On Wednesday, Brigitte Bourguignon, the new Minister of Health, unveiled three short-term measures to help emergencies before the summer.
And by July 1, François Braun must submit the conclusions of a flash mission on the subject.
This Thursday, during the Emergency Congress, he insisted on the interest of deploying the Access to Care Service, and more generally regulation.
Indeed, 40% of patients who go to the emergency room could be treated elsewhere.
The problem is that even with better organized prioritization and improved coordination between city and hospital, the lack of caregivers remains.
Emmanuel Macron had given them a month… Obviously, it was too much.
The president entrusted François Braun, president of Samu-Urgences de France, with a flash mission to offer solutions in order to relieve emergencies.
Appointment had been made for July 1st.
But as of this Wednesday, the Minister of Health, Brigitte Bourguignon, unveiled three measures without waiting for the conclusions of the mission (nor the legislative ones, etc.) and showing that the government takes the threat of a catastrophic summer seriously.
She therefore assured that overtime would be paid double, that student nurses would be “immediately” employable, and that the combination of employment and retirement would be “facilitated” for caregivers.
All set to music in a few days.
It must be said that the opportunity was ready:
The same congress where, this Thursday morning, the spokespersons of the French Society of Emergency Medicine (SFMU) and Samu-Urgences de France held a press conference to present their leads.
Without ensuring that they would be part of a plan…
"Emergencies can no longer be open bar"
For François Braun, there is no doubt, “emergencies can no longer be open bar, we can no longer serve everything”.
The tone is set.
The equation indeed seems untenable: there are twice as many visits to the emergency room than twenty years ago.
And 120 services are forced to reduce the airfoil this summer for lack of caregivers, according to Samu-Urgences de France.
If there is no miracle solution, all the emergency doctors insist on a watchword: regulation.
How ?
By inviting all French people to first go through 15 before pointing the tip of their runny nose to the emergency room.
Because today, about 40% of patients who land in the emergency room could be cared for otherwise.
By dint of treating ankle sprains, the risk is therefore to miss a heart attack.
Restart the SAS
Among the solutions, François Braun insists on the Care Access Service (SAS).
An idea not really new, but which could see its deployment accelerated.
As early as 2019, the report by Thomas Mesnier and Pierre Carli had suggested setting up this new service.
The objective of SAS?
Offer an answer 7 days a week and 24 hours a day, everywhere in France, for patients who need care.
"How to direct these patients in the right course without making them bear the responsibility of defining themselves if their case is serious or not, knowing that according to studies, there would be between 20 and 40% under-evaluation?, asks François Braun.
Only medical regulation allows this qualification of the request.
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Clearly, by calling 15, any patient, wherever he is, could first speak with a general practitioner or emergency doctor.
“The first spontaneous words are very important and the patient does not necessarily repeat them, that is why it is important that it is a doctor who picks up”, insists Karim Tazarourte, president of the SFMU.
After a few questions, the person is referred to a city doctor if the problem can wait 48 hours, an open daycare center, an emergency service or intensive care without going through the emergency box if it is a question of life. or death.
Where are we with the deployment?
The objective is threefold: to leave no patient behind, to respect the equity of care throughout the territory, and to ensure that this orientation allows emergencies to focus again on their specialty: vital or felt emergencies.
"Because a pain in the chest, it can be an anxiety attack or a heart attack", points out Agnès Ricard-Hibon, head of service of the Smu of Val-d'Oise.
These emergency physicians clearly see the usefulness of the SAS.
After a year 2021 which saw the implementation of 22 pilot projects in 13 regions, it would seem logical to generalize it this year.
The condition is that GPs offer time slots available for unscheduled care.
And in sufficient numbers.
However, several obstacles appear.
Technical, first of all.
How can I have access to the schedule of all the general practitioners in a region if some are on Doctolib and others on Maiia?
The ministry seems to have made good progress on this part of the file: since April 2022, it has been possible for regulators to see, on their computer, which doctors have open slots for unscheduled care and when.
Soon, it will be possible for the doctor who takes care of the regulation to make an appointment directly for the patient on the telephone.
This service does not solve the problem of understaffed caregivers
For this SAS to be more than an announcement effect, above all there needs to be good coordination between the city and the hospital.
A major challenge in a healthcare system in silos.
François Braun, also head of the Metz-Thionville emergency department, is nevertheless optimistic: "the deterioration in access to urgent care is not inevitable: solutions exist, they were put in place at a forced march during of the Covid-19 crisis and have demonstrated their effectiveness.
The lines of ambulances at the door of hospitals in many European countries have not been observed in France.
We have been able, thanks to medical regulation and cooperation between general and emergency medicine within the Samu and future SAS, to provide useful care through better patient orientation.
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There remains one final, essential problem.
Certainly, setting up this SAS will save precious time for caregivers and patients.
But this absolutely does not resolve the lack of human resources, both in the hospital and in the city.
Blocking out even two hours a week for “unscheduled care” seems complex for a general practitioner who no longer takes on any new patients for lack of time.
These doctors are chronically and lastingly understaffed, work sometimes 45-hour weeks, and clearly refuse to take part in on-call duty.
Same problem on the emergency side: will there be doctors to respond to 15 and receive patients in vital emergencies?
"The SAS only works if there are solutions to the needs", warns Agnès Ricard-Hibon.
And François Braun adds: "There would be nothing worse than offering a number to the population and no one answering..."
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Emmanuel Macron
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