41 APHP crisis directors signed a column in the JDD stating that they feared having patients “sorted” in intensive care. “The Kovid-19 epidemic is once again in constant progress in all areas, and -le-de-France is unfortunately found in frontline areas. In the next two weeks, with contaminations already occurring, we have a virtual certainty on the number of critical care beds that will be required and we already know that our care capacity will be exceeded at the end of this period“, Concerns a group of health professionals. But what does it really mean to” sort “patients? Science and future Professor Frederick takes stock with Ednett, Professor of emergency medicine, head of the emergency department of Avicen Hospital and signer of the Samu de Seine-Saint-Denis and JDD platforms.
Vigyan et Avenir: With contamination, which are steadily increasing, when you are afraid of being laid off in the hospital and what does it mean in concrete terms?
Pr Frédéric Adnet: In fact, under the guise of deprogramming, we have already started sorting it out in the hospital. At the moment, it is a morally acceptable sorting, to say that we do not sacrifice life. But every day there are people who need a hospital and who cannot be provided care, because we have to reserve space for someone else. The term deprogramming for example is hidden patients who came in, for example, for cancer screening, but who cannot be taken into account to make room for patients with Kovid-19.
So for you, this is already a form of sorting?
Yes. We have used the term diprogramming but what we are actually doing is sorting. In chronic pathology, when you do not detect cancer, you will find your patient with cancer later in a more advanced stage and with an increased risk of death. Ditto for untreated diabetes that worsens over time or with obesity surgery that becomes depressive, paying patients complications for several months. The handling of these people is not neutral. With this sorting, there will also be consequences for favoring patients with Kovid-19 and rearranging non-Kovid and non-essential ones. We can already see this in the United States, where the country shows an excess mortality due to chronic pathology, which has not been taken into account.
By what point do you fear the situation will worsen?
At the moment the layoff limit is acceptable, but it will increase to such a condition that we will no longer be able to accept: two patients arrive in intensive care, but I only have one free space. The problem is, if the hospital pressure increases, the pruning also increases. Our threshold is the condition that I have just described for you, that is to say that we are no longer able to care for all patients who need resuscitation. For now, we are left with an “ethical” sorting. But this is not normal. In thirty years of work, I never experienced it, during the first wave last year.
How decisions are made, who chooses which patients will be deprogrammed or who will benefit from a place in intensive care?
It is on a case by case basis. Each hospital is different and has its own crisis unit. That said, all establishments have the same surveillance: save the most lives and figure out what the lowest results will be. Even if we know that there are always consequences. There is no point hiding dust under the carpet.
Have you ever had to turn away patients who needed a place in intensive care in the past?
In the first wave, we depicted patients but never trimmed between two patients who needed resuscitation. Luckily, because this is what we are most afraid of. In the hospital, we favor rapidly progressive and fatal diseases, such as oncology, emergency surgery, interventional radiology (which involves the removal of a tumor, editor’s note), anything that is life-threatening in the short term. On the contrary, we depict chronic deformity. But we have to unravel more and more necessary pathology. Already, we went from 16 to 50 intensive care beds. The walls are not expandable. To visit these 50 locations, we had to close the cardiology intensive care unit. These patients must have gone somewhere so we managed to move them elsewhere. But it is getting harder and harder. Other countries have had to refuse intensive care patients in Bergamo, in Italy. There, health professionals explained that they had to sort through patients, so choose who could go into intensive care or not. This is what we want to avoid altogether.
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