The caregivers do not ask for additional resuscitation beds? It's wrong

A bed for a Covid-19 patient at La Timone hospital, in Marseille, September 28, 2020 (illustration) -

• "[The] caregivers are not asking us to increase the number of resuscitation beds, if only because they know very well that training a resuscitator or a specialized nurse cannot be done in six months," said Jean Castex Thursday, November 12 during his progress report on the effectiveness of containment

• This little phrase, uttered just after the mention of the number of additional resuscitation beds deployed by the government in case of need in hospitals, has far from gone unnoticed.

• Because healthcare staff have long been demanding - long before the Covid-19 crisis - the opening of additional resuscitation beds, as confirmed by two spokespersons in the middle at

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Two weeks after the start of the second confinement, Jean Castex has, as expected, made a first assessment of the measures in force since October 30.

And if the Prime Minister indicated, on this occasion, that the situation would remain unchanged at least for the next 15 days, a sentence pronounced at the beginning of his speech did not fail to make many Internet users jump.

"The caregivers are not asking to increase the number of intensive care beds, but above all want to prevent patients from arriving at the hospital" Jean Castex. # Castex18h # COVID19 # COVID__19 pic.twitter.com/4RQjMe3pkC

- Anonymous Citizen (@AnonymeCitoyen) November 12, 2020

Just after having mentioned his "admiration" for the work and "commitment" of "health professionals", Jean Castex indeed launched (from 4'20 in the video below): "These caregivers, they do not ask us to increase the number of resuscitation beds, if only because they know very well that training a resuscitator or a specialized nurse cannot be done in six months, they ask us above all to put everything in works to prevent patients from arriving at the hospital.

"

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Update on the health situation and measures to fight # COVID19.

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- Government (@gouvernementFR) November 12, 2020

A statement to say the least surprising, while he himself underlined, a few minutes earlier (from 2'58) the supposed preparation of the government in the event of a massive influx of patients in intensive care: “Today, it is 4,803 patients [of] Covid-19 who are taken care of in intensive care, which represents 95% of our normal capacity in intensive care beds, excluding crisis.

To be able to cope with this influx, we have armed over the last two weeks 1,360 additional beds, in order to accommodate more patients [from] Covid-19 but also other patients.

[…] We could go up to 10,400 beds if it was necessary since we have prepared in the last few months to face a big wave.

"

However, contrary to what the Prime Minister said, the opening of additional resuscitation beds to strengthen the 5,432 existing beds (according to the 2018 count) is indeed part of the requests of the nursing staff.

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“This reflection of the Prime Minister is of an absolute cynicism, and that shocks us deeply.

Caregivers have been campaigning for years around three themes: reopening beds, creating jobs compatible with working conditions and raising salaries ”protests against

Thierry Amouroux, spokesperson for the National Union of Nursing Professionals (SNPI) and nurse at AP-HP.

Christian Prudhomme, emergency physician at Samu 93, national delegate of the CGT and spokesperson for emergency physicians in France, agrees: “The words of Jean Castex are a total denial of the reality of the public hospital.

The issue of resuscitation beds is an old question.

For years, we emergency physicians have explained to ourselves that we do not have enough beds every summer, every winter, every weekend, that is to say almost all of the year.

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If the demand for additional resuscitation beds goes back a long way, it was still, as a recent example, among the main demands of the day of mobilization of health personnel on October 15.

“And it's even worse since the Covid-19 peak last spring, we must understand that we could have avoided thousands of deaths if we had not run out of resuscitation beds.

Due to a lack of beds, we were forced to sort out between patients with, for example, three patients who presented a benefit / risk ratio allowing them to be sent to intensive care, whereas we only had one bed, which was to condemn two for lack of space, “regrets Thierry Amouroux.

The fear of "catastrophic excess mortality"

For Christan Prudhomme, "the big mistake in the government's strategy is to have returned to 5,000 intensive care beds in May": "The government says it has trained staff but it would have been good if they did. This remains partly to keep open not the almost 11,000 intensive care beds open during the peak, but at least 7,500 beds, since we knew that the number of patients was going to increase, we just did not know when and at what rate.

There, we will reach 7,500 resuscitation beds with great difficulty.

It is much easier to increase the number of beds in an existing intensive care unit than to create an ex nihilo unit.

As we have closed a lot of small services in recent years, it has become very complicated to increase capacity quickly.

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In fact, the emergency physician fears the "catastrophic excess mortality" caused by the technical inability of the public hospital to accommodate patients who require an intensive care bed: "The two main causes of death in France are cancer and cardiovascular illnesses.

However, we are expecting a significant excess mortality due to delays in diagnosis or treatment linked to the first wave of Covid-19.

A recent study has estimated that excess mortality could rise to 2 or 5% in cancer patients because of the upheaval in the organization of care.

The more than six months required, according to Jean Castex, to "train a resuscitator or a specialized nurse" are for their part "fallacious", according to Thierry Amouroux: "We must make the distinction between two things: vacant positions and the absence of shortages.

Due to the Covid crisis, many exhausted caregivers left their posts because they suspected that they could not work in good conditions due to a lack of strong enough support from the government.

The number of vacant nursing posts in hospitals rose from 7,500 in June to 34,000 in September.

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"But the staff is there: if, tomorrow, we offer positions with a workload compatible with the quality of care, decent salaries, we can fill them very quickly," he concludes.

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