Retour d'expérience des évacuations par train à grande vitesse de patients en syndrome de détresse respiratoire aiguë sur infection à Covid-19 : les missions Chardon

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.

Retour d'expérience sur la régulation au Samu de Paris pendant la crise de Covid-19

L'épidémie de Covid-19 représente une crise dont l'ampleur n'avait jusque-là jamais été imaginée. Des modifications des pratiques pour y faire face ne pouvaient reposer uniquement sur des doctrines ou des intuitions, mais nécessitaient adaptabilité, innovation et réactivité. Un renforcement en moyens techniques et humains a été débuté dès la fin du mois de février. L'organisation de la régulation médicale du Samu de Paris a été modifiée, renforcée en fonction des flux de patients à traiter et adaptée à la spécificité de la crise de Covid. L'ensemble des mesures avait comme objectif d'apporter la réponse la plus adaptée aux patients atteints de la Covid-19 et de préserver la réponse aux appels urgents du 15. Une collaboration fructueuse s'est rapidement établie entre tous les acteurs de la santé, hospitaliers et libéraux favorisant un maintien à domicile d'un certain nombre de patients et empêchant ainsi une saturation précoce des services d'urgence. Le développement et l'intégration de nouveaux outils informatiques ont facilité et diversifié les réponses apportées. Il est, dès à présent, indispensable de pérenniser et de renforcer ces acquis afin de développer le service d'accès aux soins (SAS) nécessaire pour apporter à la population une qualité de soins optimisée.Alternate abstract: COVID-19 represents a crisis the scale of which had never been imagined before. Changes in practices to coping with them could not be based solely on doctrines or intuitions, but require adaptability, responsiveness, and innovation. A reinforcement of technical and human resources was introduced at the end of February. The organization of the medical regulation of the Samu (Emergency Medical Service) in Paris has been modified, reinforced according to the flow of patients to be treated and adapted to the Covid evolution. All the measures were aimed at providing the most appropriate response to patients with COVID-19 and preserving the answer of the emergency calls received on the 15. A fruitful collaboration was quickly established between all the actors of health, particularly with in-hospital and liberal practitioners favoring a home maintenance of a lot of patients and thus avoiding the saturation of emergency medical services. The development and integration of new IT tools have facilitated and diversified the provided solutions. It is now essential to perpetuate and strengthen these achievements to develop the service to access to care (French acronym SAS).

Setting up of a hospital Covid-19 vaccination center: A descriptive study

Background and Aims: The coronavirus pandemic challenged countries worldwide in a race against contaminations and variants. Vaccination campaigns were the answer to such an infectious spread. This descriptive study presents the organizational process of the setting up of a Covid-19 vaccination center in a French University Hospital in January 2021, the issues encountered along the way and assessment of adaptability.

Disaster medicine or medicine for exceptional health situations: What lessons for tomorrow?

The teaching of disaster medicine began in France in the 1980s. Many emergency physicians register each year for the disaster medicine "capacity", which is the most representative training program in this field. This capability includes theoretical courses, workshop and a disaster drill. Large-scale interdepartmental drills such as those carried out within the framework of the capacity of the UFR of Medicine of the University of Paris Cite, allow a situation close to reality. However, disaster medicine only covers a part of exceptional health situations (SSE). Recent examples have shown that it is necessary to extend the area of the capacity to this new domain. It is also necessary to develop training adapted for medical students in the second and third cycles and for paramedical personnel so that all of them has a basic knowledge of the subject. Copyright © 2022 Elsevier Masson SAS

Emergency Medicine from the origins to the perspectives

To understand the current emergency care crisis and the solutions that can be brought to it, it is necessary to analyze the origins of emergency medicine. Its pre-hospital dimension, which is sometimes criticized and decried, comes directly from the response to major health crises. Its regulatory recognition took time and was the subject of many discussions before resulting in a law in 1986. Bringing together the pre-hospital and hospital components of Emergency Medicine has led to the creation of a new medical specialty. Recent events, including the COVID crisis, have shown the adaptability and scalability of this system and its relevance. The current emergency crisis is part of a larger phenomenon affecting the entire hospital. Many solutions exist to optimize both upstream, downstream patients flow and the organization of the Emergency Room (ER). But, beyond these considerations, it is within the framework of an overhaul of the healthcare system that a new contract must be defined bringing together professionals and the public, around the demand and not only the existing offer of healthcare. It is the best guarantee of the relevant use of emergency medicine resources, both hospital and pre-hospital.

