ABSTRACT
Lors de la crise Covid-19 en France, il a fallu transférer des patients de zones où les lits de réanimation étaient saturés vers d'autres régions. Tous les moyens ont été utilisés : terrestre, aérien, maritime… Pour la première fois, des trains à grande vitesse (TGV) ont été utilisés. Le transport ferroviaire avait été utilisé largement pendant la Première Guerre mondiale. Ces transferts ont nécessité une collaboration extrêmement importante interservices : ministère, agences régionales de santé, hôpitaux, Samu zonaux, Samu, Smur associations de sécurités civiles, sapeurs-pompiers… L'une des collaborations des plus importantes a été celle avec la SNCF qui a permis une adaptation des rames, sécurisations des itinéraires, adaptation de la conduite… Chaque voiture transporte quatre patients intubés en syndrome de détresse respiratoire aiguë avec un médecin senior, un junior, quatre infirmiers et un logisticien pour la réalisation de la surveillance et des soins. Dans chaque rame, une équipe de régulation médicale est présente pour la coordination. Il y a eu dix évacuations sanitaires, qui ont transporté 197 patients sur 6 600 km (350‒950 km/TGV). Le transport le plus long a été de 7 h 14 min. On n'a pas relevé de complications majeures pendant les transferts. Plusieurs questions restent en suspens comme les critères de sélections des patients, la mise en place d'un train sanitaire aménagé permanent, un stock de matériel. Afin de mieux connaître les conséquences sur les patients, une étude est en cours. Les urgentistes ont une nouvelle corde à leur arc avec la possibilité d'effectuer des évacuations sanitaires en TGV pour des patients médicaux graves sur de longues distances.Alternate : During the COVID-19 crisis in France, despite an incredible increase in the number of intensive care unit (ICU) beds, these were not sufficient in the areas (Great East and Paris areas) most impacted by the disease. The decision was taken to transfer patients to other areas. The medical train was especially used in the First World War. Since then, it had not been used. The SAMU of Paris in collaboration with several partners had organized a bombing exercise in May 2019 with mass casualty evacuation using high speed trains. The ministry of health decided to urgently evacuate COVID-19 patients with acute respiratory syndrome (ARDS). High speed trains (TGV) were equipped accordingly. Sanitary fittings have evolved over time in collaboration with the train company (SNCF). A specific organization was set up: choice of routes, stations, hospitals, etc. This required a multi-service organization. In each wagon, four intubated patients were cared for by a senior and junior doctors, 4 nurses, and a logistician. The operations were coordinated by a medical regulation team posted on the train. In total, 6600 km were traveled (350–950 km per journey), the longest journey being 7 h 14 min, and 197 patients were transferred during these medical train evacuations. There were no major complications during the transfers. Some issues such as patient eligibility need to be further discussed. The possibility of having permanently equipped "hospital trains” with dedicated hardware could also be debated. We are trying in a dedicated study to assess the consequences of these transfers. In any case, sanitary transfers by TGV are definitely an option during major health crises.
ABSTRACT
La crise sanitaire de la Covid-19 a imposé une adaptabilité jamais réalisée de notre système de santé. Les services de réanimation et les structures de médecine d'urgence ont dû innover et développer des stratégies novatrices pour garantir des soins de qualité à tous les patients relevant de réanimation. La région Grand-Est, et plus particulièrement les départements de Moselle, du Bas-Rhin et du Haut-Rhin, a été particulièrement touchée. Parmi les 349 patients transférés hors de la région, 164 l'ont été vers des pays européens (Allemagne, Autriche, Luxembourg et Suisse) entre le 14 mars et le 4 avril 2020. Ces transferts internationaux, organisés par l'Agence régionale de santé et les Samu-Centre 15, ont essentiellement fait appel à des moyens aériens des hôpitaux, de l'armée et de la protection civile. L'accompagnement des patients, soigneusement sélectionnés, était assuré par un binôme médecin‒ infirmier spécialisés. Le choix de cette stratégie a permis d'éviter la saturation des services de réanimation et d'avoir à faire un choix entre les patients pouvant ou non bénéficier de soins aigus. L'adaptabilité des professionnels de santé et une organisation au plus près du terrain ont permis de réaliser ces transferts dans de bonnes conditions. Cet épisode témoigne de l'importance de laisser la gestion des crises sanitaires aux professionnels de la santé. Cet article présente l'organisation mise en place en région Grand-Est pour préparer et réaliser ces transferts internationaux.Alternate : The COVID-19 health crisis has imposed an unprecedented adaptability of our health system. Intensive care units and emergency departments had to innovate and develop new strategies to guarantee quality care for patients needing intensive care. The "Grand-Est” region and particularly the counties of Moselle, Bas-Rhin and Haut-Rhin, were strongly impacted. Among the 349 patients transferred out of region, 164 were transferred to European countries (Austria, Germany, Luxembourg, and Switzerland) between March 14 and April 4, 2020. These international transfers, organized by the regional health agency and the emergency medical call centers, mainly use flying ambulances belonging to hospitals, army, and civil protection. The support of these patients was provided by a specialized physiciannurse team. The choice of this strategy made it possible to avoid saturation of intensive care units and to make a choice between patients admitted or not in intensive care. Adaptability of health care providers and an organization as close as possible to the field allowed these transfers to be carried out under good conditions. This episode demonstrates the importance of leaving the management of health crisis to health professionals. This article presents the organization set up to prepare and carry out these international transfers.
