“The weekend of December 2, we had a doubling of calls for regulation: we went from an average of 2,000 to 4,000, which was what we had to deal with during the Covid”, explains Professor Philippe Rebel, head of the adult emergency unit – SAMU SMUR. The strike of liberal doctors, then of SOS doctors and the closure of certain emergency services in the metropolis contribute to explaining a postponement of the population on the 15th, which had not been able to reinforce the staff of its telephone platform. For three weeks, the medical regulation service, already under strain, was put to the test in the context of a triple epidemic (bronchiolitis, influenza, covid).
“Intolerable waiting times”
“Quality and working conditions have deteriorated,” comments Philippe Revel. We still receive complaints, which are justified, for lack of care in sufficient time. “He explains that during this difficult period, with a peak on December 17, caregivers returned to work sick to cope with the influx of patients. “On a voluntary basis, medical regulation agents (ARM) have returned to their rest time”, also testifies Chaumet Sandra, room supervisor at Samu 33. Professor Nicolas Grenier, president of the Medical Establishment Commission ( CME) of the CHU does not mince these words: “We held on but at a high price for the teams and especially for the patients since there were intolerable delays in care. But the missions continued to be carried out by the CHU. »
During call peaks, the medical dispatch agents at center 15 were unable to answer all the calls, knowing that the “record” for a medical dispatch assistant (ARM) is 44 calls taken per call. hour. Once the shot had passed, “we called 250 callers back in less than 2.5 hours to be able to ensure that their state of health was not serious”, points out Angélique Fresard, senior health manager of the Adult Emergencies center – SAMU SMUR .
ARMs, allies to unclog emergencies
At Pellegrin, the 15 platform brings together around 70 ARMs, around twenty regulating doctors, but also midwives (for the perinatal network), nurses from the poison control centre, a psychiatric nurse and a dental surgeon who comes punctually to regulate certain situations. It is a very difficult profession and one must practice blindly, relying solely on the indications of the caller.
While the texts give the ARM 30 seconds to assess the seriousness of the situation, “the first sentence when you pick up is often ‘I don’t feel well'”, points out Angélique Frésard. When the vital or potentially vital prognosis is at stake, the relay is taken over by regulating doctors who can send resources on site (SDIS or ambulances). Other ARMs play an upstream role, by monitoring patient care, based on the reports of firefighters and paramedics. If the patient’s condition has deteriorated, a doctor can send an SMUR team.
“When patients call here, we try to prevent them from going to the emergency room,” explains Angélique Fresard. Especially since according to a 2017 study by the Drees (Research, Studies, Evaluation and Statistics Department) one in six patients who come to the emergency room have already seen a doctor within eight days. previous ones. Sometimes they want another diagnosis or an additional examination. “The 15 is not the easy solution, warns Angélique Fresard. You must reserve your call for urgent situations. The ARMs have the delicate task of directing patients knowing that all the services are under pressure and also of making certain of the callers understand that the request they are making is not an immediate care priority and that it can be deferred.
An ARM training center has opened
Since 2019, ARMs must be certified and graduates. A training center has just opened in Bordeaux and should make it possible to consider more recruitment in the years to come. “It’s a job on which we have placed an additional level of requirement, not limiting ourselves to a simple recruitment interview but by subjecting the candidates to questions of general culture related to health, to professional situations and psychotechnical tests”, underlines Angélique Fresard.
If in fact, the number of visits to the emergency room is falling thanks to the regulation, there is also a problem downstream, pointed out in particular by Professor Philippe Revel. “Among those who come, we are more careful with a hospitalization rate of 60%, whereas for a classic emergency service, it must be between 15 and 20%. The specialized services that should take over are also overcrowded.