For years, emergency physicians have been warning about the lack of paramedics and the excessively long wait for patients in the emergency room.
But this year many voices were raised from the month of May, to warn that the summer could be catastrophic.
Lack of paramedics, doctors, lack of consultations in town, beds closed downstream... Some services have no choice but to close temporarily.
If as of May, these services can no longer manage vital emergencies, there is an even greater risk this summer of seeing avoidable deaths.
“In France today, the risk of dying from a Russian shell is limited, but not that of dying from a lack of care!
".
It is with this alert that the letter from the Samu-Urgences de France (SUDF) union ends, addressed to the new Minister of Health last Friday.
Barely installed, Brigitte Bourguignon has to face cries of alarm coming from everywhere in France: the emergencies crack.
For years, caregivers in these particularly exposed services have expressed their concerns, but the situation seems more serious than in previous years.
And does not bode well for this summer.
"It's unheard of at that time"
One would have thought that after two years of Covid-19, this spring with bright indicators would leave a breath of fresh air.
But our hospitals come out exhausted, with departures not replaced, beds cut, the attractiveness of their professions undermined.
Symbols of this crisis: emergencies can no longer cope.
Today, at least 120 emergency services are facing very serious difficulties, due to the lack of staff.
“This ranges from the closure of services day and night, on certain time slots to degraded guards, specifies Louis Soulat, spokesperson and vice-president of the SUDF.
This is unheard of at that time!
»
🏥 Cases are increasing.
Today, 112 #emergency services are dying and can no longer respond to all requests.
The health of our fellow citizens is in #danger!
@Sante_Gouv, we won't last!
pic.twitter.com/NuBdvJLrr2
– Samu-Emergency France (@SUdF_Officiel) May 20, 2022
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An unprecedented situation in more ways than one.
Resignations and the difficulty in recruiting do not only affect paramedics, but also doctors.
“This is the first time that we have seen so many professionals reorienting themselves”, continues the one who is also head of the emergency department of the CHU Rennes.
It is therefore a self-sustaining crisis: the more departures there are, the more the last survivors suffer… “Six months ago, I was still optimistic about emergencies, he continues.
But it deteriorated rapidly with three doctors who decided to leave and two who will not come in the end.
I'm not sure those who are there stay long.
I have been doing emergency medicine for 35 years and for the first time I am considering a right of withdrawal.
»
“30% more visits over the year compared to 2019”
Then, the crisis has never known such magnitude.
If the Collectif Inter Urgences has been warning since March 2019 about the degraded situation of these front-line services, three years later, some of them are closing purely and simply.
And not just in small towns: even university hospitals today limit access, especially in Bordeaux.
And no region seems spared.
"The situation is also dramatic because of the level of activity of the emergency services, with in Rennes for example, 30% more passages over the year compared to 2019", continues the emergency doctor.
With patients who are sometimes elderly, polypathological… “It can take 12 hours to find a downstream bed,” he continues.
When you can no longer pass through the corridors, there are so many stretchers, it is impossible to bring the patient a basin so that he can urinate in time!
It's frustrating for the caregiver.
Not to mention the risk of death on a stretcher…” These doctors warn: if there are tragedies, caregivers cannot be held responsible when the authorities no longer give them the means to fulfill their mission.
Finally, tensions have never been so precocious.
"Usually, the ARS meet us in June to talk about the organization in the summer, this year it's in May", illustrates Louis Soulat.
"It's the summer of all dangers"
If in May the emergency doctors can no longer treat vital emergencies, how will the summer unfold?
A traditionally complicated period, because carers also need vacations… “Some downstream services will close this summer, especially in nursing homes, in follow-up care, insists Louis Soulat.
This will aggravate the wait in the emergency room by a domino effect.
"For the first time, the hospital system is at the limits of rupture", confirms Benjamin Clouzeau, resuscitator at the CHU Bordeaux.
"It's the summer of all dangers, slice Christophe Prudhomme, emergency physician at Samu 93 and spokesperson for the Association of Emergency Physicians of France (AMUF).
We must be clear, if there is not a radical and rapid change, today there are already preventable deaths, there will be even more this summer.
Such a degraded care system is particularly scandalous in such a great power….
»
What solutions?
The new Minister of Health will have to deal with this file urgently.
She has already received some trade unionists on Saturday.
No concrete measures have yet been announced.
In the meantime, the ARS are working on solutions for this summer.
That of Ile-de-France relies both on the “reinforcement of external personnel, of the type students in the last year” and on the thirty or so existing “geriatric sectors” which avoid passages to the emergencies of the elderly.
At a meeting on Monday, there was also talk of asking caregivers on duty to take only two weeks of vacation.
“It will be counterproductive: we risk resignations at the start of the school year and even fewer carers for next winter”, regrets Christophe Prudhomme.
Especially since it has been more than three years that we ask caregivers to make efforts... In Rennes,
Crisis meeting tonight at the Ministry of Health on the unprecedented #emergency crisis #amuf we are determined to find solutions for the public hospital service and the health system
— Patrick Pelloux (@PatrickPelloux) May 20, 2022
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That's for the short term.
But a reflection on the health system in its entirety is essential if the government wants to save a system that many countries envy.
"Emergencies are only a symptom of a general problem which begins upstream with the shortage of general practitioners and continues downstream with the lack of beds in the departments", summarizes Benjamin Clouzeau.
Hence the importance for these doctors not to pull an “Emergency plan” out of their hat, dressing version… One of the solutions for SUDF would be to impose the call to 15 as a day and night filter.
“So that at least we can deal with real emergencies in time, argues Louis Soulat.
Sorting by 15 at night is accepted, during the day much less.
»
Raising wages, an imperative
As often, it will be a question of salaries.
Revaluing hardship (therefore night and weekend schedules) seems inevitable.
“It would be quite quick to do since it was put in place during the Covid, continues the emergency doctor from Rennes.
But unfortunately that will not be enough.
But it would restore the attraction for those who would be tempted to leave.
»
To share the constraints, the old debate on the participation of general practitioners in night duty is back.
Frédéric Valletoux, president of the Fédération Hospitalière de France (FHF) proposed it, prompting an outcry.
“If we make the permanence of care compulsory, we will oppose city medicine to hospitals”, warns Louis Soulat.
Another explosive file: the freedom of installation of doctors.
The new minister also assured that she would make medical deserts her priority…
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