White plan triggered at the hospital: what is it?

[Mise à jour le 9 novembre 2022 à 16h45] Health Minister François Braun announced to the National Assembly on 9 November the launch of the ORSAN plan, which oversees the white plan, to face the bronchiolitis epidemic in France. “It is an epidemic that exceeds the epidemic peaks that we have known for more than 10 years” he argued. the map of ORSANfor Oorganization of the Rresponse of the health system in situations Sanexceptional itaries, is a system for organizing French care. The activation of white plane in hospitals is an emergency measure to deal with a massive influx of patients.

In the context of the epidemic of covidthe white plan was triggered for the first time end of February 2020 then lifted and retriggered over the epidemic waves that followed. The 15th February 2022, the Ile-de-France Regional Health Agency announced in a press release the lifting of the obligation of generalized white plans to all private and public health establishments in the region. Depending on the local situation, each health establishment can thus return to the level 1 of its crisis management plan (the internal mobilization plan), or maintain the level 2 of the white plane.

What is the white plan?

Enshrined in law since 2004, the white plan contains measures of organizations intended to deal with an exceptional health situation or increased activity of a hospital. It makes it possible to organize the reception and care of a mass influx of victims an accident, a disaster (attacks for example), an epidemic or a deadly and lasting climatic event (a nuclear risk for example). Faced with the spread of the Covid, it was triggered on Friday, March 6, 2020 in hospitals in the most affected regions (especially in the Grand-Est and Ile-de-France regions) and widened to all hospitals in France March 13reflecting an absolute necessity in the face of coronavirus pandemic. It was never lifted, but only eased when the situation in hospitals calmed down. In the past, the white plan was triggered on the occasion ofepidemics of influenza in 2017 at the national level, of gastroenteritis in 2005 in 6 departments and of the heat wave in 2003. The white plan is also triggered during crisis situations such as attackslocally or throughout France (this was the case in December 2018 after the attack on the Christmas market in Strasbourg).

Who triggers the white plan?

The white plan can be triggered by the director or head of the public or private health establishment who then informs the representative of the State in the department, or at the latter’s request. The information is then transmitted to the director general of the regional health agency, the departmental emergency medical aid service and the representatives of the local authorities concerned. The white plane can also be triggered by the prefects defense zone and by the Prime Minister if the nature of the health situation or the scale of the influx of patients or victims justifies it, which was the case with thecoronavirus epidemic (Covid-19). Non-emergency hospitalizations can be deprogrammed (fibroscopies, dermatological care, prosthesis fittings, etc.).

When is the white plan triggered?

From a general point of view, the white plan is triggered if the situation of tension is combined with sustained activity and a restricted reception capacity. The indicators are :

► A 20% increase in the number of emergency visits for three consecutive days or,

► 10% of the number of daily patients with no hospitalization solution for more than eight hours,

► A similar situation is observed in the department.

The choice of these thresholds may need to be weighed against situations of tension already observed in the establishment over time. The lifting of the white plan is pronounced by the director when the situation has stabilized.

What are the measurements of the white plan in level 1 then 2?

The white plan identifies all the material and human resources likely to be mobilized and defines the conditions for their use gradually (level 1 then 2). In particular, it provides for the terms and conditions under which the necessary medical staff can be kept on site and, if necessary, recalled its volunteer staff when the situation warrants it.

The measures of the white plan taken by the health establishment must include:

• The establishment of a crisis unit piloted by the head of the establishment or his representative, and responsible for managing the alert, or the crisis.
• The organization of sorting, reception of patients, their distribution according to the nature and severity of their pathology in specialized units or, failing that, those most suited to their care. L’adding extra beds in services.
• The methods for transmitting the alert within the establishment, as well as the internal and external links to the establishment to ensure the circulation of information.
• A map of confinement and a plan ofevacuation of the establishment.
• Maintaining on-site teams of volunteer personnel.
• the graduated recall of volunteer staff on rest, in order to have sufficient resources but also to be able to organize rotations in the event of a lasting crisis.
• A transfer of patients from services involved to services less involved, other establishments, even home discharge when possible.
• A deprogramming of non-urgent activities : consultations, surgeries,…
• The inventory of means available by the medical-technical services (pharmacy, laboratories, medical imaging) and logistics (laundry, catering).
• Reinforcement of the means of communication: the telephone switchboard is reinforced and communications are reserved for the white plan only, reinforcement if necessary by a mobile health post.
• The organization of a medical triage strict in a sufficiently large room and under the responsibility of a triage doctor, separate from the traditional reception of emergencies, and separate from the reception of families and the media.
• The organization of car traffic on the site with signage and additional arrows to facilitate internal traffic, use of reinforced surveillance and guarding measures.
• the possible recourse to associative means : volunteers from first aid and social assistance associations for the treatment of light care or support actions.

The flow of new arrivals must be controlled in order to prevent contamination of the entire establishment in the event of an accident: nuclear, radiological, bacteriological and chemical.

The expanded white plan: when and why?

The enlarged white plane constitutes a reinforcement plan which completes the initial white plan. It is reserved for situations for which the organization of the reinforced health system does not, on its own, make it possible to deal with an event. For example, when the care capacities of a healthcare establishment are overwhelmed in the face of a crisis of exceptional magnitude. The Department Prefect then mobilizes other additional resources (material and human), at department level. The expanded white plan has been put in place in the French departments to deal with the coronavirus epidemic, with the aim of:

• To ensure the management of a large number of victims in the health establishments best suited to their condition, within compatible time limits and in appropriate security conditions.
• Organize the reception of a influx of unregulated victims by directing them to the best possible way by means of information in order to preserve the health establishments.
• Organize the functionalities of the entire system: health establishments, liberal health professionals, other players in the health sector, medico-social sector, health authorities, with a view to overall management.
• Ensure that all establishments and sectors of activity of the health system are operational.

the expanded white plane also includes three appendices relating to the organization of a exceptional vaccination campaignthe organization of the distribution of health products outside the pharmaceutical circuit, as well as the evacuation of one or more health or medico-social establishments when the means of the health system are exceeded.

Each public or private health establishment is responsible for developing its white plan. It must bring together the intra-hospital organization instructions of the establishment and the procedures for setting up a crisis unit. The white plans of the health establishments are integrated into a expanded white plane which defines the role and place of each, within the department, in exceptional circumstances. The white establishment plan is evaluated and revised each year. At each revision, the Regional Health Agency ensures the consistency of the establishment white plan with the extended white plan.

When was the white plan triggered during the Covid epidemic?

In the context of the Covid epidemic, the white plan was triggered for the first time on February 25, 2020 in the hospitals of Creil and Compiègne to deal with the first cluster censuses of coronavirus cases. The white plans were successively launched in the hospitals of the various cities and regions affected by the coronavirus from Friday March 6, 2020. The measures were then widened before being triggered throughout the national territory by the Minister of Health Olivier Véran, on March 13, 2020. Subsequently, the deprogramming of non-emergency hospitalizations was decided on March 28, to cope with the influx of patients affected by the new coronavirus, in the more than 600 health establishments referenced to receive “Covid-19 patients “. On July 5, 2020, the Guyana, triggers its white plan in three hospitals: in Cayenne, Kourou and western Guyana to deal with the increase in the number of hospitalizations linked to the COVID-19 epidemic. In front of the second wave of the epidemic of coronavirus in Francein october 2020, the white plan has been reactivated in several French hospitals. He is once again December 15, 2020 by the CHRU of Nancy because of the ever-increasing number of Covid patients. He was re-triggered in the summer of 2021 then early December 2021.