2023-09-06 23:05:10
FORT-DE-FRANCE, September 6, 2023 (APMnews) – While its emergency rooms are overflowing in a context of rising Covid cases and the dengue fever epidemic, the Martinique University Hospital is counting on regulation by the 15th, but also on the strengthening of responses to unscheduled care needs, explained Tuesday the director of Samu and the head of emergencies, during a press conference, followed remotely by APMnews.
If the tensions in the emergency room of the CHU of Martinique are not new, the service is going through a critical situation due in particular to an epidemic of dengue, a “still active” circulation of the Covid, heat waves which particularly affected the elderly and sand mists causing respiratory ailments, Professor Papa Gueye, director of Samu, explained to APMnews during a telephone interview on the sidelines of the press conference.
All of these factors have caused the emergency room to be particularly overflowing since mid-August. In Fort-de-France, the service, which records 120 passages per day on average, has experienced peaks of up to more than 180 patients.
In this context, the regional health agency (ARS) Martinique announced on Friday that from Monday September 4, “people not covered by emergencies will be redirected by them to appropriate care”.
The message is given to the population “not to come to the emergency room when you do not have a serious emergency”, “without having called your doctor” or the Samu, explained Papa Gueye.
Concretely, emergencies have been regulated by the 15 since this week. When they still move without going through the Samu, “they are redirected”. “We offer them a phone to call 15” if they don’t have one.
The care access service (SAS) operates in Martinique with the presence of two liberal doctors at the Samu from 7 a.m. until 11 p.m., “in continuity of the permanence of care”, underlined Papa Gueye during the conference. Press. “It’s starting to work”, even if “the results are not immediate”, he pointed out, specifying that regarding “60% of [appelants] come under hospital regulation.
Asked by APMnews on the sidelines of the press conference, Dr. Yannick Brouste, head of the emergency department at the Martinique University Hospital, clarified that the “night regulation” by the 15th had already started “a few months ago”. As for the SAS, whose pilot phase had been launched at the beginning of the year, its operation had to be interrupted before resuming “before the summer”, following medical regulation assistants (ARM) might be trained internally.
The overcrowding of emergencies having implications for patients who require care, “we asked the ARS to see how to find solutions to avoid this traffic jam and ensure that we can provide quality care. “, reported Yannick Brouste during the press conference. “We are also counting on the will of each patient” by calling on them not to come to the emergency room when it “does not require it”, knowing that the regulation “will inevitably have an impact on the activity of center 15”.
Sometimes, “80-90 patients wait in the corridors” of the emergency room, he told APMnews. A tent has been set up in front of the entrance to the service, “under the supervision of the firefighters”, in order to release “the extra-hospital flow” and to avoid keeping the rescue teams waiting.
On Friday, three people were hospitalized for Covid in intensive care. “As much as for dengue fever, knowing that for dengue fever, if all goes well, people leave faster,” also described Yannick Brouste.
“It has been a long time since we have seen patients in prone position or who require oxygen” in a reinforced way due to the Covid, he underlined during the press conference. “We are discussing the return of the mask to caregivers and patients at the level of the care sectors. Within 48 hours, we will have a memo.”
Lack of medical staff
The head of the emergency services also pointed to difficulties with medical resources, specifying that at Samu, only one doctor instead of two was present H24 in hospital regulation. “At the emergency level, we lost a line of hospitalization [de courte durée] and a short line.” Regarding the paramedical staff, “the establishment has always made sure to protect” emergencies, but in the face of epidemics, “necessarily staff will start to fall”, he worried.
The tension on the medical workforce in the emergency room “has been constant for several years” and was exacerbated following the implementation of the provisions on the capping of the remuneration of the interim medical, added Papa Gueye, considering nevertheless that measures of attractiveness exist, such as the possibility of “more stable contracts” and “the 40% cost-of-living allowance recently approved by the government” (cf. dispatch from 03/04/2023 at 17:27).
“But regardless of the number of doctors, it is the increase in flow” that becomes “unmanageable”, he insisted. The challenge is “to try to ensure that unscheduled care is taken care of by specific” channels.
The ARS “is in the process of developing several non-scheduled care channels which revolve around city medicine, but also other advanced consultation initiatives, first aid reception centers, which will make it possible to provide solutions, because there is no point in telling people not to come to the emergency room if suitable care solutions are not found for them”, he considered.
On the territory, another challenge is to improve prevention by allowing “people to be seen regularly by their doctor” in the city, in particular by developing specialist consultations, he developed.
Yannick Brouste clarified that, among emergency visits, 40% might be redirected “or deferred”. He mentioned the problem encountered by the elderly, “who do not necessarily have a means of transport, are often isolated at home”, which might require, faced with the constrained offer in liberal medicine, a “development of the network liberal nurses”.
“We are in the process of rebuilding the health network in Martinique with the ARS”, he sketched.
At the level of the effectors, “there are things to improve in Martinique”, continued Papa Gueye, stressing that, particularly in the face of the needs of the elderly population, “doctors are organizing themselves to redo home visits”.
Moreover “the network of SOS doctors is not total in the territory” and therefore deserves “to be increased”.
The director of the Samu pointed out that the territory is well endowed with liberal nurses. “They are regarding 1,500, it’s a [atout] that must be used”, he pleaded, calling in particular for the establishment of Samu correspondents among these personnel. Regarding medical specialties, “dentists are also organizing themselves to have permanent care”, he also illustrated.
“This whole system, a city-hospital collaboration, will allow the hospital to refocus on its main mission, which is to treat the most serious patients and get them home as soon as possible.”
Regarding the downstream, the CHU alone “will not succeed in filling all the holes, hence the importance of the territorial hospital group (GHT)”, explained the director of Samu.
Yannick Brouste specifically mentioned the project to open an “emergency center” for which “the Saint-Paul clinic is one of the applicants”.
The CHU must also “reorganize at the level of the care services, the computer system”, because “we rely heavily on certain tools which allowed us to anticipate the flows”, added the head of the emergency department.
mlb/san/APMnews
1694042434
#Emergency #news #APM #French #Society #Emergency #Medicine