La médecine d’urgence de la création aux perspectives

Résumé Pour comprendre la crise actuelle des urgences et les solutions que l’on peut y apporter, il est nécessaire de d’analyser les origines de la médecine urgence. Sa dimension pré hospitalière qui est parfois critiquée et décriée est directement issue de la réponse à des crises sanitaires majeures. Sa reconnaissance réglementaire a pris du temps et a fait l’objet de nombreuses discussions avant d’aboutir en 1986 à une loi. Le rapprochement de la composante pré hospitalière et hospitalière de la Médecine d’Urgence a permis la création d’une nouvelle spécialité médicale. Des événements récents, notamment la crise COVID, ont montré l’adaptabilité et l’évolutivité de ce système et sa pertinence. La crise actuelle des urgences fait partie d’un phénomène plus global qui touche tout l’hôpital. De nombreuses solutions existent optimiser aussi bien l’amont, l’aval et l’organisation du service d’accueil des urgences (SAU). Mais, au-delà de ces considérations c’est dans le cadre d’une refonte du système de soins qu’il faut définir un nouveau contrat rassemblant les professionnels et le public, autour de la demande et pas seulement l’offre existante de soins. C’est le meilleur garant d’une utilisation pertinente des ressources de médecine d’urgence aussi bien hospitalières que pré hospitalières. Summary To understand the current emergency care crisis and the solutions that can be brought to it, it is necessary to analyze the origins of emergency medicine. Its pre-hospital dimension, which is sometimes criticized and decried, comes directly from the response to major health crises. Its regulatory recognition took time and was the subject of many discussions before resulting in a law in 1986. Bringing together the pre-hospital and hospital components of Emergency Medicine has led to the creation of a new medical specialty. Recent events, including the COVID crisis, have shown the adaptability and scalability of this system and its relevance. The current emergency crisis is part of a larger phenomenon affecting the entire hospital. Many solutions exist to optimize both upstream, downstream patients flow and the organization of the Emergency Room (ER). But, beyond these considerations, it is within the framework of an overhaul of the healthcare system that a new contract must be defined bringing together professionals and the public, around the demand and not only the existing offer of healthcare. It is the best guarantee of the relevant use of emergency medicine resources, both hospital and pre-hospital.

Make cystic fibrosis research results accessible to all: a French initiative managed by patients and relatives

Objectives: A group of patients and relatives with a scientific background, coordinated by Vaincre la Mucoviscidose, selects and translates lay summaries published by the ECFS into French to popularise Journal of Cystic Fibrosis articles. These summaries of the latest research results are disseminated towards the entire cystic fibrosis (CF) community in France. The objectives of this work consist of looking back in the past two years of the selection, translation and publication process and drawing the lessons learned. Methods: Lay articles are rated monthly by the group. The two articles with the highest number of votes are translated and disseminated via social media (Facebook, Twitter, Linkedin) and the Vaincre website. Between 2020 and 2021, 39 lay articles were analysed. We evaluate the topic distribution, impressions and engagement rate using statistical tools. Results: Median impressions were respectively 14,385, 910, and 1,095 for Facebook, LinkedIn, and Twitter. The engagement rate median were respectively 4.56, 5.60, and 3.25% for Facebook, LinkedIn, and Twitter. A word cloud has been built from the article titles to highlight the most frequent keywords in the selected articles. It highlights the patient’s expectations well: treatment efficiency and tolerability, pulmonary exacerbations, Sars-Cov-2 and pregnancy topics. We also look at the difference between the most read articles and the selection made by our group to see if we match patients’ expectations. Conclusion: We found that the dissemination of short articles on social networks can be a contribution for the community of CF patients to better understand the progress of research. The word cloud shows the priorities of patients and relatives with regard to recent research, and can be of help for researchers as a tool to design scientific projects closer to CF patients’ expectations.

Medical Transit and Evacuation Center (MTEC) for severe COVID patients

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.

Centre médical de transit et d’évacuation (CMTE) pour les patients COVID graves Medical Transit and Evacuation Center (MTEC) for severe COVID patients

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.

