- To cope with the wave of patients affected by Covid-19, France has increased its resuscitation capacity "to almost 14,000 beds, compared to about 5,065 usually", according to the Ministry of Health.
- Is this one-off increase sufficient to face a new crisis?
- Some doctors believe that the number of beds is insufficient and plead for a lasting increase in resuscitation capacity.
“We avoided the worst by very little. At the end of March, we were just under pressure, ”remembers Djillali Annane, head of the resuscitation service at the Raymond-Poincaré hospital in Garches (Hauts-de-Seine). "On March 31, in particular, we almost got totally overwhelmed, it was played within hours."
To cope with the wave of patients affected by Covid-19, the number of beds was quickly increased and a transfer of patients from the most affected regions to the rest of the territory was implemented. At the peak of the coronavirus crisis, resuscitation capacities have thus risen "to almost 14,000 beds, compared to approximately 5,065 usually", indicates the Ministry of Health at 20 Minutes. A rise in numbers sufficient to deal with the epidemic, which has killed more than 28,000 people in the country?
"Without the evacuation of patients in the provinces, we would have known the catastrophe"
Djillali Annane, president of the National Union of Physicians Resuscitating Public Hospitals, is affirmative: “We were faced with a real lack of beds. And without the evacuation of patients in the provinces, we would have known the disaster, like our colleagues in the Great East. Struck first by the epidemic, the Haut-Rhin establishments saw their services very quickly saturated in March, forcing health personnel to make priority choices according to the patients.
"Our colleagues in the Grand-Est were overwhelmed, and as of March 15, they alerted us: it will happen quickly and you will not be ready," says Anne Wernet, anesthesiologist at the Perpignan hospital center. This time in advance allowed us to organize ourselves, by installing equipment in other departments to go in emergency from 24 intensive care beds to almost 45, and we thought we could go up to 75. ”
"We had the opportunity to scale up, going from 40 beds to more than 64 for Covid-19 patients and a dozen additional beds for other patients," says Xavier Capdevila, responsible for anesthesia-resuscitation at Lapeyronie hospital in Montpellier. "This adaptability, and the quarantine put in place allowed us to never be overwhelmed".
Efficient adaptability or "system D"?
When the first assessments were made, two camps emerged for the future of the resuscitation system. Some, like Anne Wernet and Xavier Capdevila, both heads of anesthesiologist-resuscitation unions (Snphare and Sfar *), plead for better "adaptability" in the event of a crisis, by planning to increase capacities on an ad hoc basis. “The question of the number of resuscitation beds is not the right one. France has shown that it can generate a low-cost and extremely optimal ephemeral resuscitation model. What is essential is to better train the staff to have a faster climb if necessary, ”defends Xavier Capdevia.
Others, on the other hand, believe that saturation has shown the limits of resuscitation services. “This forced us to invent a D system with additional pseudo-reagent beds, installed in unsuitable hospital areas, with different equipmentand less space… ”, regrets Djillali Annane. "It will also be interesting, at the time of the assessment, to see if these beds were really as effective for patients as real resuscitation structures ..." In other words, did "makeshift" beds experience a rate higher mortality?
"These new beds did not guarantee 100% patient safety"
The director of the AP-HP (Public Assistance - Hospitals of Paris) Martin Hirsch gave his opinion on May 13 last before the Senate Committee, with regard to the 39 hospitals in Paris. “We have to be careful, but I don't think the number of intensive care beds has been a factor that has weighed on mortality or excess mortality. "I am not saying that we were in comfort," added the former high commissioner of Nicolas Sarkozy, but the AP-HP was able to ensure that "[its] capacity is never exceeded".
A comment that annoys Christophe Prudhomme, spokesperson for the Association of Emergency Physicians of France (AMUF): “These new beds did not guarantee 100% safety for patients: the respirators were not efficient enough or the staff n "had not received the training, even if he was full of goodwill," said the CGT member. “Seine-Saint-Denis, where I work, was the first saturated department in Ile-de-France, and the result is that today it is the one where mortality is the highest. We cannot sell the next world by keeping our capacities at 5,000 beds, or by continuing to suppress them as planned by several regional health plans. ”
A political question
Despite the overload in certain resuscitation services at the peak of the crisis, the executive does not intend to permanently increase hospital capacities in resuscitation. The Ministry of Health indicates to 20 Minutes that the government's objective is indeed "to return to our usual capacity of about 5,000 beds to allow health workers to return to normal functioning and a little respite" and to be able " thanks to the massive acquisition of respirators […] very quickly charge up in the event of a second wave, up to 10,000 or even 14,000 beds ”
This debate should feed into the political debates of the coming weeks. “The crisis has shown the limits of the downsizing of public services, and of this just-in-time policy concerning hospitals. We must assume that we have more beds than necessary to be able to cope in the event of a glitch, ”insists rebellious MP Eric Coquerel. "It is not necessarily necessary to drastically increase the number of intensive care beds, which are very expensive, but rather to look at how we can modulate services, better train staff to be flexible in the event of a crisis", replies Annie Chapelier, nurse and former LREM MP, who has just joined the new dissident group at the Assembly. The future hospital plan promised by Emmanuel Macron in recent weeks could provide more answers.
* National Syndicate of Hospital Anesthetists Resuscitators and French Resuscitation Society.
Nice
Deconfinement: No tension in resuscitation, "only" 3% of residents affected, the Alpes-Maritimes go orange
Politics
Coronavirus in Mayotte: The French army will install ten resuscitation beds
- epidemic
- Deconfinement
- Hospital
- Covid 19
- Coronavirus