★ SEMES sets out a series of recommendations for influenza or other respiratory infections

Acute respiratory infections (ARIs), such as influenza A or COVID-19, are causing a 35% increase in emergency department visits compared to this time last year.

As the Spanish Society of Emergency Medicine (SEMES) warns, this rate has not yet reached its peak.

In this sense, at the end “Weekly report on sentinel surveillance of ARI and SARI: influenza, COVID-19, and other respiratory viruses,” The report released on January 4 stated that during week 52, the influenza hospitalization rate was 9.5 cases per 100,000 residents (versus 5.9 cases per 100,000 residents the previous week). Regarding COVID-19, the hospitalization rate for the week was 3.5 per 100,000 inhabitants (previous week: 2.4 per 100,000 inhabitants). Likewise, influenza spreads with greater intensity than other respiratory viruses and continues to be a growing presence in hospital emergency settings.

In communities such as La Rioja, attendance increased by 30% and income increased by 50%, according to SEMES data. The same happened in Castile and León, with an increase of 25%, and in Murcia, where attendance increased by 50%; for example in Basque Euskadi, Comunitat Valenciana or As In Asturias, these dates are already record-breaking, with a 20% increase compared to November 2023 and December 2022.

In the Balearic Islands, on the other hand, emergency services are severely saturated due to insufficient patient drainage, which is why contingency plans for emergency room saturation have been activated for several days. Likewise, the number of patients waiting for a bed increased by 60%, and nursing time increased by more than 4 hours.

patient advice
Influenza viruses are mainly spread from person to person through the air, saliva droplets and nasal secretions expelled when coughing, talking or sneezing. These viruses can remain on hands, surfaces, or become dispersed in the air, so infection can occur by touching your eyes, nose, or mouth after being exposed to droplets from someone with the flu.

Prevention is the best way to fight the flu. Some tips from SEMES to avoid contagion:

1. Wash your hands often: before eating, before handling food, after leaving the bathroom, and after blowing your nose or coughing.

2. Cover your nose and mouth when you sneeze or cough: If possible, use your arm or a tissue instead of your hands.

3. Use disposable tissues: Throw them away after each use and do not store used tissues or leave them on a table or bedside table.

4. Avoid kissing and very close contact, as well as sharing glasses, cutlery, towels and other items that may have come into contact with saliva or secretions.

5. If someone in your home has the flu, clean common surfaces (doorknobs, sinks, handles) more frequently using common cleaning products and open windows more often to ventilate rooms.

6. Live a healthy life: sleep well, eat well, drink water, exercise, avoid alcoholic beverages and tobacco.

7. The use of masks is only recommended in the following situations:

anyone People who are sick or starting to have flu-related symptoms when in the presence of other people, especially in poorly ventilated areas.

anyone In health centers such as health centers and hospitals. Its use in waiting rooms is important to avoid transmission to vulnerable groups.

anyone Health care providers in the presence of patients with influenza A (H1N1) influenza A or patients with symptoms consistent with the influenza A (H1N1) virus.

anyone In enclosed spaces, try to maintain ventilation.

8. Get vaccinated: You need to get a flu shot if:

anyone adult:

· 60 years or more.

· Minors under the age of 60 who are in dangerous situations.

· pregnant woman.

· Health center staff.

· Workers in the national security forces and corps or essential public services such as firefighters.

· smoker.

· People who have direct occupational contact with animals.

anyone child population:

· Minors aged 6 to 59 months.

9. Ask a professional if you have any questions: If you have any questions, please consult a health care professional.

10. Stay home if you have symptoms: The virus can spread from 1 day before to 7 days after the onset of symptoms, with the highest contagion in the first 3 days. It is recommended to stay at home to ensure you do not spread it to others.

