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In emergency services, will “flash measures” be enough to “hold on” this winter?

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Can the emergency services avoid the saturation of a looming winter peak, by operating on the same “bases” as during the summer? The question is asked, while an instruction was sent to the regional health agencies and published in the Official newspaperon November 22, with a view to extending or perpetuating almost all of the measures – 38 exactly, out of 41 in total – implemented, between July and September, to avoid the catastrophe announced for lack of caregivers and beds available.

“A disaster that did not happen”, we defend Avenue de Ségur, without denying the difficulties encountered during the summer period in these services, the “entrance door” to the hospital, which crystallize the ills of the entire health system.

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“Regulate” entering emergency rooms, upgrading night work in hospitals, extending bonuses, remunerating self-employed doctors in permanent care…: the “toolbox”, according to the agreed language element, had been established by François Braun as part of the “flash mission” he had piloted before joining the government. He put it into practice, from mid-July, in the wake of his appointment as Minister of Health. Now he intends to include these measures beyond the three months initially planned, and make them a solution to allow emergencies to ” hold “ this winter.

An “exceptional” response becomes the norm

This is not entirely a surprise: at the conclusion of the launch of the National Council for Health Refoundation, on October 3, François Braun had already said “project some of these measures into the future”, ensuring that they had “paid off”. He repeated it, communicating on the acute crisis that pediatrics is going through. Without delivering, and the health actors regret it, the content of the two reports commissioned from the General Inspectorate of Social Affairs, on the subject, and delivered at the end of September.

Read also: Article reserved for our subscribers “In pediatric surgery, almost all services are overdue”

Quoting the Inspectorate, the instruction that had just been published mentioned a “reduction of tensions in the structures most in difficulty” and one “better interprofessional solidarity”. “These summer measures made it possible to test the implementation of organizations sometimes requested for a long time by the actors in the field, can we read there, while leaving everyone the flexibility to choose the most suitable tools locally. »

Among these tools, the “regulation” of access to emergencies by a call to 15 and the orientation, when possible, of patients to city medicine, has fueled many reactions since July. Among the unions of emergency physicians, the positions did not vary much. “Regulation before emergencies can be the least bad solution if there is an alternative care offer, next to the hospitalsays Louis Soulat, vice-president of SAMU-Urgences de France, the objective being to reserve access to emergencies for those who need it”. “It only puts the pressure on the SAMU, it’s deleterious in the long term, argues Patrick Pelloux, president of the Association of Emergency Physicians of France. We are in the process of making an exceptional response, a derivative, a form of norm…” According to the latest ministerial statistics, this “filtering” has made it possible to reduce emergency room visits by 6%, for a parallel increase of 20% in regulatory activity.

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