Offbeat: Three questions about activation of level 2 of the "tension hospital" plan in Ile-de-France

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Faced with an influx of patients, deprogramming of non-urgent operations are envisaged in the coming days by the management of the 'AP-HP.

  Trois questions sur l'activation du niveau 2 du plan © provided by Franceinfo

"The situation is serious." The e President of the Medical Commission for the Establishment of Public Assistance-Hospitals in Paris, Rémi Salomon, alerted , Wednesday, November 23, on the "footprint" concerning emergencies in Ile-de-France. Faced with an epidemic of bronchiolitis "fairly strong this year" and a "lack of beds" and "staff", he confirmed the activation of level 2 of the plan "hospital in tension" of the AP-HP, revealed Tuesday by France Inter .

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What is the "hospital in tension" plan?

The plan "Hospital in tension" is an "organizational device specific to each establishment". It is "distinct from the white plan" and "can [the] precede", exhibits the National Agency for Health and Medico-Social Performance (ANAP).

This plan is intended to respond to "situations of saturation of reception capacities" of hospitals. Within the AP-HP, it has three activation levels, depending on the intensity of the tensions encountered: the level 1 of "proven voltage", level 2 of "accentuated voltage" and level 3 for a "Large or prolonged tension", details a note from the General Inspectorate of Social Affairs (PDF) published in December 2019.

The first level thus implies the activation of a standby cell, with a weekly meeting , and reinforced monitoring of activity and availability of beds.

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What does level 2 of the AP-HP plan correspond to?

At level 2 of the plane, the tension is officially considered to be "proven". Consequently, "the local watch cell widens and turns into a crisis unit", details the IGAS. The meeting of this cell passes at a daily rate. More concretely, "medical services patients can be deprogrammed, admissions to surgery are modulated, reinforcements may be requested from professionals in another hospital sector".

Monday, the heads of service of the main Parisian establishments had already received for instructions to initiate medical deprogramming, according to L'Express . "We are aware of the difficulty of this exercise and the tensions that this can generate within the medical community," said the AP-HP, which explained its decision by "an unprecedented peak" of 188-Brancard beds used in Adult emergencies, for lack of beds. Nonagenarians found themselves in corridors for 20 hours.

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Confirming an "emergency overflow", Rémi Solomon says he is concerned about an increase in the "stress level" of caregivers, with "the risk, indeed, that there is a drama from time". The passage to level 2 should make it possible to avoid such an outcome. According to France Inter, deprogramming of non -urgent operations will multiply in the coming days.

What can happen in the event of aggravation?

The last step provided in the "tension hospital" plan of the AP-HP, level 3, can be activated in the event of "prolonged or large" tension ". This occurred in January 2017, due to an important influenza epidemic. The management of the hospital group then mentioned "the installation of additional beds", "the deprogramming of certain programmed activities" or "the conversion of day or week hospitals in full hospital beds".

Another possibility is the activation of the "white plan". Such a decision was made in Ile-de-France during the COVVI-19 crisis, especially in December 2021. While Ile-de-France establishments were still only at level 1 of the "tension hospital" plan, the 'Regional health agency had asked them for the "generalized trigger for these white plans". The ARS then cited "deprogramming" and the possibility of "reorganizing staff schedules to ensure continuity of care". This device is more "heavy" than that of "establishment in tension", notes the site of the Ministry of Health .

To avoid getting there, Rémi Salomon, launched, Tuesday, on Twitter, a call to the French . "The flu is coming, the covid goes up, the hospitals are already saturated, he listed. More than ever, vaccination against flu is recommended, especially if you are over 60 years old or if you have chronic disease. Reminder of the COVID vaccine too! And should we remember that the mask and ventilation make it possible to reduce the transmission of all these viruses? "

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