Tribune. The Covid-19 crisis has highlighted the importance of critical care units (resuscitation, 5,500 beds, continuous monitoring units, 8,000 beds and intensive care, 5,900 beds) in the arsenal of responses to health risks . It also revealed the weaknesses of their organization, particularly in terms of reception capacity and reserve of nursing staff. In October 2020, the United Nations, based on expert reports, believed that “Future pandemics will emerge more often, spread faster, do more damage to the global economy and kill more people than Covid-19”, reinforcing the importance of a reflection built on the structuring of the critical care system of tomorrow.
Historically, determining critical care reception capacities was limited to the calculation of a number of beds dictated by the need to meet the needs of an older, more fragile population and to support the development of care in high risk. Calculated in this way, the supply of beds nonetheless remains very disparate depending on the country with, for example, an average density of 11.5 beds per 100,000 inhabitants in Europe against 28 beds per 100,000 inhabitants in the United States, without affecting mortality. The prognosis of the patients seems all the more favorable as there is tension on the beds in critical care, by favoring effective decision-making processes, more adapted care and respecting ethics. This was confirmed by a French team during the Covid-19 pandemic.
Our response to recent events (pandemic, terrorist attacks, industrial disasters) offers a new perspective on critical care: effective crisis management is underpinned by a flexible and responsive system whose governance is based on field expertise and trust between administrators and nursing staff.
Nurses and caregivers, THE missing resource
During the first wave of Covid-19 in France, between March and June 2020, 7,148 critical patients were hospitalized, greatly exceeding the capacity of the 5,500 beds available. This rapid increase in reception capacity relied largely on staff working in other sectors but skilled in critical care. If the versatility of doctors trained and able to practice in critical care (anesthetists-resuscitators, cardiologists, pulmonologists, etc.) has been a major asset of our health system, nurses and caregivers have been THE missing resource. According to the Federation of Private Hospitalization (FHP), nearly 58,000 nursing and nursing assistant positions are vacant in health establishments, due to a lack of attractiveness and recognition. France is indeed among the last five OECD countries in terms of the remuneration of its caregivers..
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