ABSTRACT
Purpose: It has been proposed that patients with intestinal failure (IF) and intestine transplant (IT) are at higher risk of severe complications of COVID-19 due to weakened immunity and comorbidities. Multidisciplinary teams had to adapt their clinical approaches in order to keep these patients as safe as possible during the pandemic. Data is lacking. Method(s): Retrospective, observational, multicenter study performed with 3 surveys to assess COVID-19 practice changes in IF and IT patients. Result(s): 17 centers were included in the analysis;six had a 3 (+/- 4) months moratorium on performing transplant. Nine delayed their routine follow up including "protocol" biopsies. Nine reported decrease in new referrals. Sixteen incorporated telemedicine. Two reported rehabilitation services (home health, PN deliveries) being affected. In the first survey, 10 centers (59%) reported having IF and IT patients with COVID-19. In the other 2 surveys, a total of 25 IF and IT patients were reported positive for COVID-19. Of the 11 IF patients, 8 were male;7 were adults, with a mean age of 60 (+/- 8) years. Nine of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, cough and sore throat;hospitalization was required in 45.5%, all patients survived. A total of 14 IT patients were positive;8 were female;all of them were adults, mean age: 47 (+/- 16) years. All of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, dyspnea and cough. Hospitalization was required in 50%. Immunosuppression was discontinued in 1 patient, decreased in 5 (all on tacrolimus), and left unchanged in 8 cases;3 patients (21%) died. Conclusion(s): Many aspects of healthcare have been impacted by the COVID-19 pandemic. Centers adapted to new paradigms in patient care. Despite the availability of telemedicine, hospitals that treat IF and IT patients have found difficulties to sustain an appropriate home care regimen and referrals. IF patients did not have increased mortality, but IT recipients did, with similar results to those reported for other solid organs.
ABSTRACT
During the third wave of the COVID-19 crisis in the Île-de-France region, the prolonged tension on critical care beds led to the development of the concept of a CMTE (Medical Center for Transit and Evacuation). This unit based in a hospital, near the technical resuscitation platform, aims to accommodate for a few hours, sort, condition and then transfer serious COVID-19 patients for whom the medical regulation of the departmental SAMU initially failed to find a place in critical care. It therefore makes it possible to secure pre-hospital care and optimize the management of a flow of serious patients linked to the pandemic. This article describes this structure, its components, its operation and its relationship with the SAMU. It is considering its application to contexts other than the pandemic.
ABSTRACT
Au cours de la troisième vague de la crise COVID-19 en région Île-de-France, la tension prolongée, sur les lits de soins critiques, a conduit à développer le concept d’un CMTE (Centre medical de transit et d’évacuation). Cette unité, basée dans un hôpital, à proximité du plateau technique de réanimation, a pour objectif d’accueillir, pendant quelques heures, de trier, de mettre en condition puis de transférer les patients COVID-19 graves pour lesquels la régulation médicale du SAMU départemental n’a pas réussi initialement à trouver une place en soins critiques. Elle permet donc de sécuriser la prise en charge pré-hospitalière et d’optimiser la gestion d’un flux de patients graves lié à la pandémie. Cet article décrit cette structure, ses composantes, son fonctionnement et ses relations avec le SAMU. Elle envisage son application à d’autres contextes que la pandémie.
ABSTRACT
This article summarizes the history of the law relating to the creation of the SAMU and medical regulation and recalls the involvement in this field of leading political figures. It puts into perspective the historical reluctance and the attempts to modify the law of 86. It details the articles and analyzes the discussions of the law recently passed while the Covid-19 crisis was not over, to put in place the experimenting with a single number for emergencies.
