A month-long “flash mission” to take stock of the emergency situation followed by a round table with all the stakeholders. These are the provisions announced Tuesday, May 31 by Emmanuel Macron as part of a trip to the hospital center of Cherbourg (Manche).
It is that the emergency services are suffering: 119 of them are even in great difficulty, according to a list from the Samu-Urgences de France (SUdF) union. consulted by franceinfo. That is nearly 20% of the 620 establishments – public and private – which have such units in France.
Consequence: they are already forced to limit their activities or are preparing to do so. “There is a breakdown in access to care”warned Patrick Pelloux, president of the Association of Emergency Physicians of France, at the microphone of franceinfo, Friday, May 27.
At the origin of the difficulties encountered by the establishments, the shortage of human resources stands out as the first explanatory factor: 89% of hospitals under pressure lack medical staff while 47% are short of non-medical staff (nursing assistants, nurses, administrative staff, etc.), according to the SUdF list. The reason: difficult working conditions and a lack of attractiveness in the profession.
Another difficulty: the lack of so-called “downstream” beds, intended for patients who need to be hospitalized when they leave the emergency room. Closed beds, most of the time, due to an insufficient number of caregivers to take care of them. Thus, 30% of the hospitals listed by SUdF suffer from both a lack of staff and a lack of beds.
The list of Samu-Urgences de France – not exhaustive, especially since it does not include Corsica, Guyana and the West Indies, for lack of data – shows however that more than 60 departments, including Mayotte, are concerned by these emergency room difficulties. The situation is particularly critical on this island in the Indian Ocean, where the only emergency service is facing a lack of beds and staff. Val-de-Marne, Gironde and Ille-et-Vilaine are also hard hit, each with five emergency services in distress.
Moreover, all hospitals are affected, regardless of their size. Like the establishments of Remiremont (Vosges), Redon (Ille-et-Vilaine) or Manosque (Alpes-de-Haute-Provence), many small hospitals are struggling. But 14 of the 32 largest hospitals – university hospital centers (CHU) or regional hospital centers (CHR) – are also on this list. Among them, the CHUs of Dijon (Côte-d’Or), Angers (Maine-et-Loire) or Lyon (Rhône).
Therefore, how to ensure a minimum service? Seventy-four emergency services have thus resorted to closures, often partial. Sometimes, the establishments are forced to close certain nights, as in Voiron (Isère), when others remove teams from the Smur (mobile emergency and resuscitation service) – the Metz University Hospital for example. The emergencies of Senlis (Oise) have been temporarily transferred to Creil.
In some still rare cases, emergencies are purely and simply closed. This is the case in Chinon (Indre-et-Loire), where emergencies ceased to operate on May 18 due to a large number of sick leaves. Of the thirty paramedical staff, only one nurse was able to work, reports indeed The New Central Republic.
Other centers choose to regulate the arrival of patients. In Cherbourg, for example, access to emergencies is conditioned from 3 p.m. on a prior call to the Samu, responsible for directing patients according to the seriousness of their situation. Another solution: load shedding. Nearly 10% of emergency services in tension thus redirect their patients to other hospitals. To compensate for the lack of staff, a quarter of the emergency services referenced by SUdF also turn to temporary work.
Sign of the gravity of the situation, four hospitals (Rennes, Roubaix, Tourcoing and Longjumeau) have also triggered the white plan. This device makes it possible to ensure the care of patients, by calling back staff on rest or by deprogramming non-urgent operations. “When you trigger a white plan, normally it is in an emergency situation, for example a big industrial accident, with a factory blowing up and people injured, or during the most critical waves of Covid.,” explains Jacques Adamski, secretary general of the CGT of hospital workers in Roubaix, to France 3 Hauts-de-France. However, this system can also exhaust the staff.
One month away from the holidays, this tense situation worries health professionals. “It will probably be the most difficult summer we have ever known. We have to find solutions quickly”warned Frédéric Valletoux, the president of the French Hospital Federation, on franceinfo.
Some establishments ask staff to cancel leave or resort to overtime. The Amiens hospital center has thus shortened the holidays of some of its employees to a maximum of three weeks, or even two weeks for some, when that of Saint-Brieuc grants a bonus of 350 euros to those who shift their leave.
Solutions which risk, according to some caregivers and unions, accentuating an already present exhaustion and causing new departures.