Claire Saliot, 91, spent a grueling night on a stretcher in the Avranches emergency room. His daughter testifies in The Parisian. “The department was completely clogged, and it was very distressing for her. My mother lost her dignity and all her points of reference. How can we accept it?”
This situation is far from isolated. Previously confined to winter epidemic peaks, the phenomenon of “stretcher patients” now sets in in the middle of summer. Due to a lack of beds available in traditional hospitalization services, emergency rooms find themselves saturated. At AP-HP, more than a hundred stretcher beds are deployed daily to deal with this structural congestion.
For Dr. Gérald Kierzek, emergency physician and medical director of True Medical, the situation is reaching a critical level.
Rising mortality: scientific proof of the danger
A national prospective study published in the journal JAMA Internal Medicine confirms the seriousness of the situation.
“Patients who spend a night on a stretcher in the emergency room have a risk of hospital death increasing by almost 40%, from 11.1% to 15.7%. These figures come from the No Bed Night prospective study carried out in 97 French emergency departments and published in JAMA Internal Medicine in 2023″ first recalls the medical director of True Medical.
The vulnerability of dependent people is even more marked in the face of this observation.
“For patients with limited autonomy, this risk almost doubles. If all patients could have been hospitalized before midnight, 3% of deaths could have been avoided.”
Serious and repeated medical complications
Prolonged waiting on uncomfortable stretchers also causes serious physical repercussions for patients.
“Beyond mortality, patients stuck on stretchers present an increased risk of complications: nosocomial infections, falls, bleeding, pressure sores, heart attack or stroke” adds Dr. Kierzek.
In addition to these acute pathologies, the patient’s overall state of health is affected.
“Prolonged waiting particularly exposes elderly people to confusional disorders, interruption of their usual treatments, and an overall deterioration of their condition. The Court of Auditors, in a parliamentary report, noted that 68% of serious adverse events (SAEs) are linked to patient deaths. Of which 63% are considered avoidable by the declarants, mainly due to delays in treatment.”
An intolerable attack on the dignity of patients
Beyond the medical impact, the accumulation of stretchers in the corridors creates degrading situations. And for several years, the medical world has denounced them. “Direct testimonies from caregivers describe unworthy conditions and institutional mistreatment! We can recall the words of Dr. Christian Brice in Saint-Brieuc in 2020: ‘It is an attack on human dignity to wash your patients in the corridor on stretchers, and not to be able to feed them.’ Professor Bruno Riou also denounced in 2019 the ‘corridors of shame’ where elderly patients die for lack of beds.
A system running out of steam: upstream and downstream failures
According to the emergency physician, the explosion in the number of “stretcher patients” is not a coincidence: it reflects a breakdown in care at all levels of the health network. “All this is very revealing of upstream and downstream dysfunctions. The stretcher problem is the symptom of a double systemic failure. Upstream, emergencies have become a default mode of access to care. Passages have increased from 10 million in 1996 to 20.9 million in 2022, including 14% people over 75 years old” further denounces Dr. Kierzek.
Medical desertification in cities puts constant pressure on hospital structures. “The lack of treating doctors and medical desertification push patients towards the hospital for lack of alternatives. But the aging of the population makes care complex in the city, making recourse to emergency rooms and hospitals essential. However, we closed local hospitals…”.
And that’s not all. The drop in the number of conventional beds also blocks the exit from emergency rooms. “Downstream, 33,800 beds have been closed since 2017, and 30% of hospital beds have been eliminated in France. The most serious problem is the lack of sufficient approval: the hospital lacks hospitalization beds” Dr. Kierzek is indignant.
Dr Gérald Kierzek: “France is in the process of third-worldizing its health”
For the emergency doctor, the deterioration of the hospital system requires a radical revision of public health policy choices.
“France is in the process of third-worldizing its health. The situation is not an isolated accident. It is the documented product of a continuous decline in hospital capacities, a shortage of personnel and an organization which has transformed emergencies into an outlet for all failures. But let’s continue to entrust health strategy to technocratic managers as has been the case for 30 years!” concludes the doctor.
Faced with this alarming observation, emergency management requires urgent structural reforms to guarantee the safety and dignity of each patient.