ABSTRACT
Résumé Cet article résume l’histoire du texte de loi concernant la création du SAMU et la régulation médicale et rappelle l’engagement dans ce domaine de personnalités politiques de premier plan. Il met en perspective les réticences historiques et les tentatives de modification de la loi de 86. Il détaille les articles et analyse les discussions de la loi récemment voté alors que la crise Covid-19 n’était pas terminée, pour mettre en place l’expérimentation d’un numéro unique pour les urgences. Summary This article summarizes the history of the law relating to the creation of the SAMU and medical regulation and recalls the involvement in this field of leading political figures. It puts into perspective the historical reluctance and the attempts to modify the law of 86. It details the articles and analyzes the discussions of the law recently passed while the Covid-19 crisis was not over, to put in place the experimenting with a single number for emergencies.
ABSTRACT
The COVID-19 health crisis has imposed an unprecedented adaptability of our health system. Intensive care units and emergency departments had to innovate and develop new strategies to guarantee quality care for patients needing intensive care. The “Grand-Est” region and particularly the counties of Moselle, Bas-Rhin and Haut-Rhin, were strongly impacted. Among the 349 patients transferred out of region, 164 were transferred to European countries (Austria, Germany, Luxembourg, and Switzerland) between March 14 and April 4, 2020. These international transfers, organized by the regional health agency and the emergency medical call centers, mainly use flying ambulances belonging to hospitals, army, and civil protection. The support of these patients was provided by a specialized physician-nurse team. The choice of this strategy made it possible to avoid saturation of intensive care units and to make a choice between patients admitted or not in intensive care. Adaptability of health care providers and an organization as close as possible to the field allowed these transfers to be carried out under good conditions. This episode demonstrates the importance of leaving the management of health crisis to health professionals. This article presents the organization set up to prepare and carry out these international transfers.
ABSTRACT
Physical and mental health of elder people is of major importance for an increasingly aging society and closely related to the aspect of daily social contact. Threatened by the SARS- CoV-2 pandemic, elderlies and other risk groups retreat and isolate themselves to minimize the risk of infection. How to solve the arising consideration of pros and cons of social contact? By using a user-centered approach, we developed an artificial, social companion and interaction partner named “Josy”. Josy is a cost-efficient, quickly realizable and easily accessible solution for the duration of the pandemic but also beyond that. As an interactive avatar, Josy stimulates physical and mental state by offering helpful tasks for structuring everyday life in order to improve the quality of life of isolated, elderly people. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Introduction: On January 30, 2020 the World Health Organization (WHO) declared the 2019-CoV outbreak in China as a global public health emergency and subsequently, a pandemic on March 11th. It was considered that intestinal failure and intestinal transplant patients might have a higher risk of severe complications from the COVID-19 disease, multidisciplinary intestinal failure teams had to adapt their clinical approaches in order to keep this vulnerable group of patients as safe as possible during the pandemic;but data was lacking. Therefore, in order to improve our knowledge, we designed a voluntary, international survey aiming to address the impact of the COVID-19 disease in intestinal failure and transplant patients worldwide. Patient and Methods: A retrospective, observational, multicenter survey was sent to all centers registered at the Intestinal Rehabilitation and Transplant Association (IRTA). The survey contained three modules: the 1st one consisted of 14 questions about the hospital's activity during the COVID-19 pandemic. The 2nd one, contained 43 questions, was about intestinal failure patient management and outcome and the 3rd one (52 questions) focused on intestinal transplant patients. We used the Google Form platform. We aim to present the preliminary results of the first module. Statistical analysis was performed with the IBM SPSS Statistic version 25.0® program. Results: 13/42 (41%) centers responded;including centers from France, Netherlands, Italy, United States, UK, Sweden, Germany and Argentina. Only 2 centers reported moratorium on intestinal (IT) or multivisceral transplant (MVT), with a mean of 3 months (±4) [Table 1]. Since the pandemic started, 2 institutions reported 4 patients with intestinal rehabilitation or on TPN diagnosed with COVID-19 while 7 centers hospitals claimed to have had 9 patients post-IT/MTV affected by the disease. While 7 centers had their routine follow up and 'protocol biopsies' in the post-IT/MTV affected, none reported higher rates of rejection or complications. At the same time, 8 centers (77%) were affected by a mean of 15% decrease in referrals for new evaluations of intestinal failure or transplantation (compared to 2019) [Figure 1]. All centers adapted to utilizing telemedicine to follow up on IT/MVT patients Conclusions: Many aspects of healthcare have been impacted by the COVID-19 pandemic. The survey showed that the number of affected patients has been lower than expected, the reduced number of centers required transient moratorium of their activity, but a secondary observation was that despite the availability of telemedicine, and probably related to the lockdown, there has been a significant reduction in the referrals for evaluation of intestinal failure and transplant patients, that may have the deleterious effect of the delay of treatment in health care system.