The alert given at the national level since mid-May reports 120 emergency services forced to resort to closures or to prepare for them. A situation that the hospitals of Carcassonne and Narbonne have avoided. But without denying the monumental difficulties to which the health system – hospital and liberal – must quickly, very quickly, respond.
A hypothesis not to be excluded
The Samu-Emergency Association of France; media department heads, from Philippe Juvin to Mathias Wargon; or even Patrick Peloux, president of the Association of Emergency Physicians of France: for about ten days, all have been promising a “catastrophe” summer in emergency departments. A forecast whose conditions are already in place: 120 services, concerning nearly 20% of public and private establishments in the country, have already limited their activity or are preparing for it.
An outcome which has, for the time being, spared the two major public hospitals in Aude, Carcassonne and Narbonne. But for Alain Guinamant, director in Carcassonne, impossible to promise that the worst will be avoided. “Firstly because we have not yet arrived in the summer, the most complex period to manage. These suspensions of Smur lines, or these emergency service closures, we see them elsewhere. arrived in Pellegrin (Bordeaux), one of the major university hospitals in France
: it can therefore happen everywhere else, and it is therefore not a hypothesis to be excluded in the Aude. The concern of public hospitals, but also private, it is very strong.
Red lights
If Alain Guinamant does not rule out the idea of joining the long list of disrupted emergency services, it is because Aude, like the whole of France, is undergoing the same painful combination of aggravating factors: first a return to “normal” levels of emergency room attendance, even an overrun compared to 2019, when the Covid years (2020 and 2021) had plunged the figures. Difficult to digest in establishments for which this same Covid period has meant staff losses: perennial with departures of staff worn out to the bone; or temporary with absenteeism always above the norm. If we add to this the difficulties of recruitment, and a city medicine which is also suffering, despite the structuring efforts undertaken with the professional territorial health communities (CPTS), everything comes together to explain the present danger… and coming. With a valuable indicator, the decree of the regional health agency (ARS) which sets the list of “positions relating to a specialty for which the supply of care is or risks being insufficient, by establishment and by specialty”: in 2017, in Occitanie, 34 hospitals were concerned for 408.5 positions, including 71.9 positions for emergency workers in 14 CHs; in July 2020, after the 1 re
Covid wave, 414 positions in 35 CHs were listed, including 48 emergency room positions. On January 5, 2022, the latest decree amounted to 455 positions for 37 CH, including 19 concerned for 62 emergency room positions (**)…
The SAS as a way out? At the national level, emergency closures have already sparked a waltz of ideas: obligation of participation of all liberals in medical guards, revaluation of hospital on-call nights and weekends, sorting at the entrance. With the hindsight allowed by his“25 years of business”the head of emergencies at the Narbonne hospital center, Dr. r Alain Péret, calls for reflection. For emergencies, but also for the whole of a sick health system:
“What I am sure of is that no one has the miracle solution. And that you have to remember that the organization of health varies from one city to another. As between Carcassonne and Narbonne, with a geographical difference: in Narbonne, the on-call medical center is 150 m from the emergency room: the instantaneous reorientation of patients, we have therefore been doing this for 12 years, and it works in the opposite direction. But the question also depends on the general practitioner fabric, downstream beds,…” A global context to which the SAS (care access service) must respond, for which 22 pilot sites were selected in January 2021 to experiment with this measure of the Pact for the overhaul of emergencies. An SAS intended to meet the demand for vital, urgent and unscheduled care,“to provide the population with more readable and coordinated care between the city and the hospital” , promised the Ministry of Health. The tool, which is managed by the regional health agency, is under construction in Aude. And raises expectations in this delicate context, for“ensure the care of all patients” summarizes Alain Guinamant:
-Since May 18, entries are no longer free, but regulated, patients must call 15 before showing up.(**) With 35 positions including 8 emergency workers at the Carcassonne hospital center, and 12 positions at the Narbonne CH.
