Coronavirus: France's strategy to increase to 14,000 intensive care beds

Text by: Philippe Lecaplain

To respond to the coronavirus epidemic, the French government said on Saturday March 28th that it wanted to reach a target of "14,000 to 14,500 resuscitation beds throughout the national territory". Not that easy.

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Before the coronavirus, there were 5,000 intensive care beds in France; the government now wants to increase their number to 14,000 or even 14,500. But you don't create a resuscitation bed by snapping your fingers. The public health code is very clear and binding. Several criteria must be met. You need a bed as such, of course, but also a whole set of equipment: a respirator to provide artificial ventilation , regulated intravenous infusion systems, not to mention monitoring devices for permanent monitoring of all vital functions.

These machines must be served by a whole team. Under the responsibility of a nursing manager, at least two nurses for five patients, and a nursing assistant for four patients. Not to mention the presence of a specialist doctor 24 hours a day. The opening of a resuscitation service in a hospital establishment is subject to the approval of the Regional Health Agencies.

How to almost multiply them by three ?

There are also " all kinds of other activities, transport by Samu, operating theaters, recovery rooms, where there are respirators, since you are under general anesthesia, explains the Director General of Health Jérôme Salomon . And so these respirators could be used, since we have called for massive deprogramming of surgical activity in all establishments. […] We recover teams of anesthesiologists, anesthetic nurses, operating room nurses, and respirators. "

In a crisis situation, degraded solutions can indeed allow the care of additional patients. In terms of premises, the continuous surveillance or even the recovery rooms of the operating theaters can be refitted to be used as resuscitation units. The equipment is also reassigned.

In terms of staff, the anesthetists and nurse anesthetists, released from the operating room thanks to the postponement of many non-emergency procedures, are reassigned. This aspect is however the most delicate. Because caregivers must not only be qualified, but they are themselves susceptible to infection by the virus. Witness the recent deaths of three doctors in the Grand Est.

Private clinics involved

The president of the federation of private non-profit hospitals Marie-Sophie Desaulle recalls that in 72 hours, " 200 additional sheave beds " were thus created in Île-de-France. Lamine Gharbi, president of the Federation of Private Hospitals and Clinics (FHP), assures that 100,000 patients have been deprogrammed in the operating room to make room in hospital services to mobilize resuscitation means.

Redevelopments have already taken place. Others will be organized. In public hospitals of course but also in private establishments and all clinics. In addition to this, as part of the military operation Resilience, the army health service delivered twenty "heavy respirators". It is therefore time for general mobilization.

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