EMS (SAMU) of the defense zone: Missions and organization in the Paris region

In Île-de-France (IDF), the SAMU Zonal in accordance with the ORSAN plan, ensures the coordination and in particular the reciprocal reinforcement of the 8 SAMU of the region which is also the Defense Zone. As such, it has been mobilized during several exceptional health situations since 2014 such as the 2015 terrorist attacks and the COVID. Its objective was to harmonize the medical response and optimize the use of existing resources within the SAMU of IDF. It has established the means of communication and the organizations needed to manage the crisis, in particular temporary and dedicated structures for medical regulation.

SAMU Zonal : missions et organisation en Île-de-France

Résumé En Île-de-France, le SAMU Zonal conformément au dispositif ORSAN assure la coordination et notamment le renfort réciproque des 8 SAMU de la région qui est aussi la Zone de Défense. À ce titre, il a été mobilisé au cours de plusieurs situations sanitaires exceptionnelles (SSE) depuis 2014 telles que les attentats terroristes de 2015 et la crise COVID. Son objectif était d’harmoniser la réponse médicale et d’optimiser l’utilisation des ressources existantes au sein des SAMU d’IDF. Il a établi les moyens de communication et les organisations nécessaires à la gestion de la crise notamment la mise en place des structures transitoires et dédiées de régulation médicale. Summary In Île-de-France (IDF), the SAMU Zonal in accordance with the ORSAN plan, ensures the coordination and in particular the reciprocal reinforcement of the 8 SAMU of the region which is also the Defense Zone. As such, it has been mobilized during several exceptional health situations since 2014 such as the 2015 terrorist attacks and the COVID. Its objective was to harmonize the medical response and optimize the use of existing resources within the SAMU of IDF. It has established the means of communication and the organizations needed to manage the crisis, in particular temporary and dedicated structures for medical regulation.

Fast urban responses for new inclusive spaces & habitat during the pandemic

FURNISH (Fast Urban Responses For New Inclusive Spaces & Habitat) is a project funded by EIT Urban Mobility, which aims to increase local digital manufacturing capacity and to promote the reclaim of public space, thanks to the use of mobile prototypes of urban furniture. These mobile elements, in addition to allowing the use of the city, serve to mitigate the overcrowding of pedestrians and cyclists in the urban public space, in order to reduce the contagion from Covid-19. The challenge is to increase local resilience during the Covid-19 crisis by enlarging safety in the use of urban public space. © 2021 FrancoAngeli. All rights reserved.

20 months of COVID-19 and after

This article summarizes the main phases of the COVID crisis and the role played by the emergency services during the 20 months of the epidemic. It analyzes the place of large numbers of inter-hospital transfers by rail or air, especially during the recent wave that affected the overseas territories. He comments on certain measures introduced in the wake of this crisis.

COVID-19 crisis: Medical students as back up for medical regulation

The COVID-19 epidemic required reinforcement of technical resources and personnel within the framework of medical regulation activities but also for EMS and MICU interventions. This reinforcement has been adapted to the evolution of the activity. In the SAMU of Paris, the activity imposed the doubling of medical regulation work posts from the second week of March in order to respond to both the usual calls but also to the demand related to COVID. Only the 2nd cycle medical students were therefore integrated into this organization, they benefited on their arrival from a training adapted to their level of study and to the functions to be performed within the medical regulation and also throughout their activity of supervision by a senior doctor of Emergency physician or GP of the EMS system. This activity was therefore secured by senior doctors as in any hospital internship. This organization contributed, particularly in Paris, to the management of the surge of EMS calls. This reinforcement was then maintained, both in the context of the crisis and in daily activity in the deployment of the Access to Care Service.

Understanding and monitoring the evolution of the Covid-19 epidemic from medical emergency calls: The example of the Paris area

We portray the evolution of the Covid-19 epidemic during the crisis of March–April 2020 in the Paris area, by analyzing the medical emergency calls received by the EMS of the four central departments of this area (Centre 15 of SAMU 75, 92, 93 and 94). Our study reveals strong dissimilarities between these departments. We show that the logarithm of each epidemic observable can be approximated by a piecewise linear function of time. This allows us to distinguish the different phases of the epidemic, and to identify the delay between sanitary measures and their influence on the load of EMS. This also leads to an algorithm, allowing one to detect epidemic resurgences. We rely on a transport PDE epidemiological model, and we use methods from Perron–Frobenius theory and tropical geometry. © Académie des sciences, Paris and the authors, 2020. Some rights reserved.