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
Introduction: In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method(s): We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lo Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Result(s): The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26 years (P < 0.001). The interventions lasted an average of 1 hour and 27 minutes. Discussion(s): This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion(s): The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents. Copyright © 2022 Elsevier Masson SAS
ABSTRACT
Introduction: In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method(s): We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lo Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Result(s): The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26 years (P < 0.001). The interventions lasted an average of 1 hour and 27 minutes. Discussion(s): This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion(s): The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents. Copyright © 2022 Elsevier Masson SAS
ABSTRACT
Résumé Introduction En partenariat avec l'Association SAUVlife (unité mobile de télémédecine) « phygital » et le SAMU 50, l'UMT où une unité phygitale a été déployée dans la Manche destinée à des patients âgés et/ou dépendants pour lesquels l'accès aux soins est rendu difficile par la carence de médecin traitant et de la diminution des visites à domicile. Ce nouveau vecteur pourrait être une alternative au recours aux urgences hospitalières. Méthode Nous avons réalisé une étude observationnelle rétrospective monocentrique de l'activité de l'UMT du 1er janvier au 30 juin 2021 au sein du service du SAMU 50 au CH Saint-Lô. Après régulation médicale, les patients ne relevant pas d'une urgence vitale pouvaient bénéficier d'une intervention de l'UMT. Résultats L'UMT est intervenue 681 fois. Au décours, 65,6 % de patients ont pu être laissés sur place. Cette unité phygitale a réalisé 621 téléconsultations permettant à 414 patients (66,7 %) de rester chez eux et 199 patients (32 %) d'être transportés vers un SAU. Ceux transportés étaient significativement plus âgés avec un âge moyen de 71,26 ans (p<0,001). Les interventions ont duré 1h27 en moyenne. Discussion Cette expérimentation est inédite dans le cadre de l'urgence. Cet outil semble répondre à la carence d'offre de soins du département. Son utilisation dans le cadre de la pandémie de COVID-19 est probante et permet par ses prises en charge à domicile une limitation des transmissions virales. Toutefois, les interventions sont longues et l'utilisation de l'UMT peut être optimisée tant sur le temps d'intervention que sur le nombre réalisé par jour. Conclusion L'unité mobile de télémédecine est un vrai apport en l'absence de médecins généralistes pour réaliser des visites à domicile de soins non programmés d'autant plus dans un contexte épidémique où elle limite le recours aux urgences et in fine la transmission des agents infectieux. Summary Introduction In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lô Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Results The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26years (P<0.001). The interventions lasted an average of 1hour and 27minutes. Discussion This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents.
ABSTRACT
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
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
BACKGROUND: The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help. OBJECTIVES: To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy. RESULTS: A total of 24 662 consecutive patients were included;19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years;women, 73 [59-83] years;P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes;women, 79 [31-220] minutes;P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001). CONCLUSION: Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.