Should it be compulsory to transfer from a hospital with a saturated emergency room and intensive care unit to one that is less in demand?
The option, which was not chosen on Wednesday, was it really considered by the government to fight against the third wave of the Covid-19 pandemic?
Emmanuel Macron put forward “additional reinforcements” in intensive care to cope with the influx of serious patients from Covid-19 and to go “in the coming days” to more than 10,000 beds, against 7,665 currently.
Legally, the solution of transfer without authorization would have been possible, in the event of a vital emergency or "in consideration of the technical capacities of establishments" as indicated in Article L 1110-8 of the Public Health Code.
There remains a problem of medical ethics raised by many doctors.
Disregarded the consent of a patient's family?
“It's unthinkable!
immediately opposes Bertrand Guidet, head of the intensive care unit at Saint-Antoine hospital in Paris.
Imagine, you transfer a patient against the advice of his relatives and he dies during transport?
Or is it going wrong in the host hospital?
".
"This measure would go against the bond of trust forged with families"
Even if the probability of a death during the evacuation is tiny, recognizes the specialist, "for the doctor, this measure would go against the bond of trust woven with the families".
Another solution exists.
“If a patient arrives at the hospital in great distress, he can then be taken care of in the emergency room, telling the families that the intensive care unit is full and offering them a transfer.
There, it's totally different ”indicates Bertrand Guidet.
As for the Pompidou hospital, his colleague Jean-Luc Diehl, head of the intensive medicine and intensive care unit, is also “in principle against”.
But obviously, if the pressure continues to increase and prevents new patients from being admitted to intensive care, this decision can be "interesting," he says, knowing that this involves several ethical principles.
At the end of the chain, it's up to the doctors to find solutions, warns the resuscitator.
In Pompidou, no transfer has taken place since mid-March!
Families oppose it.
"We must therefore open a maximum of beds even if this is done at the expense of the care of other patients, that too, it is a real ethical concern".
A thousand patients transferred in spring 2020
On March 11, the Minister of Health Olivier Véran called for a new use of the impressive transfer operations carried out from mid-March to mid-April 2020. These had made it possible to relieve the intensive care units completely overwhelmed by the first wave of the epidemic.
In total, a little more than a thousand patients had joined, mainly from Hauts-de-France, the Grand Est region and Ile-de-France, a hospital in another region of France or even sometimes from a neighboring country.
If the government for a time considered making these transfers compulsory, it is because history has not repeated itself, this time coming up against the reluctance of families, often opposed to seeing their loved one leave. hundreds of kilometers.
The situation is no longer the same as it was 12 months ago, with visits to patients now being authorized whereas they were not allowed last spring.
Fewer than 40 Covid patients hospitalized in intensive care have been transferred out of their region since mid-March this year.