This study describe the organizational impact of the Covid-19 pandemic in Emergency Medicine. Published in JEUREA : https://doi.org/10.1016/j.jeurea.2021.04.001

1. RESILIENCE
STRATEGY IN
EMERGENCY
MEDICINE DURING
THE COVID-19
PANDEMIC IN PARIS
Dr MINKA Sally Oceane, Bichat
Hospital, Paris University, FRANCE

2. INTRODUCTION
• The SARS-CoV-2 pandemic started in China in December 2019 in the city of WUHAN,
Hubei Province.
• SARS-CoV-2 is a respiratory virus in the coronavirus family. It is responsible for viral
pneumonia grouped under the term of Respiratory Disease in Covid-19(1) (2)
• The transmission of this virus takes place in a human-to-human manner by the projection
of droplets ; or transported by the hands(3)
• The infection can be asymptomatic in 30 to 60% of cases(4)
1. Valencia DN. Brief Review on COVID-19: The 2020 Pandemic Caused by SARS-CoV-2. Cureus. March 24, 2020; 12 (3): e7386-e7386.
2. Li H, Liu S-M, Yu X-H, Tang S-L, Tang C-K. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020003329. May 2020; 55 (5): 105951-105951.
3. Tu Y-F, Chien C-S, Yarmishyn AA, Lin Y-Y, Luo Y-H, Lin Y-T, et al. A Review of SARS-CoV-2 and the Ongoing Clinical Trials. Int J Mol Sci. Apr 10, 2020; 21 (7): 2657.
4. Pastor Institute. Covid-19 disease (New Coronavirus). Updated June 09, 2020.

3. EPIDEMIC
SITUATION
January 30, 2020 : OMS declared "the Public Health Emergency of
International Scope (USPPI)
March 11, 2020 : the state of Mondial Pandemic
March 14, 2020 : France entered at stage "3" of the epidemic
March 17 to May 11, 2020 : period of lockdown in France
December 31, 2019 to June 18, 2020 :
Positives cases : 8,318,370 in worldwide /1,492,177 in Europe /
158,641 in France
Deaths cases : 448,735 in worldwide /172,621 in Europe/29,603 in
France

4. OBJECTIVE OF THE STUDY
Describe the impact of Covid-19 on the organization of our emergency
services and the resilience we had to face.

5. METHODS
• We carried out a descriptive observational study of the "adaptation strategy" of two
Parisian emergency services : Bichat and Lariboisiere Hospitals.
• This study focused specifically on the operation of these hospitals to deal with the first
wave of covid-19 pandemic in France from March 01, 2020 until the end of lockdown on
May 11, 2020.

6. RESULTS :
RESILIENCE
STRATEGY
ARCHITECTURAL
ADAPTATION
FUNCTIONAL
ADAPTATION
ADAPTATION OF
HUMAN
RESOURCES
ADAPTATION
PREVENTION
STRATEGY
TELEMEDICINE
BOOM
ETHICAL
REFLECTION

7. ARCHITECTURAL
ADAPTATION

12. ARCHITECTURAL ADAPTATION : STEP 1
Creation of Covid + boxes in emergencies
Strengthening prevention strategies
Maintenance of surgical activities
Stop face-to-face consultation activities

13. ARCHITECTURAL ADAPTATION : STEP 2
Extension of the Covid + area in the emergency room
Hospital sectorization
Discontinuation of non-emergency surgical activities
Implementation of teleconsultation

14. ARCHITECTURAL ADAPTATION : STEP 3
Human reinforcements
Increase in intensive care beds
Referral of patients to clinics
Ethical discussions

15. FUNCTIONAL
ADAPTATION

16. ADAPTATION OF HUMAN RESOURCES
Human
reinforcements
based on simple
volunteering.
Cooperation with
intra-hospital
services
Synergy between
the City and the
Hospital

17. PREVENTION STRATEGY
No effective treatment
No vaccination
Little protective equipments
surgical masks and FFP2,
overcoats, caps, non-sterile
gloves, protective glasses

18. PREVENTION STRATEGY
Mar. 2020
Health authorities did not recommend the
wearing of masks in the general
population. Surgical masks were reserved
for sick people, their close contacts and
nursing staff.
23 Mar. 2020
The state of emergency was declared,
allowing the government to requisition all
stocks of masks imported or available in
pharmacies for hospital staff.
6 Apr. 2020
The speech of health authorities changed
by recommending the wearing of
alternative masks for the public.
20 July 2020
Wearing a mask was made mandatory in
France in closed spaces (or establishments
open to the public).

