Usually dealing with terrorism, counter-terrorism and special forces, a person is inclined to observe the world from a very broad, dramatic point of view, often concentrating on striking actions, experienced by third parties, which raise the indignation or pride of entire nations. You end up losing touch with everyday reality, even the smallest. For years now, newspapers and even military and geopolitical historiography have focused on the usual themes which, unfortunately, continue to hold sway with a flurry of increasingly theatrical events. For several months, however, in Italy the focus has been on the greatest friend / enemy man can have: nature. The earthquake, which has shaken Central Italy for months, is an uninterrupted nightmare that is bringing some of the most beautiful and productive regions of our country to its knees. In recent days, even if he were a well-trained accomplice, the bad weather made the situation worse, causing death and disasters. In the midst of all this there are several strands of stories that touch the lives of the victims, the tragedy of those who have lost everything, stories of inefficiency and files opened by the various prosecutors to look for those who have failed in their duty and where. A special chapter is dedicated to the "volunteer" aid and system that only Italy manages to mobilize whenever needed. But what amazes - and excuse the puns - is that the mass media continue to be amazed. What is happening, see the deployment of the Civil Protection, of the Fire Brigade (volunteers or not), of the ANPAS (National Association of Public Assistance), Alpine Rescue, Red Cross and a thousand other realities, represents the movement of a gear that cannot be never stops, and that is oiled especially when the emergency is less visible to everyone.
This article stems from direct experience and is that of volunteering in Public Assistance, the main support of the national 118 service. An operational logic that, for better or worse, is borrowed from other associations that offer similar services, based on the emergency in any situation and that employs staff not regularly paid.
The entire city health assistance system rests entirely on the voluntary performance of many young people who think it is more useful to spend a few hours with an orange luminescent uniform rather than wasting it somewhere else with headphones and cell phones. The tradition of Public Assistance starts in the mid-nineteenth century. Even today, several Mercies or Crosses exhibit a sort of wooden cart in their seat, covered by a worn-out curtain on which a symbol is embroidered: these were the first ambulances, driven only by human strength. Since those pioneering years, time has passed. The war in the Crimea and the First World War have improved - on the skin of soldiers - both emergency medicine and the entire first aid system whose benefits have had a relapse among civilians. To make school were the Americans who in the sixties founded the EMS (Emergency Medical Service) with the adoption of the famous Star of Life, world mark of all ambulances. In Italy we waited until the nineties when the first independent emergency number, the famous 118, was activated in Bologna (in the 1992 Cossiga it will elevate it to national reference). Despite the continuous changes, still today volunteering is fundamentally a vocation. Not everyone does it, not everyone knows how to do it, nevertheless the level of preparation of those who today travel in an ambulance has made great strides. Among the volunteers there are no hierarchies such as in the military sphere, there are no age limits - if not those imposed by one's physical form - everyone knows how to do something and even those who do not feel like climbing into the back room with a victim and a stretcher can make his contribution in any other form. Our system differs from that of other countries, especially as regards what a volunteer can and cannot do. In Italy there is no paramedic as in the American EMS: for example, an Italian rescuer cannot administer drugs because it is not required by law. From a qualitative point of view, the level of a local rescuer is equivalent to a first US EMT (Emergency Medical Technician) level with a training period of 180 hours of lessons, both with the possibility of performing BLS-BLSD and pediatric BLS techniques. The staff of the Emergency Ambulance Crew (EAC) in London, for example, qualifies after a period of 22 weeks of training in which they learn to assist the paramedics.
Although at the antipodes of the rescue the base was "take the patient and take him to the hospital as soon as possible", now the system focuses more on the actual competence of those who physically perform the service. Of course, an emergency intervention does not always imply situations at the limit, but is also based on a series of fundamental maneuvers and techniques aimed at securing the patient and then transferring him to the nearest PS. In essence there are more or less simple urgencies, but the important thing is to understand that an apparently peaceful situation can turn for the worse quickly and in the game there is a person's life. All decisions made on the rescue vehicle are constantly monitored by the doctors of the Operational Center who dispense instructions by solving any questions from the operators. 118 doctors and nurses are, in fact, too few and cannot be sent anywhere: their presence is examined, case by case, by the CO according to the seriousness and the assigned codes (Green, Yellow or Red). A volunteer must learn the various procedures of rescue and security: immobilization with the various available principals, treatment of burns, contused wounds or fractures, extricate a victim from a vehicle, administer oxygen when needed and even intervene on a cardiac arrest thanks to the use of automatic emergency defibrillators (AEDs). The contribution of a rescuer often touches the emotional sphere of a person in difficulty: moral and emotional support is something that doctors often cannot do, but which is useful as a medicine. The qualification courses - whose frequency varies according to the resources and the Regional practice - are taken care of by the 118 department which issues a certificate of high value, however most of the preparation falls on the "veteran" personnel of the PA who puts daily his experience gained "on the road" is available. Nobody can intervene on the predisposition to rescue and on the nervous hold of an individual, there are in fact no courses that prepare for the sight of certain unpleasant situations that can happen during the service.
When the telephone is ringing at the switchboard of a PA, it is not only for emergency calls, as the rescuers take care of an infinite number of tasks: transporting dialysis patients or people with mobility difficulties, supplying blood and plasma to hospitals or simply the blankets for those who are cold are only a small part of what is required. There are also some private conventions that lead the volunteers to go around the streets of Europe to transfer patients who need special care. To all this we must add the constant training and the increasingly frequent exercises aimed at understanding the increasingly complex areas in which an emergency service could be performed.
Several PAs have the continuous need to conform and renew their equipment, both of the vehicle fleet and of the medical health aids. The money that goes into the cash desks serves to the evolution of the performances and to the salary of the few rates of fixed personnel which guarantees the basic services (always overworked) 24 hours on 24.
Motivation, friendship and awareness of the importance of what you do is the main glue that links the relationships of those who spend their time between a few chats, a lot of work and the emergency in the urban jungle. Young and not so young people mix their experiences: in a public administration the personal data does not exist, everyone learns from the other. The analogies with the military world are different, but perhaps the most important of all is the spirit of belonging that everyone pours into his own uniform and the color of his own Cross. Once, for better or for worse, there was the lever that inculcated certain values that some people fooled with contempt as "militarists".
Unfortunately, such an important reality is often forced to deal with laws and bureaucracies that do not facilitate the absolution of the pre-established tasks. The cuts in health in each region force many PAs to close or halve services. Obviously we must also deal with a vocative crisis among young people, induced by lifestyles in which the words "sacrifice" and "altruism" are not trendy. Certain old companies do not have the strength to carry out structural adjustment work and for this reason they have to demobilize. Given the interaction of the PA with the urban fabric, superior to any other state or even municipal institution, each lockout corresponds to a blow to the public welfare.
The images of these days - sad and unpleasant - must make us reflect on what volunteering means in the Italian system, but above all to investigate the driving force that drives the soul of these people. The serious fact is that precisely the State, which in the matter of medical aid and not only could intervene in a more energetic way, values its men as long as the need exists (it reminds me of something about the army). Once the emergency is over, every small PA on the territory returns anonymous, in the midst of its everyday difficulties and the growing need to see its virtues recognized.
It is the usual value of Italy that always comes from the bottom.
(photo: ANPAS)
