(Rivista Internazionale - December 1997: The Awakening Unit of the St. John the Baptist Hospital - 2/6)

The "Awakening Unit"

A new model has been created for the complex management of patients in the "awakening" stage of serious post-traumatic coma. The pluridisciplinary team enables a multimodal approach supported and optimised by the presence of various skills, interacting and integrating with each other in a concentric manner, their only objective being how best to serve the patients primary needs.

Over the last two years, albeit the increase of road accidents, technological progress and the promptness of first-aid, intensive care and neurosurgery have significantly increased the survival rate of young people with craniocerebral trauma. In Italy, it is calculated that, for every 100,000 inhabitants, there are around 200 cases of severe head injuries per year.
Recent studies indicate that a significant percentage of patients surviving the acute stage die during the subsequent clinical course, not so much from the lesions suffered during the trauma, but because care and treatment are inadequate for the complex clinical picture.
These patients are emblematic of the disease in its broadest sense, the summa of all the physical and mental impairment. Besides affecting motor functions, olfactory, facial and acoustic nerves, there is the impossibility of swallowing, the need for incisions in the stomach and throat, as well as the danger of concomitant infections and orthopaedic problems, secondary damages occurring during the intensive stage and, finally, the changes in the state of consciousness involving perceptive and mental isolation.
No voluntary act is possible, no needs can be expressed or even the most elementary need satisfied without even an intrinsic sense of self-preservation.
Despite this, these patients' possibilities of survival and recovery can be enormous, but greatly depend on the care of the clinical team to whom they are entrusted.
Unfortunately, to date the emphasis has been solely on the organisation of the first-aid and rescue network, whereas we now realise the importance of a system functioning in every part, something which requires the reform and reorganisation of the structures managing the subsequent phases. To eliminate the "avoidable deaths" and improve the medium and long-term prognosis is it necessary to create special units.
Unhappily, once the intensive care stage is overcome, "ad hoc" centres for receiving these types of patient are almost non-existent in Italy.

The patients thus end up being "parked" in wards where lack of, or inadequate or delayed, treatment, inevitably creates complications (bed sores, septic states, neurological complications, muscle or tendon retractions) not only hindering their recovery but even endangering their lives.
The professional and moral conflict aroused by these health deficiencies, or even better "no-mans land", has prompted the Sovereign Military Order of Malta to take up this cause and, amid many difficulties, to set up the first "Awakening Unit" in Italy in its St. John the Baptist Hospital in Rome. This unit has involved breaking away from the traditional concept of rehabilitation, laying the foundations for a new approach and placing it on an equal footing with the most prestigious ones operating on an international level. For over three years the "Awakening Unit" has been accepting seriously ill patients, guaranteeing their survival and helping to bring them out of coma. It is based on well-proven scientific theory and is equipped with sophisticated diagnostic and therapeutic means.

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