REGIONAL ECONOMIC FORUM MOLDOVA 2025

19th Edition – Vatra Dornei, July 9–13, 2025

Thematic Panel:

Health and Medical Services in the Moldova Region

Speaker:

Dr. Ramona Guraliuc – Head of Emergency Department, Botoșani

Topic of the Intervention:
“Management of Medical Emergencies in Small Hospitals / The Need for a Digitized Rapid Response System / Training and Retention of Staff in the Emergency Department”

The Head of the Emergency Department at the Botoșani County Hospital, Dr. Ramona Guraliuc, delivered a sincere, dynamic, and highly relevant message regarding the critical state of emergency medicine in small hospitals.

Pressure on the Emergency System – “We Are Heading Towards Disaster Medicine”

Dr. Guraliuc spoke openly about the overload of the emergency system, which faces a constant influx of patients while resources – human, logistical, and financial – remain limited.

“The number of emergency presentations exceeds our resources, and statistically speaking, we are heading toward disaster medicine.”

She emphasized that currently, there is no real analysis of the cost per patient in the Emergency Department, as the focus remains on professional competence and saving lives, not accounting.

“A life is priceless. But we must look at things realistically. Emergency medicine consumes a lot of money, we have double budgeting, and many patients are not even insured. Yet, we cannot refuse them. Fortunately!”

This universal openness of Emergency Departments, regardless of insurance status or origin, is essential, she says, because “we never know what might be behind a vague chest pain – it could be a heart attack.”

Digitalization – an Urgent Necessity, Not a Luxury

An essential aspect addressed by Dr. Ramona Guraliuc was the importance of digitalizing the medical intervention process, with emphasis on the use of telemedicine, already partially applied within the Emergency Department in Botoșani, in collaboration with SMURD and the ambulance service.

“We already apply telemedicine in the pre-hospital phase. Colleagues in the field transmit real-time data for complex cases, allowing efficient coordination. Sometimes, a single specialist is enough to oversee dozens of interventions simultaneously.”

Dr. Guraliuc supported the need for investments in digital infrastructure and rapid diagnostic equipment (such as enzymatic tests), which can significantly reduce reaction times and increase the accuracy of medical decisions.

“We need a national interoperable database, accessible in real time. Many patients arrive at the Emergency Department unable to communicate effectively – either due to neurological conditions or cognitive disorders. In such cases, the medical history and treatment regimen must be immediately available.”

This digital component is, in her opinion, fundamental for the efficient operation of the emergency network, especially in underserved or medically disadvantaged areas.

A Silent Crisis: Lack of Qualified Staff and Exhaustion of Medical Teams

Dr. Ramona Guraliuc highlighted one of the most acute problems in Romania’s emergency system – the severe shortage of qualified medical personnel, especially in hospitals in less developed areas. In a realistic and candid presentation, she described the current situation at UPU-SMURD Botoșani, a representative example for many similar units nationwide.

“The Mavromati Botoșani Emergency Department operates with a total of 13 doctors, one of whom is the head of the department. We have three shifts: two for emergencies and one for the mobile intensive care unit. We cover medical activity permanently – 24 hours a day, 7 days a week.”

This reality reflects a constant overwork of medical personnel, who must compensate with effort and dedication for the lack of human resources.

In her opinion, the decisive factor in maintaining system functionality is the team – the cohesion, professionalism, and adaptability of the existing staff despite continuous pressures.

“We may not have an ideal number of doctors, but through efficient coordination and optimal use of available resources, we can provide quality emergency services. I believe we are living proof that it is possible to function properly, but real coordination and commitment at the decision-making level are needed – not just nice plans on paper.”

This silent human resource crisis is often ignored in public policies but has direct effects on the quality of medical care, reaction times, and ultimately patient safety.

Triage and Protocols: Between Necessary Standardization and Defensive Pressure

Another important point addressed by Dr. Ramona Guraliuc concerned the essential role of proper triage in Emergency Departments, as well as the legal and administrative pressure felt by doctors, especially in the context of an increased risk of malpractice.

“We often end up requesting paraclinical investigations not necessarily because they are absolutely clinically necessary, but to protect ourselves professionally. Emergency medicine risks slipping into defensive practice.”

Currently, triage activity in Emergency Departments is regulated by color codes and waiting times strictly established by legislation. These are intended to prioritize cases based on severity and make medical intervention more efficient. However, the reality on the ground – marked by overcrowding and staff shortages – affects the strict application of these protocols.

“Standardization is necessary and welcome, but when a single doctor must manage dozens of cases simultaneously, the efficiency of the triage system is inevitably compromised.”

This tension between the need for legal compliance and operational constraints causes an overlap of responsibilities and increases pressure on medical staff, affecting not only the medical act but also decision safety.

What Does the Patient Expect? Speed, Safety, and Protocol Compliance

Dr. Ramona Guraliuc highlighted the fundamental expectations of patients who turn to emergency services:

“Patients demand a prompt diagnosis, effective treatment, and the shortest possible waiting time. To meet these needs, rigorous organization, strict adherence to medical protocols, and a well-structured multidisciplinary team are essential.”

She also emphasized that emergency medicine is not limited exclusively to interventions for acute life-threatening situations but also involves the efficient management of crises caused by exacerbations of chronic diseases — a growing segment that consumes significant resources within the Emergency Department.

Conclusions: From Debate to Concrete Commitment

In concluding her intervention, Dr. Ramona Guraliuc stressed the need to transform dialogue and theoretical analyses into real commitment and concrete actions by decision-makers. She highlighted that the challenges facing emergency medicine, especially in small hospitals, cannot be solved by debates or good intentions alone but require the implementation of clear strategic plans supported by adequate financial, technological, and human resources.

Assuming responsibility at all levels — from medical institution leadership to public authorities and the private sector — is essential to guarantee a functional emergency system capable of effectively responding to the growing needs of the population. Only through real collaboration and sustained investments can the necessary framework be created for a modern, digitized, and well-organized emergency medicine system that saves lives and provides quality care even in the most vulnerable regions.

This call to action highlights the importance of shared responsibility and political will to overcome the current crisis and secure the future of public health in the Moldova region.