Advice on when to go to the emergency room.
Flu symptoms appear suddenly and may include:

anyone Muscle pain

anyone Chilled all over

anyone Dry cough (no phlegm)

anyone fever

anyone Headache

anyone sore throat

anyone Vomiting and diarrhea may occur in some cases

Treatment includes:

anyone Relatively rested.

anyone Drink plenty of fluids.

anyone Avoid drinking alcohol and smoking.

anyone Take medicine to improve flu symptoms (medicines to reduce fever, headache…).

anyone The flu is caused by a virus, so antibiotics cannot improve symptoms or speed healing.

anyone Do not give aspirin to children or teenagers (it can cause a rare but serious syndrome called Reye’s syndrome).

Flu complications are uncommon and occur primarily in older patients or those with chronic medical conditions.
To avoid saturating health centers and hospitals, SEMES advises patients with influenza and COVID-19 not to visit emergency rooms unless absolutely necessary. Although these viruses can cause annoying illnesses, it is possible to combat them at home (self-care) for people with no previous history of the disease.
We urge people to take responsibility and only go to the emergency room if a specific set of circumstances occur:

anyone If the patient is a vulnerable person, such as an infant, the elderly, or someone with a special medical condition.

anyone If you feel short of breath, choking, or having difficulty breathing normally.

anyone If you have chest pain accompanied by a severe cough.

anyone If you continue to have vomiting or diarrhea.

anyone If there is a change in consciousness.

anyone If you have a high fever for 48 hours that does not go away with conventional medications.

anyone If you are in a sensitive group such as pregnant women, immunosuppressed people, people with heart disease, chronic illness or diabetes.

Advice on emergency access and drainage.

The emergency department prioritizes those patients with the highest priority based on triage level first. Therefore, lower classification levels will have longer delays.
On the other hand, please note that the first level of care consists of primary care and HED should be reserved for severe cases once the first assessment has been carried out by the first level. Additionally, the Emergency Coordination Center can provide telephone advice and properly manage what to do and where to go.
However, 70% of emergencies are not referred but come on their own initiative.
Going directly to the emergency room means delaying care for the most seriously ill patients. Health is everyone’s right, and protecting health is everyone’s obligation.

It is necessary to remember that referrals from primary care to emergency departments are for the acute care provided within these services and not for attendance at other specialties/services.
One of the major problems currently existing in emergency departments is the lack of drainage (patients waiting for timely admission). On the other hand, updated structured contingency plans are necessary and critical to deal with these crises. Based on this, some recommendations from emergency physicians are:

Level 1. Globally, 5% – 7% of emergency room patients are awaiting hospitalization:

· Issue notifications about increases from management to all hospital services.

· Investigate opportunities to enhance home or short-term residential treatment units.

· Priority is given to ED admissions.

· Establish regular meetings through process management.

level 2. Globally, 7% – 12% of emergency admissions are awaiting hospitalization:

· Strengthen the units and services under consideration, with a particular focus on those that accelerate emissions from households and into factories.

· Daily meetings were held with the heads of emergency departments and departments with the greatest drainage problems to agree on measures such as staff reinforcements and hospital infrastructure management.

· Adapting surgery to healthcare needs.

· Plan for expanded areas for urgent care and hospitalization.

Level 3. Globally, 12% to 15% of emergency room patients are awaiting hospitalization:

· Surgical activities are suspended, except for urgent or priority 1 interventions.

· Urgent care and inpatient expansion areas open.

· All essential hospital services have been strengthened.

In addition, after three days of a 10% increase in demand for emergency care due to influenza outbreaks (compared to the average of the past 6 months), the need to strengthen emergency departments will be studied in line with previously agreed plans. Relationship between center management and ED director.
as the picture shows Dr. Tato VazquezAccording to the President of SEMES, “The role of HED is to meet needs, but without adequate drainage, they cannot guarantee this assistance. That is, if patients waiting for admission are not admitted in time according to all quality indicators.” In this sense , Dr. Vázquez assured that if this were not done, emergency rooms would become “patient warehouses,” making new admissions impossible, in addition to statistically increased mortality. Likewise, patient dignity and privacy are not guaranteed in this case, as admissions “must be completed within 4 hours of the decision,” adding that it is the manager’s job to reschedule daily admissions. Ensure emergency room admissions meet quality standards so these essential services can function appropriately.

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SEMES