Airports have emergency rooms

Report from the rescue center : How Berlin's emergency rooms are preparing for the Covid 19 rush

Cut, broken wrist, stomach ailment, disoriented senior citizen, fainting, cut again, disoriented senior citizen - all new additions to a Berlin rescue center within an hour of an evening.

“And all of them rightly so,” enthuses the doctor on duty. "Normally there would be ten minor cases here, people with little ailments and a lot of time." At the moment, fewer patients are coming after fights or car accidents, plus the current ban on visits - you can finally concentrate on medicine. And then the doctor says a sentence, because of which he will ultimately ask to remain anonymous: "Thanks to Corona!"

"Everyone has the air, off to the intensive care unit"

The rescue doctor knows that the virus is likely to put his clinic to the test soon: "All colleagues who have a bit of air now are trained for the intensive care unit." Epidemiologists warn of a "mass attack of infected people", as is the case in the The federal government's pandemic plans are called.

Health Minister Jens Spahn speaks of the "calm before the storm", Angela Merkel of the fact that schools, pubs and shops must be closed and exit restrictions must remain in effect.

Almost 725,000 people infected with coronavirus were registered worldwide by Monday, the number of unreported cases is probably many times higher. In Germany there will soon be 60,000 known cases, 3000 sufferers had to be hospitalized, and almost 460 - previously seriously ill - patients died. The viruses, officially called Sars-CoV-2, can cause the lung disease Covid-19.

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Because of the fear of it, says the ambulance doctor, only emergency patients dared to go to the emergency rooms, and the lockdown ensures that less bad things happen on the streets: "Since Merkel's speech we have around 25 percent fewer cases - so we can rely on Covid -19 to prepare. "

In a dramatic appeal on March 18, the Chancellor swore the German citizens to solidarity and discipline. Since then, it is also said in various clinics, the waiting rooms have been emptier. Berlin's health senator Dilek Kalayci, SPD, even fears that, fatally, even people with heart attacks will stay at home for fear of infection.

Paperwork keeps caregivers away from work

Concerns about infection could give clinics the time they need to avert disaster. Because almost everywhere there was a lack of nursing staff, renovations were necessary, and paperwork kept highly qualified staff from doing more. “The chances are not bad that we will make it,” says Hendrike Stein. For 16 years the surgeon has headed the rescue center of the state-owned Vivantes Clinic in Berlin-Neukölln, one of the largest emergency rooms in the country.

Stein also says that there are 15 percent fewer patients, and that treatments that can be planned in-house have been postponed - but overall the work will not be less. Anyone who can, should usually help in the intensive care units in the near future: What should I watch out for with the ventilators? Which documents are still compulsory despite Minister Spahn's announced paperwork avoidance? How can Covid-19 cases be separated from other patients?

Flutter tape, warning sign, lock door to the Covid-19 hallway

“There's a different sense of community,” says Stein. “More pragmatism among decision-makers.” A new era began for the doctor. Seven hours of sleep became five, and one rescue center became two: one for Covid patients, one for non-Covid patients. Stein had one of the tracts cleared, and hung a flutter tape and warning signs on the lock door: Covid area - access only with a mask on. Even if all doctors, nurses and security guards are already wearing one.

[You can follow the latest developments in the coronavirus pandemic here in the news blog.]

A look into the locked Covid-19 hallway: a dozen empty beds, a nurse pushing a device behind a curtain, filled disinfectant dispensers.

Stein has just gone into her office when there is a knock. An ophthalmologist comes in and has no more patients on her ward - all appointments have been postponed. Now she should familiarize herself with the hustle and bustle of the rescue center. In the emergency rooms, it is important to identify infected people in good time.

In Neukölln someone arrives every day with a fever or shortness of breath, reports Stein, who does not think of an infection despite constant corona news. Stein has suspected cases tested, but because the analysis of the smear can take days, the patients also come to a computer tomograph: "This is how we see changes in the lungs."

Protective masks are locked away

There is another knock, a nurse with a box of new masks under his arm. Before the crisis, the employees took one-way masks from the station warehouse over the course of shifts five, six, and seven. Now everyone receives one a day that has to last eight, nine, ten hours - and is wet after the layer of damp breath. “You don't make yourself popular,” says Stein. “There is a dispute when I explain that we cannot hand out a high-security mask for every coughing patient.” The box remains with the boss.

