Sardinia's emergency departments are furious: "We're being blamed for a system that doesn't work."

Sardinia's emergency department directors say enough. To the criticism, the exploitation, the attacks. They—and those who work in their departments—are often blamed for patient wait times, for lack of admissions. And, ultimately, for the excessive suffering of those who turn to hospitals and find no adequate treatment.

In a lengthy letter of protest sent to the local health authorities (ASL) commissioners and the health councilor, the directors of several emergency facilities on the island weigh in. They are Anna Laura Alimonda (Santissima Trinità), Giovanni Sechi (Alghero Civil Hospital), Wolfgang Orecchioni (AOU Cagliari), Luca Pilo (Ozieri), Michela Matta (San Francesco di Nuoro), Priscilla Ongetta (San Martino di Oristano), Nicola Tondini (Paolo Dettori di Tempio), Stefano Sau (Health Director of Areus), Paolo Pinna Parpaglia (Santissima Annunziata, Sassari), and Pietro Fortuna (Paolo Merlo, La Maddalena).

They draw inspiration from a case: that of an elderly woman in Carbonia who died after 12 days in the Sirai emergency room after a broken femur. Some had cried foul, but when the news became public, her relatives themselves defended the work of the doctors, nurses, and healthcare workers, who cared for the elderly woman—who suffered from multiple ailments—to the best of their ability.

Meanwhile, the staff had been caught in the meat grinder, with the director at the forefront: "We want to reiterate right away that defending our colleague is defending us all," the doctors wrote. But they added that "the solidarity shown to a professional affected by media exposure is not a gesture of professionalism, but an act of justice towards those who acted in accordance with their mission, in an organizational context that daily tests the entire healthcare system." In their colleague's place, it could have been any one of them: "Every emergency room director, every doctor, every nurse who works daily in the emergency departments," they wrote, "acknowledges themselves, their own difficulties, and their own sense of responsibility in this affair."

Anger is growing because "once again, we are witnessing the sudden and belated indignation of those who, despite fully understanding the system's structural criticalities, choose to point the finger at the one facility that never closes: the emergency room."

The directors point out that this very department "represents the gateway to the entire healthcare system, but it is not its end point. Waiting times, delayed admissions, and patient management difficulties are not the result of the inefficiency of the professionals working there, but rather the direct effect of a struggling hospital network, where peripheral facilities—often located in disadvantaged areas—are forced to contend daily" with a myriad of dysfunctions. These include: the absence or limited availability of specialized departments; the chronic shortage of beds in hub facilities; and the failure to implement regional resolutions and regulations requiring referral centers to accept patients from peripheral spokes.

In this context, "every transfer becomes a daily battle, every hospitalization a negotiation, every clinical decision an act of responsibility that is often made alone, amid simultaneous emergencies and resources reduced to the bare minimum."

Added to all this is a scourge that has plagued the healthcare system for years: boarding, "that is, the prolonged stay in the emergency room of patients already assessed and awaiting admission. A phenomenon as frequent as it is unacceptable, it transforms emergency rooms into forced hospitalization wards. We often find ourselves managing patients for days or even weeks, in overcrowded conditions that jeopardize the safety, dignity, and quality of care. Boarding is not the responsibility of emergency doctors or nurses: it is the symptom of a system that is no longer able to guarantee its own flow of care, and that unloads the entire organizational dysfunction of hospital care onto the emergency room."

Those who work in emergency rooms "know well what it means to care for patients on stretchers, waiting for a bed that never becomes available. Yet, despite everything, the staff continues to provide care, dignity, and safety, often beyond all human and professional limits."

Doctors on the front lines are "tired of witnessing superficial and offensive media campaigns, which make those who every day, with dedication and expertise, support a system that would otherwise collapse, look guilty."

If we really want to change something, "we must start by rigorously applying existing rules, enforcing the Hub & Spoke networks, and recognizing the value and sacrifice of those who work in Sardinia's emergency rooms. The Carbonia case is not an exception: it is the daily snapshot of a reality that everyone knows about, but few have the courage to denounce."