For several days, France has been suffocating under extreme temperatures. While dozens of departments are placed on heat wave red alert, the health consequences are already starting to be felt. Increase in calls for emergency services, increase in discomfort, dehydration, worsening of chronic illnesses… Faced with this growing pressure on the health system, Prime Minister Sébastien Lecornu announced the activation of the level 2 ORSAN plan.
A measure intended to enable the health system to cope with a heatwave which could last several days.
What exactly is the ORSAN plan?
The ORSAN system, for “Organization of the response of the health system in exceptional health situations”, is a national plan intended to coordinate all the players in the healthcare system when a situation exceeds usual capacities.
“The ORSAN plan was activated because the health system is under great strain, here especially because of the heatwave, which increases visits to emergency rooms, dehydration, discomfort and decompensation among vulnerable people.explains Dr. Gérald Kierzek.
According to the emergency doctor, this is not just a hospital plan. “ORSAN is above all a coordination framework making it possible to simultaneously mobilize hospitals, community medicine, the medico-social sector and regional health agencies when the situation goes beyond usual operations”, he specifies.
Concretely, this system allows in particular:
- To strengthen healthcare teams;
- To open additional beds if necessary;
- To reorganize care pathways;
- To coordinate hospitals, clinics, EHPADs and private doctors more closely;
- And, if necessary, to postpone certain non-urgent activities in order to preserve capacity for the most serious cases.
“It is less a simple ‘hospital plan’ than a coordinated alerting of the entire health system,” summarizes Dr. Kierzek.
Why does the heatwave put so much pressure on emergencies?
Since the start of the heatwave, health authorities have observed an increase in calls to emergency services, medical consultations and interventions by SOS Doctors.
The Minister of Health, Stéphanie Rist, has also warned of a risk of “emergency overload”, particularly among the most vulnerable populations: elderly people, chronically ill people, infants or isolated people.
Extreme heat in fact promotes heatstroke, dehydration, discomfort, but also the aggravation of numerous cardiac, respiratory or renal pathologies.
The delayed effect of the heatwave: why do complications sometimes occur several days later?
A phenomenon particularly worries health professionals: the delayed effect of the heatwave.
“The medical consequences do not always appear the same day. They often occur after several days of exposure, when the body has accumulated fatigue, dehydration and imbalances. explains Dr. Gérald Kierzek.
According to him, “heat acts like a real physiological debt”. Initially, the body manages to compensate. But as the days go by, reserves become exhausted, especially among the elderly or fragile.
“We then see delayed onset of discomfort, falls, kidney failure, cardiac decompensation, respiratory worsening, confusion or even severe exhaustion”explains the emergency doctor.
Result: even when temperatures begin to drop, emergency departments often continue to see new patients arriving.
“The heat wave is sometimes over, but then its patients arrive”emphasizes Dr. Kierzek.
Structural tensions that persist at the hospital
For the emergency doctor, this new activation of the ORSAN plan also highlights the chronic fragilities of the French hospital.
“The basic problem is that hospitals are under permanent tension and we have to trigger white plans or ORSAN repeatedly to keep up,” regrets Dr. Kierzek.
And to conclude: “This does not solve the structural problems of lack of resources, personnel or even air conditioning in certain establishments. Our health system is on its knees. We saw it during Covid, we see it every winter with the flu and now every summer with heatwaves.”