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.

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.

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.