19. TELEMEDECINE BOOM
• The Covid-19 pandemic has facilitated the deployment of telemedicine in France.
• Indeed, budgetary, and regulatory constraints which existed until then have been amended to
allow the rapid implementation of teleconsultation (5).
• Creation of the COVIDOM platform for remote consultations and monitoring of patients suspected
or confirmed of Covid-19 infection without criteria of severity and returning home.
• 19% of the consultation activity was carried out by teleconsultation. ORTIF was one of the
platforms used to ensure this activity (6).
5. Minka F. Evaluating the impacts of teleconsultation in primary care according to MAST: Model for Assessment of telemedicine. Memory article; Thesis of General Medicine defended in April 2019 at
UVSQ. 2020.
6. Dashboard. Covid-19 epidemic. Crisis unit. Document prepared by the teams from the Strategy and Transformation Department, the Patients, Quality, Medical Affairs Department and the
Department of Public Assistance Information Systems at Paris Hospitals. Source CIVIC. June 9, 2020.

20. ETHICAL
REFLECTION
Limitation of care procedures were undertaken for COVID
patients who were not eligible for resuscitation.
Specifically for these patients and in close collaboration with the
mobile palliative care teams, we favour comfort care.
These care limitations were collegial (resuscitator, emergency
physician, palliative care physician, elderly doctor) and carried
out in the interest of the patient.
Once ruled, the decision was recorded in the medical file.
Families were not allowed to visit relatives. A psychological
hotline had therefore been set up to help these families.

21. DISCUSSION
• The Covid-19 outbreak has prompted a wide range of responses from health systems
around the world.
• There is a pressing need for up-to-date policy information as these responses proliferate,
so that researchers, policymakers, and the public can evaluate how best to address Covid-
19.
• The pandemic triggered a chain reaction, yet within the limited range of response options
available we have seen significant national differences in management and outcome.

22. DISCUSSION
• Our organization was inspired by disaster medicine and exceptional health crisis, applied in
conventional medical settings.
• Covid-19 is a major organizational challenge for the emergency department and the hospital.
• Moreover, in France, similar in other countries, hospital pressure related to COVID has been and
remains very variable.
• It is therefore essential to report on the different types of organization possible to deal with a
massive influx of patients during an epidemic period.

23. CONCLUSION
• We should remember that our organizational strategy is above all the ability to change our work
habits not only according to the proportion of COVID patients to be taken care of, but also
according to the number of hospital beds available in post emergencies.
• In the ‘pre pandemic period’ and the ‘low pandemic period’, we operated in a mixed mode in Covid
and no Covid zones; And in ‘high pandemic period’, in all Covid mode.
• For patients who consulted for non-infectious reasons and who could come under primary care,
they were redirected to general practices.
• We continually adapt, without ever giving up; this is the definition of Resilience!

24. BIBLIOGRAPHICAL REFERENCES
1. Valencia DN. Brief Review on COVID-19: The 2020 Pandemic Caused by SARS-CoV-2. Cureus. March 24, 2020; 12 (3): e7386-e7386.
2. Li H, Liu S-M, Yu X-H, Tang S-L, Tang C-K. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020003329. May
2020; 55 (5): 105951-105951.
3. Tu Y-F, Chien C-S, Yarmishyn AA, Lin Y-Y, Luo Y-H, Lin Y-T, et al. A Review of SARS-CoV-2 and the Ongoing Clinical Trials. Int J Mol Sci. Apr 10, 2020; 21 (7): 2657.
4. Pastor Institute. Covid-19 disease (New Coronavirus). Updated June 09, 2020.
5. Minka F. Evaluating the impacts of teleconsultation in primary care according to MAST: Model for Assessment of telemedicine. Memory article; Thesis of General
Medicine defended in April 2019 at UVSQ. 2020.
6. Dashboard. Covid-19 epidemic. Crisis unit. Document prepared by the teams from the Strategy and Transformation Department, the Patients, Quality, Medical
Affairs Department and the Department of Public Assistance Information Systems at Paris Hospitals. Source CIVIC. June 9, 2020.

25. THANK YOU !
https://doi.org/10.1016/j.jeurea.2021.04.001