in the emergency room of Nîmes, “whatever the season, there is no longer a moment of hollow”

“So far, we’ve had three sunburns, but no heatstroke.” At the emergency reception of the hospital center of Nîmes (Gard), at the beginning of the afternoon, Wednesday July 19 resembles all summer days. The season is most evident in the influx of trauma patients, where broken bones, sprains and other bruises are treated, which result from popular outdoor activities during school holidays. However, it is not an ordinary day in the Gard prefecture: the department is placed on orange “heat wave” vigilance, with a heat peak of 37.5°C. The alert, extended until Thursday afternoon, is accompanied by advice on the dangerousness of such temperatures: “Do not go out at the hottest hours (11am-9pm)”, “limit your physical and sporting activities” And “check in” elderly relatives, recommends Météo-France in particular.

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During this first day of heat wave, few cases directly related to the temperature present themselves at the CHU, where the emergency waiting room is already full. A 39-year-old woman, placed under observation after feeling unwell, left in less than an hour after taking the time to rehydrate. But sometimes, the role of the heat is difficult to assess immediately: is it responsible for the fall of this 96-year-old man who was repairing his gate in full sun on Wednesday morning, supported for a trauma to the level of the nose? “Hard to say”, hesitates Nabila Benhamed, at the counter where newcomers present themselves. It will take a blood test to establish if he was dehydrated.

Vulnerable patients and some reckless

Patients weakened by high heat are often “multipathological”, summarizes Jacques Crampagne, head of the post-emergency service of the CHU. In particular the elderly, more at risk because they are more fragile, but also because they lose the feeling of thirst. “The Effects of Heat are often manifested by falls: people are weakened, they fall, get injured, and we discover on this occasion their dehydration.” The temperature comes on top of pre-existing health issues and sometimes even the effects of medications. “Diuretic or blood pressure treatments increase the risk of dehydration”, as well as certain psychiatric treatments, explains the emergency doctor. The danger increases all the more as the heat lasts: it is generally after a deterioration of several days that the elderly arrive at the emergency room.

Younger patients are not spared, however. In the emergency room of the CHU de Nîmes, they are not the most numerous, but mark the spirits. Earlier this week, Marine Pichenot, a nurse, treated “an 18-year-old boy, brought in by the firefighters. He had gone running in town and hadn’t stopped vomiting since, without being able to rehydrate”. Without seriousness, his case illustrates the risk of physical activity on hot days, which is suffered for some workers: “He recognized that he was a little unaware of the risk, he had not realized that we were in peak heat.”

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The young man had recently arrived from Paris and, in the eyes of Nîmes caregivers, this may explain his error of assessment. At the reception, an experienced agent is worried about these holidaymakers “who drive all day and jump in the water when they get there”, at the risk of thermal shock. Among the young patients who have suffered from heatstroke in recent days, his colleagues remember an American, a Belgian, but no Gardois.

The lack of crowds in the emergency room on a heat wave day, in a city which holds the record for the highest temperature measured in a large metropolitan area in France (44.4°C in June 2019), does it testify to the habit of the inhabitants in the face of high heat? Jacques Crampagne qualifies and recalls in particular that local traditions such as votive festivals, which punctuate summer in the Gard, are also an opportunity for risky behavior: “The association between votive festivals, excess alcohol and heat, we observe it every year in the emergency room.” Overall, he observes all the same that the instructions for caution are better and better understood, especially in vulnerable patients.

“With the heat, it is more difficult to concentrate”

Before the possible arrival of victims of the heat, the heat wave adds a load to the activity of the service. Caregiver, Marina Ferrand multiplies the “water towers” since starting duty at midday, to prevent patients who entered for another reason from becoming dehydrated on their stretcher. But she cannot satisfy many of them. “If they are waiting for exams, they are not allowed to drink, to stay fastingshe notes. Some are tense, sometimes they have been waiting for twenty-four hours. I try to inform them, but I can’t do anything.”

Air conditioning insulates the hospital from the tropical ambience outside. On his stretcher, Pascal is even delighted that he is doing better than in his poorly insulated social housing in the city center. But the system has its limits. “When you open the window, which is sometimes necessary for odors, the air conditioning stops”deplores Sandrine Couret, caregiver. “Anyway, right now it’s not refreshing”. “With the heat, it is more difficult to concentrate, we are less patient”testifies Marine Pichenot, who is lucky this Wednesday: she works in the shock room, where patients are sent in critical condition and where it is 10°C cooler than in the rest of the building.

To these sometimes painful conditions will perhaps be added an upsurge in arrivals at the emergency room, if the high heat persists. The ARS can trigger a heat wave plan allowing the opening of additional beds. But in the face of global warming, which threatens to make these peaks more intense and more frequent, “We have to anticipate, that’s for sure”observes the emergency physician Jacques Crampagne. “The key is the downstream beds”in other departments, making it possible to transfer patients requiring hospitalization and free up space in the emergency room.

From this point of view, the heat wave is only one problem among others in his eyes: “Whatever the season, there is a pathology. There is no longer a low point and a reduction in the number of entries.” If the management of the hospital has increased its capacity thanks to the elevation of a building inaugurated in March, it is seeking to fill 47 vacant positions in the establishment, with indirect repercussions on the emergency situation. “We are constantly in difficulty”, summarizes Ludovic Palmier, also an emergency doctor, who recalls that the CHU has to deal with the influx of tourists in the Gard. On Wednesday, in an emergency corridor, about fifteen patients are lined up on stretchers. The situation is no longer unusual in this University Hospital as in many others: “In winter, it happened that we had 30 or 40 during viral epidemics”, recalls Ludovic Palmier. In Nîmes and elsewhere, this peak is not about to fall.