At the dawn of the new confinement of 16 departments, the resuscitators note that despite the health crisis, nothing has changed in a year.
- With just over 5,000 intensive care beds, i.e. 7 beds per 100,000 inhabitants, France remains understaffed, even a year after the start of the health crisis.
“Resuscitators have been denouncing problems of medical and paramedical understaffing for several years, it is time to get out of this short-term vision”. Received on the evening of Tuesday April 16 by President Emmanuel Macron, the resuscitators drew up an alarming report. A year after the start of the first confinement, and while the pandemic is constraining our health system more than ever, the situation in the hospital has changed little. As at the height of the crisis in April 2020, resuscitators are experiencing an influx of patients which threatens to exceed reception capacities. In this context, they intend to warn about the long-term consequences of this lack of resuscitation resources on patient care.
“Always the same short-term means”
At the start of the health crisis, faced with a massive, unprecedented and incessant influx of patients, intensive care physicians, followed by all health professionals, demonstrated extremely strong responsiveness. Faced with the emergency, they put themselves in working order, forced to deprogram hospital activity outside of Covid, to reorganize the management of resuscitation and continuous monitoring beds, as well as to the health transfer to less impacted regions. A year later, the resuscitators deplore having to resort to the same solutions that they thought at the time “ephemera”.
“We were expecting a strong political signal between the 1st wave and this 3rd which is emerging.
However, we have to resort to the same unsatisfactory short-term means. Deprogramming such as evacuations to absorb the flow of Covid-19 patients is a suffering as much for health professionals as for patients and their families.“comments Olfa Hamzaoui, secretary of the group Women Doctors in Intensive Medicine and Resuscitation – FEMMIR.
France is under-equipped with resuscitation beds
With just over 5,000 intensive care beds, i.e. 7 beds per 100,000 inhabitants, France is under-resourced. This overall underfunding masks strong territorial heterogeneity: some regions are a little better endowed, such as Ile de France (9.34) or the PACA region (9.1), while others have a reduced offer, such as Pays de Loire (4.76) or Brittany (4.85). “If, during the first wave, the under-endowed regions had been affected, the scenario would have been catastrophic”, insists Olfa Hamzaoui.
Each year during the winter period conducive to epidemics such as the flu, the occupancy rate of intensive care beds already fluctuates between 90% and 100% in many regions. A rate that does not make it possible to deal with a health crisis situation.
“Every winter, we alert the authorities when we approach 100% in intensive care. As soon as the occupancy of intensive care units exceeds 80%, the reception capacities of patients in vital distress immediately requiring intensive care are compromised and the system into tension. The French are discovering with COVID-19 the use of ephemeral beds as an adjustment variable to the detriment of the creation of sustainable means. We are going to have to live for a long time with the virus: if nothing is done to perpetuate human resources and resuscitation beds, we will not be able to cope with the next waves” deplores Nicolas de Prost, resuscitator at the Henri Mondor hospital.
Lack of specialist resuscitation nurses
Added to this is the lack of specialist resuscitation nurses. Exhausted by the first and second wave, many are missing, which forces the services to rely on new recruits and temporary workers. However, let us remember, it takes more than a year to fully train nurses in resuscitation.
“If measures had been taken for a year to train and retain paramedical staff, fatigue would be less and morale better. And at the same time, resuscitation would be a more attractive specialty”, comments Nicolas de Prost.
On the side of the doctors, the chronic understaffing in the intensive care units is not without consequences: it puts pressure on the staff in post and places an additional workload on them. These degraded working conditions induce very frequent burn-outs (up to 50% of medical and paramedical personnel in intensive care), and have a negative effect on the attractiveness of this specialty, the essential nature of which has been highlighted by the crisis. .
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