Virtual – How is a field hospital set up? What organization of care is put in place with this type of structure? Used in the context of the health crisis linked to Covid-19, two models of field hospital, one military, the other civilian, were presented during the virtual fair Rescue Expo 2021, dedicated to medical assistance, emergency care and risk prevention [1].
On March 16, 2020, while the Emile Muller hospital in Mulhouse found itself overwhelmed by serious cases of Covid-19, with 15 to 20 patients intubated every day in the emergency room, the President of the Republic, Emmanuel Macron, announces in a televised address the deployment of a field hospital near the hospital establishment in support of the intensive care unit.
The announcement is exceptional. Usually used during military operations carried out abroad to treat war wounded, the military resuscitation element of the army health service (EMRSSA) is for the first time deployed on French territory to treat sick civilians.
A hospital set up in two days
After the presidential address, it took less than a week to activate the military field hospital in the main car park of the hospital group of the Mulhouse and South-Alsace region (GHRMSA). Once the equipment was transported to the site from Chanteau, near Orléans, 48 hours were needed to set up the modules in tents and make the support system operational.
The EMR consists of a large central aisle connected on both sides by separate spaces. On one side are the three resuscitation units and a decontamination unit, while the pharmacy unit, the medication preparation area, the medical office and the command post are placed on the other side of the corridor. central.
“EMRSSA’s mission has been clearly defined. The aim was to help the intensive care unit of the Emile Muller hospital, with two objectives: to treat patients with a high level of care and to protect the nursing staff of the army health service from the risk of contamination by SARS- CoV2 ”, indicated the Prof. Pierre Pasquier (Army instruction hospital, Clamart), during its online presentation.
The resuscitation units at the field hospital have a total of 30 beds, which are added to the 20 resuscitation beds at the Mulhouse hospital. “We find there the usual means to treat in critical situation: capacities of mechanical ventilation, continuous intravenous infusion, enteral nutrition in constant flow and continuous monitoring. “
More than 80 caregivers mobilized
The mobilized team is made up of 83 caregivers from the military health service (doctor, anesthetist, resuscitator, nurse, nursing assistant, physiotherapist, etc.). Resuscitation care is provided “under difficult operating conditions”, with limited space and freedom of movement limited by protective equipment.
Every day, anesthetists and resuscitators from the military field hospital meet with their colleagues from the civilian hospital “so as to manage the flow of patients” between the two structures. “The challenge was to create a permanent flow of patients so as not to overload the reception capacities of the civilian hospital. “
A first intubated and ventilated patient was transferred to the field hospital on March 24, 2020. Almost a month later, due to an improvement in the situation, the reception capacity was reduced by dismantling 10 beds. The structure then had 46 patients received since the start of the operation. The installations were finally dismantled in May 2020. The operation was not repeated.
Versatile mobile unit
Concerning the civilian version of the field hospital, it takes the form of a mobile health unit condensed on a single heavy vehicle. Once the deployment location has been defined, five cells can be extracted from it on rails by an accordion opening system, then equipped (see the presentation video here). The deployed unit then occupies an area of 66 m2 and is 12 meters long.
This unit was developed by the Toulouse University Hospital as part of the European EGALURG program, which aims to support collaborations to improve health care in emergency and disaster situations, explained the Pr Vincent Bounes, head of Samu 31 at Toulouse University Hospital. This one-of-a-kind field hospital has been called the Europe Occitanie Multipurpose Mobile Unit (UMPEO).
Originally designed to be used in the Pyrenean regions during major events causing massive influxes of people or in response to disasters liable to saturate local health care structures, the device was finally adapted to help cope with the Covid-19 pandemic.
This mobile unit was first deployed in September 2020 in several small towns in the Pyrenean chain of Haute-Garonne for a screening campaign for Covid-19 by PCR test. Nearly 1,000 tests have been carried out in this way. It was then used for a month and a half in support of the Bayonne hospital as a short-term hospitalization unit (circuit outside Covid-19).
Mobile vaccination center
This mobile sanitary solution has the advantage of being quick to set up. It only takes 20 to 45 minutes to exit and line up the five cells from the main cabinet. These can then accommodate the intensive care cabins with all the equipment necessary for emergency medicine. A maximum of 18 simultaneous patients can be accommodated there.
This miniature hospital also has the capacity to be completely autonomous from a technical point of view. “It has an energy capacity, a water and oxygen reserve sufficient to ensure two hours of autonomy, whatever the configuration and the disaster,” said Professor Bounes in his presentation.
The activity of the mobile unit is currently devoted to vaccination against Covid-19. The vehicle travels through the municipalities of rural areas of Haute-Garonne where the unit serves as a reference vaccination site, thus facilitating access to vaccination for the elderly and dependent. Between 150 and 300 individuals are vaccinated each day.
Another similar mobile unit has recently been developed to carry out decontamination operations. The Europe Occitanie mobile decontamination unit (UMDEO) was also used in March 2021 for a vaccination campaign against Covid-19, which made it possible to vaccinate up to 1,000 people in one day, said Prof. Bounes.
Image credit: extract from the presentation film UMPEO – Unité Mobile Polyvalente Europe Occitanie / Multipurpose Mobile Unit Europe Occitania
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