Management of the covid crisis on board a marchant navy vessel

The merchant navy vesselAtalante was on a scientific mission in March, April 2020 as the Covid pandemic spread across the planet. The maritime crew were faced with a double risk, the interruption of routine medical care and the appearance of a cluster on board. These two risks were avoided by adapting quickly and effectively to this exceptional situation. A replacement for the usual medical treatment has been put in place and health measures have been rigorously applied. This answer is interesting to consider in the event of SSE (exceptional health situations) involving medicine in a situation of isolation.Copyright © 2023 Elsevier Masson SAS

Gestion de la crise covid à bord d'un navire de marine marchande : Atalante

Résumé Le navire Atalante de la marine marchande effectuait une mission scientifique en mars, avril 2020 alors que la pandémie de Covid se répandait sur la planète. Le personnel de bord a été confronté à un double risque, la rupture de soins médicaux courants et l'apparition d'un cluster à bord. Ces deux risques ont été évités en s'adaptant rapidement et efficacement à cette situation exceptionnelle. Une suppléance à la médicalisation habituelle a été mise en place et les mesures sanitaires ont été appliquées avec rigueur. Cette réponse est intéressante à considérer en cas de SSE (Situations sanitaires exceptionnelles) impliquant la médecine en situation d'isolement. Summary The merchant navy vesselAtalante was on a scientific mission in March, April 2020 as the Covid pandemic spread across the planet. The maritime crew were faced with a double risk, the interruption of routine medical care and the appearance of a cluster on board. These two risks were avoided by adapting quickly and effectively to this exceptional situation. A replacement for the usual medical treatment has been put in place and health measures have been rigorously applied. This answer is interesting to consider in the event of SSE (exceptional health situations) involving medicine in a situation of isolation.

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).

Does the remote consultation mobile unit or phygitale medical unit, a new way of managing unscheduled care in general medicine, make it possible to reduce the use of emergency rooms?

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

Does the remote consultation mobile unit or phygitale medical unit, a new way of managing unscheduled care in general medicine, make it possible to reduce the use of emergency rooms?

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

L'unité mobile de télémédecine ou unité médicale phygitale, un nouveau vecteur de prise en charge des soins non programmés en médecine générale, permet-elle de diminuer le recours au SAU (service d'accueil des urgences) ?

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.

Veiller, agir, prévenir : de la médecine de catastrophe à la gestion médicale des situations sanitaires exceptionnelles

Résumé Comme toute activité médicale et comme toute activité de soins, la régulation médicale porte en elle une dimension éthique. Elle est même avant tout éthique. C’est le sujet de la première partie de cet article qui s’appuie sur la distinction et la conjonction entre éthique de la conviction et éthique de la responsabilité telle qu’elles furent exposées par le sociologue allemand Max Weber. Les actions déroulées par les SAMU durant la pandémie de COVID-19 ont exacerbé le rôle politique de la régulation médicale. La deuxième partie tente d’en faire la démonstration. Le rôle de santé publique et politique des SAMU, désormais reconnu par tous les citoyens et tous les appareils de l’État, amène nécessairement à une redéfinition de la médecine dite de catastrophe. Summary Like any medical activity and like any healthcare activity, medical regulation carries with it an ethical dimension. Even more it is all ethical. This is the subject of the first part of this article, which is based on the distinction and the conjunction between the ethics of conviction and the ethics of responsibility as they were exposed by the German sociologist Max Weber. The actions carried out by SAMUs during the COVID-19 pandemic have exacerbated the political role of medical regulation. The second part attempts to demonstrate this. The public health and political role of SAMUs, now recognized by all citizens and all State services, necessarily leads to a redefinition of so-called disaster medicine.

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.

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.

Regulatory Authorities and Continuing Education Around the World: Adapting to COVID-19.

At a time when the world continues to be gripped by one of the most significant pandemics in history, medical regulators are understanding, more than ever, the value of effective regulation on the provision of health care locally, nationally and across national borders. It has never been more important for regulators to work together, share experiences and information, and strive for regulatory best practice.

Sacrifice and risk in the time of COVID-19.

The COVID-19 pandemic has changed the face of healthcare delivery. This article discusses the concept of medical sacrifice and personal risk, and how healthcare workers can apply these concepts when working outside their comfort zones, while remaining within the limits of their clinical competence. Guidance from the General Medical Council and the medical defence organisations is reviewed and considered in its practical application. We explore how a medical student, now a 'fast tracked' junior doctor, and a senior consultant, with pre-existing health issues, can feel confident working as part of the NHS response to COVID-19.