The transfer of patients, breath of oxygen for saturated regions



“By the end of next week, probably around a hundred patients will have been evacuated from the Île-de-France region to other regions”, government spokesman Gabriel Attal said on Sunday March 14, confirming the health minister’s announcements on Thursday March 11. Medical evacuations “Will ramp up, he said, at the rate of six evacuations on average per day (by air) and then at the end of the week, a more massive operation with medicalized TGVs which will make it possible to transfer several dozen patients to regions which are today less under pressure ” .

Three first transfers took place on March 13 and 14. These Covid-19 patients in intensive care in Île-de-France were transported Saturday morning by helicopter to the hospitals of Nantes, Angers and Le Mans, areas where the pandemic pressure is less strong. Two other patients were transferred Sunday to the Bordeaux University Hospital and a last was to be transferred to Pays de la Loire. Faced with the saturation of hospital services, other highly affected regions, such as Hauts-de-France and the PACA region, also resort to medical evacuations. Before those of the day, 163 had taken place throughout France since January 26.

A lever in the face of saturation of services

“A transfer is decided when you feel that the situation will become untenable: if all the beds are occupied”, recalls Lamine Gharbi, president of the Federation of Private Hospitalization (FHP). Situation that the Île-de-France is dangerously approaching with 95.90% of its occupied hospital capacity. Therefore, public and private, everyone is mobilizing ”, insists Lamine Gharbi. In practice, each day, the number of available beds is entered in the operational resources register (ROR), which makes it possible to allocate patients.

“No question of transferring, a heavy device, if one is not close to saturation”, underlines Professor Patrick Goldstein, head of emergencies at the Lille University Hospital. In Hauts-de-France, transfers took place to Belgium, Normandy, or even Saint-Malo: “The west of the country remains the least energized place, as during the first wave”, notes Jacques Léglise, director general of the hospital conference of the Federation of non-profit private hospitals and personal assistance establishments (Fehap).

Select patients and modes of transport

It remains to select the patients to be transferred. “Stabilized patients, nor in the initial phase or in the acute phase of the disease “, notes Professor François Braun, president of Samu Urgences de France and doctor at the CHR in Metz.

Several means of transport can then be mobilized, depending on the distance and the number of patients: the classic ambulance, the helicopter, the high-speed train (TGV) medicalized or the plane. To use the latter, make sure that the patient is neither too tall nor too fat, “110 kg maximum”.

Each mode of transport then has its human resource requirements: “4 to 5 people per patient” by ambulance (doctor, nurse, pilot, fire brigade), “3 to 4 people in a helicopter, 7 people (pilot included) for two patients transported by plane, 56 people (train attendant, nurses, first-aid workers and logisticians) for 24 patients in a medicalized TGV “, explains François Braun. Finally, there are the material requirements, including oxygen cylinders (200 aboard a TGV).

Heavy logistics whose cost is difficult to quantify: “A helicopter evacuation will be billed per flight minute”, points out François Braun, who considers that the TGV remains economically the most interesting transport with “The more patients and the more comfort”.

Distance, a double penalty

In all cases, the agreement of the families remains essential. “We are talking about evacuating patients several hundred kilometers from where they live., points out François Braun. Relatives, sometimes, refuse. ” In November 2020, Nadia Slimani and her three brothers and sisters thus saw their father leave, from Avignon to… Lorient. “At the time, I said to myself that it was far. But we didn’t hesitate for long ”, remembers the young woman.

To support her father, she moved to Brittany for a few months. “I kept my family in the loop almost every day. ” Then, the coma continuing, Nadia returned to the South. Her father woke up not long ago after four months in a coma. In Brittany, always. “To open your eyes far from home, far from us, it will remain a trauma”, she confides. Like a double pain, despite the joy of being alive.

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