Filtered access and cascading closures: the shortage of caregivers in the emergency room is turning into a crisis ” disaster “with already 120 services forced to limit their activity or preparing for it, a prelude for some of a summer “atrocious”. From emergency physician memory, “we have never experienced such tension even before the summer period”. Lack of doctors, nurses, orderlies or “downstream beds” to transfer patients: the emergency services of these hospitals face serious “difficulties”according to a list drawn up by the association SAMU-Urgences de France (SUdF) and which AFP obtained.
These 120 services represent almost 20% of the approximately 620 establishments – public and private – hosting one or more emergency services. No territory is spared, with 60 departments affected in all regions, according to this count which does not include Corsica, the Antilles and Guyana. For a practitioner practicing in one of the establishments concerned, “The situation is catastrophic” and would do “almost regret the pandemic” of Covid.
Additional sign of an unprecedented crisis, 14 of the 32 largest French hospitals (CHU and CHR) are on this list. That of Bordeaux has thus just set up a “regulated access” every night between 8 p.m. and 8 a.m. Except “proven emergency”it is impossible to enter the first service of Nouvelle-Aquitaine without a prior phone call to 15.
That of Grenoble, which is already running with a less mobile SMUR team, could follow, the union of hospital doctors SNMH-FO pointing a “risk of closure” the night “in the very short term” because “many doctors leave the service”. In Chinon (Indre-et-Loire), emergency activity has been completely suspended since Wednesday, because most of the nurses in the service are on sick leave. The maternity is no longer able to ensure deliveries.
Other institutions have opted for “load shedding”sending patients back to other sites, such as Laval (Mayenne), or have had recourse to the white plan, which makes it possible to deprogram operations and reassign personnel, such as the Rennes University Hospital.
Alarm calls from the profession
The picture is alarming, and the worst is yet to come. “We have an imminent risk of a breakdown in access to care. It is already happening and it is likely to worsen quite considerably during the summer, when the holidays are over.”warned Professor Rémi Salomon, president of the Paris Hospitals Medical Conference (AP-HP), Thursday on Franceinfo.
“It’s going to be excruciating, unheard of”with “unexpected and involuntary deaths” of patients, even predicted Patrick Pelloux, president of the Association of Emergency Physicians of France (AMUF), in an interview with West France Wednesday. Like many hospital workers, he is calling for a rapid revaluation of night and weekend call and on-call duty. But the crisis has given rise to other more radical proposals.
“We have to sort on arrival at the emergency room, we must not allow everyone to go there easily”, said Philippe Juvin, head of emergencies at the Parisian hospital Georges-Pompidou, Friday on Public Senate. The president of the French Hospital Federation (FHF), Frédéric Valletoux, for his part asked on Tuesday for a “obligation of participation of all practitioners” to medical guards, provoking an outcry from the Liberals, who denounced remarks “Between Lies and Slippages”. The boss of Marseille Hospitals (AP-HM), François Crémieux, estimated in an interview at Release Thursday that “the immense freedom of liberal doctors has become a taboo in our country”.
Luc Duquesnel, the boss of the Confederation of French medical unions, the first union among the Liberals, said he was against an obligation “individually”but not collectively “territorially”, during a press conference on Thursday. However, he conditions it on a “boost” for “remunerate properly” the guards, whom he judged “extremely urgent”wondering “the government’s wait-and-see attitude on such a hot topic, just a few weeks before the summer holidays”.
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