Medication in hand, Nicolas slowly enters the “shock removal” room of the emergency department of the hospital in Gap, in the Hautes-Alpes. It is in this small room filled with medical equipment that priority cases are treated, requiring resuscitation, respiratory assistance or even cardiac stimulation. “So, how are you feeling?” the nurse energetically asks the patient of the day. Admitted in emergency for a crisis of tachycardia, the man answers, a hand on the heart. “It’s going down, I don’t feel it pounding anymore,” he explains, smiling. Nicolas makes sure he takes his pills well, checks his heart rate. It is still a little too high – the release will not be for now. “On the other hand, it is possible that you will soon be changed places”, warns the nurse, while a team from the mobile emergency and resuscitation structure (Smur), composed of an emergency doctor and a nurse from the service, has just left.
Nicolas does not linger. Neon green fangs on his feet, the caregiver goes from corridors to treatment rooms, prepares patients, monitors the admissions board, lifts a heavy stretcher… “We never really stop”, he breathes. On this hot Friday in July, the Gap emergency room is like an anthill. It’s only 2 p.m. and 70 patients have already been admitted. “On average, we receive between 100 and 110 people per day during the summer, compared to around 60 in the low season”, indicates Nathalie Dubrulle, health manager of the service. Abdominal pain, stroke, loss of consciousness… The so-called “classic” pathologies are almost doubled by the influx of tourists, to which are added summer injuries, such as serious allergic reactions due to wasp stings, drowning, dehydration or even, recently, a paragliding accident. Not to mention the Covid patients.
Today, the flow is tense, but controlled. “But all it would take is one or two departures from Smur or a sudden arrival of serious patients for things to suddenly intensify,” says Nathalie Dubrulle. Last Wednesday, the service was so overwhelmed that the health manager says she was forced to participate in the care herself. And each day brings its share of constraints: this Friday, a nursing assistant from the block came as reinforcements in the service, for example, while an absence in cardiology is already announced for the next day. “We are holding up thanks to the good will of the staff, and because we are lucky to have an extremely close-knit and available team. But it’s a permanent adaptation”.
A “fragile” situation
To prevent the surge of patients during this summer period, the management of the Intercommunal Hospital Center of the Southern Alps (Chicas) and the head of the emergency department of Gap, Pierre Visintini, have nevertheless been far-sighted. In addition to the four emergency doctors present daily in Gap during the day and the three night doctors, an additional doctor has for example been added to the workforce in the afternoon for the period from July 14 to August 22. Fifteen beds were also reopened in the various departments of the hospital at the beginning of July, and fifteen others will reopen in geriatrics by August 1, thanks to a series of hirings before the summer. “It is necessary, because the lack of downstream beds for patients who need to be hospitalized at the exit of the emergency room is a real problem: we have been subject to too many closures in recent years”, estimates Dr Visintini. Concerning the overwork of his teams, the head of department is well aware of the efforts made: he himself has just carried out an unscheduled night call, in order to replace at short notice a sick leave at Center 15 of the hospital. “But in Gap, we are not far from reaching our objectives in terms of staff, he nuances. Even if bad news can always fall on us, such as a doctor who resigns or unexpected holes that must be filled.”
The head of department knows by heart the problems of fluctuating schedules. In addition to the Gap site, the Chicas is also made up of the Sisteron site (Alpes de Haute-Provence), located about fifty kilometers away. The emergency services of the two cities, themselves linked to the other hospitals of the Territory Hospital Group (GHT) of the Southern Alps, work in close collaboration. In this territorial mille-feuille, a “moving” team of emergency doctors has thus been called upon since 2020 to intervene in turn in the emergencies of Gap, Sisteron and Embrun, east of the Hautes-Alpes. “Concretely, each emergency physician hired in Gap undertakes to spend 25% of their time in Sisteron or Embrun”, deciphers Dr. Visintini. This initiative notably made it possible to reopen the emergencies of Sisteron, closed for a year at night between 2019 and 2020.
“Without that, we would not open. But the situation remains fragile”, comments Valérie Lebreton, health manager at Sisteron hospital. Some nights during this early summer, the schedule was more than uncertain, which worried the unions. “The balance is precarious: in August, there are still five nights for which an emergency doctor is missing in Sisteron”, alerted mid-July Valérie Clément, CGT secretary at Chicas. “The establishment implements all possible means to ensure continuity of care”, responds for its part the management, which ensures that this problem will be resolved by the presence of the famous territorial team of emergency physicians.
“We are tired”
In the corridors of the emergencies of Sisteron, these doubts are added to the pressure which already weighs heavily on the shoulders of the staff. Especially since the emergency room of the Manosque hospital, 45 minutes by car, has been regularly closing their doors at night since the beginning of summer. “It has a direct impact on us: we welcome their patients from the end of the afternoon, in addition to tourists, frail elderly people, people without attending doctors, Covid patients… It’s very complicated , we are tired, deplores Emilie, a nurse in Sisteron for five years. Recently, we had eleven patients in the short-term hospitalization unit, which normally only has four places. Some days, she also testifies to a service “more than overwhelmed”, in particular by what caregivers call “bobology”: small benign injuries, angina or headaches which should have been taken care of by the town medicine.
Despite the reinforcement for the summer period of a nurse’s aide during the day, an additional nurse at night, an intern during the week, a laboratory technician on Sunday afternoons and a customer management to register patients until 9 p.m., the work to be done remains colossal for the teams. Between April and June 2022, no less than 4,360 patients thus went through the Sisteron emergency room – an increase of 20% compared to the previous year. “And in the meantime, we also have to adapt to changes in the schedule,” recalls Emilie. Last week, the nurse had to return two days from her week off to replace a sick colleague. “Fortunately the team is united, that’s what allows us to hold on,” she says.
“Honestly, sometimes we don’t have time to eat, we reduce pee breaks. Patients wait so long that they are often irritated, even aggressive”, testifies his colleague Audrey, who has worked for twenty years at the hospital. Leaning over the admissions screen, the nurse remembers the “big days” of previous years. “Ten years ago, if we did 20 visits a day, it was exceptional. Now, we are more at 60 or 70 patients daily during the summer.” Today, the day was rather calm: at 6:30 p.m., his screen indicates about forty passages. “But we are not immune to it going up suddenly, she tempers. You always have to be ready.”