Undoubtedly, German clinics are among the best in the world. Equally undisputed: over the years, foster care facilities have been abolished en masse, clinic buildings have been neglected. The pandemic is still reaching its peak, but protective masks, gloves and disinfectants are already in short supply. From private, church and state houses it is said that disposable articles are washed for re-use and that treatments that also involve gowns are not always carried out in full clothing.

The corona pandemic highlights the problems of the health care system, the shortage of personnel, the increasing average age of patients and the financing. Put simply, until 2003, clinics received an amount from the health insurances for each treatment day. The insurance companies found that it cost too much, if only because doctors wanted to observe their patients in bed for longer rather than shorter periods of time.

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The federal government and the health insurers introduced the case-based lump sums: Since then, depending on the diagnosis, there have been fixed amounts that often do not cover the actual costs. Planned operations that have now been postponed due to the pandemic are lucrative. So far, the federal government has made a vague promise that there will be enough money for Covid 19 treatments.

"Difficult conditions with mass casualties"

Neukölln's hospital is there for 600,000 potential patients in southern Berlin. In the event of a disaster, it would be responsible for the wounded at Schönefeld Airport. It is worrying that internal documents in 2015 said: “Difficult conditions with mass casualties.” Last year, almost 80,000 patients arrived in Stein's emergency room, which was once designed for 25,000 patients a year.

In the meantime, sums of money have been invested in buildings and technology. "Apparatus, medication, protective material is one thing, more important is motivated staff," says rescue center chief Stein. "It's just like that in the emergency room, but most intensive care units are missing people."

After nursing protests, Minister Spahn decided in 2019 that an intensive care nurse should care for a maximum of 2.5 patients per day shift. Not only in Berlin, say clinic managers, this could not be adhered to before the corona crisis, there are not that many nurses. Spahn lifted the regulation for the time being.

The decisive factor for the extent of the pandemic will be how many intensive care beds with ventilators and trained staff there are - in Berlin there were 1,045 such places in January, then machines were ordered and former intensive care nurses were asked to return to the wards. There are now likely to be 1,300 of these intensive care beds. What if not hundreds, but thousands, need a ventilation place?

The vast majority of cases will not be as severe but will require medical attention. Senator Kalayci is therefore having an ad hoc clinic built on the exhibition grounds. It is not yet clear where the up to 800 employees will come from. Perhaps the Covid-19 center will not open in April as planned, but in May. They are still looking for an operator in the Senate: Would Vivantes?

Central information on the corona crisis in Berlin:

In Neukölln there is a knock on Stein's door again, a nurse brings four boxes with 1,500 disposable gloves each. They are also locked in, the colleague has to move on, a patient is waiting. The Senate and the Federal Government fully rely on the commitment of the employees in the clinics. What about the doctor's offices? Apparently they did not have any stocks of protective material, and many medical practitioners in private practice are not receiving any patients at the moment. And the health authorities? Every fifth position in Berlin's public health service is vacant.

“After all,” says Stein, “the paths between the disciplines are shorter, the hierarchies have become a bit flatter.” Every day at 12.30 pm, Stein meets with other bosses for the in-house pandemic team: How many new cases are there, who needs staff What is the Robert Koch Institute currently saying?

Maximum supply? "Do we want to maintain"

So far, the German health care system has promised every insured person treatment based on the latest research. “Everyone has got used to a kind of maximum care,” says Stein. “Of course we hope to be able to keep it up.” Even before the pandemic, however, unpleasant decisions had to be made in Neukölln when 30 patients arrived in an hour: demented home residents, victims of stabbing, families overburdened after household accidents.

Whoever comes first is decided according to a triage system, from “trier” - French for “sort”. Experienced nurses divide the patient into urgency levels: suspected stroke is treated immediately, lacerations later.

The fear of Covid-19, ultimately of suffocation, does not stop at the helpers. In the past few weeks, said a medical officer, ten percent of Berliners who were demonstrably infected with corona were employed in the health service. But without the doctors and nurses in the hospitals, as the next few weeks will show, no crisis plan works.

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