a woman who had been hit by a tram right outside the hospital. Had she been any further away, she would have died. This is an important consideration because the hospital is the only one in Croatia with a trauma center, and many cities and villages are many hours away. Transportation to the trauma center in a timely fashion could mean the difference between life and death for many accident victims. There are some helicopters that will airlift people to the centers from some of the islands or remote locations, but are not abundant enough to solve the problem. We also learned that many of the accidents that occur in Croatia are seasonal agricultural injuries, such as falling off of a ladder while picking cherries. This could mean that the ICU ward would be more full during these periods, which could lead to problems with the space issue.

The burn unit that we toured was state of the art and brand new. While visiting this area, we learned some important facts about burn victims. The most common victims are usually old or disabled, and suffer burns while at home, such as falling onto a hot stove. Diabetics are also susceptible to burns; there was a man in the unit who was a diabetic and scalded his leg because he could not feel the temperature of the water. The most severe burn victims in the hospital were victims of traffic accidents, and had been burned in their cars. We also learned that advances in burn care, as well as orthopedics, tend to happen in times of war. Croatia experienced war in the early 1990s, so advances have recently been made.

The visit was extremely informative and educational, and our group left feeling as though we had learned a great deal about Croatia's healthcare system and quality of medical care. We would not have been able to tour the same facilities in the United States, so we were very grateful for this opportunity. Overall, we felt that the aesthetic issues were troublesome (the building is very old, so it appeared unclean and rundown in spots), but that the quality of care and technology are up to par with other nations in European Union, which Croatia hopes to join in the next few years.

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