THE first time he came back from Ukraine, he found it hard to get used to the silence. It was a relief, of course, being away from the sounds of war, but every time an ambulance siren pierced the air above Buenos Aires, Dr Adolfo Savia jumped out of his skin.
He had wanted to go to Ukraine from the moment the war began, and in September 2022 a Harvard Humanitarian Initiative finally made that possible. The constant bombing, including of hospitals and clinics, and profound empathy for those living on the frontline, made working in a war zone “a complicated experience” but it was one based on a simple premise. Dr Savia says: “I am an emergency doctor – when people get hurt, I must be there.”
This same premise guides his actions every day – as head of emergency, first at Sanatorio Anchorena Recoleta, for the past 18 months at San Juan de Dios, and now also at the Central Hospital of Pilar, inaugurated in May; as the former medical director for the private emergency medical service ACUDIR, as president of the Emergency Council of the Argentine Society of Medicine, as a teacher of emergency medicine at private and public universities, and as a doctor on a mission to Ukraine.
“I think about emergency medicine hundred percent of the time,” Adolfo Savia says. “I am an ER physician, it’s what I do, what defines me. My specialty is to treat patients with a time-dependent emergency. I am trained to be there in their worst moment and make an important difference.”
Preventing disaster or death from time-dependent emergencies depends on doing the right thing in a narrowing window of opportunity. Treating acute ischemic stroke is no different, except that a successful intervention may reward you with the rare sight of a patient recovering before your eyes.
“It is the most spectacular sensation,” Dr Savia says. “The impact is enormous, for the patient and for the healthcare system. The patient gets better and it’s all worth it, but to make the patient better you must also make the system better – or it would be no more than an accident. The work must be multiplied, so that the system changes the reality for all patients.”
This shared commitment to changing the quality of treatment for every stroke patient is the basis for a natural alliance between Dr Savia and the Angels Initiative – a partnership that to date spans five years and three hospitals.
“Angels has made a difference in my life,” he says. “It has given me the opportunity to make a difference in other lives.”
FROM time to time, Dr Savia still shows students and new colleagues the video of the first stroke simulation workshop conducted at Sanatorio Anchorena Recoleta in 2018. In this simulation the dummy patient was “treated” at CT, so when the first real patient arrived, they were treated at CT too – a key priority action that most stroke-treating hospitals around the world have yet to adopt. The hospital’s first WSO Angels gold award came in early 2019 and although it was soon surpassed by five diamond awards, Dr Savia displayed the gold on his office wall for four years.
“It was the most important one,” he says. “It was a reminder of what we had achieved, it recognised the efforts of everyone who made it possible, and it stood for all the people we were able to help.”
When he joined San Juan de Dios Hospital at the start of 2022, Dr Savia brought his experience and the stroke protocol that had been developed in Recoleta with him, so change happened much faster. And at the new hospital in Pilar where he had the opportunity to design the emergency unit from scratch, he optimised it for stroke, including locating the CT scanner just metres away from the emergency entrance.
In each instance he found that pathway changes introduced for the benefit of stroke patients – such as prenotification and delivering the patient directly to CT – had advantages in all emergencies, because they entailed shrinking the gap between hospital and prehospital teams.
“It’s a very powerful way to tear down the barriers,” Dr Savia says. “If the teams are close for stroke, then they are close for all trauma.”
As medical director at ACUDIR he oversaw the development of an app that reinforced the most important actions in the prehospital phase – “no more, no less, only what is necessary”. Working in this capacity gave him unique insight into the prehospital perspective, but rather than describe two disparate vantage points he emphasises the continuity of care.
“It’s the same patient,” he says. “It’s a chain. From the minute someone dials 107, the stroke protocol begins. Recanalisation ‘starts’ in the ambulance when you recognise the symptoms and act with speed to get the patient to a hospital where they can receive treatment.
“It’s the same patient, only in different moments and situations, and if the chain breaks you won’t have a good outcome.”
This chain of survival (more commonly used to describe interventions after cardiac arrest) is a key concept in the Angels playbook for changing outcomes for stroke patients. So is the duty to leave one’s legacy, another phrase Dr Savia has made his own. “I believe in every sentence of Angels,” he declares. “I ‘buy’ all of them, they are my motto for what I do.”
DR SAVIA’s explanation of what he does is equal parts clarity and compassion.
He says, “I studied medicine to become an emergency physician. I wanted to be in the exact spot where ‘things happen’, help people, solve problems and move on to next patient requiring help.
“I tell my students, this is the most asymmetrical doctor-patient relationship because in an emergency the patient didn’t choose us. They didn’t ask, where is Adolfo working? They don’t choose me but because I choose to do this work every day, I have to fulfil and exceed the patient’s expectations. I have to do better.
“In emergency medicine you have a very brief window of opportunity to prevent death, to diminish complications, but also to bring calm and kindness to patients and relatives or even bystanders who find themselves in the very worst moment, and are victims sometimes of terrible things.”
Dr Savia’s point of view is that of an emergency physician who has witnessed trauma both in a war zone and on the emergency ward. But let’s imagine a world in which everyone thought the same way about human suffering – as an “amazing opportunity to do good things in dark moments”.
