“Dreadful” exercise in Cherbourg: what the department’s caregivers learned from it

“Dreadful” has ended. These Wednesday 22 and Thursday 23 May 2024an emergency medicine exercise dedicated to serious burn victims, unpublished in France, took place in Cherbourg-en-Cotentin (Manche) at the initiative of the Samu.

He had required months of work and mobilized nearly 1,000 people. The key: the renewal of the European doctrine on severe burns. Feedback from the Manche emergency doctor who was in charge of his medical coordination, Dr Thomas Delomas, head of Samu 50.

Interview

Have the objectives of your exercise been achieved?

“Redoubtable” is a great success. According to our scenario, we organized the medical evacuation of around 150 victims: 60 in absolute emergency, 75 in relative emergency and three deaths. There were also around ten people involved in the medical-psychological unit. The victims were ventilated to burn treatment centers in two stages, a first wave by plane and a second by train, medically treated. This allowed us to correct small malfunctions directly. At the debriefing, all the partners – public, private, associations and observers, were happy. It’s been a long time since we put private and associative healthcare players back on the same playing field. This made it possible to recreate the link and that is extremely important. One of the axes of the scenario was to make them play the great noria of the victims’ exit from the hospital to the evacuation sites. There was no need for extra-departmental reinforcements, they were completely autonomous. And this is really welcome in the current context. Experiencing something like this, something positive, feels really good. And as professionals, we don’t have the opportunity to experience an exercise like this in the Channel ten times in our career.

What will the conclusions of your exercise be used for?

Our feedback will first be studied internally. We will know how to set ourselves up in the future and not make any more mistakes. We will then transmit our conclusions, in particular on the medical evacuation of serious burn victims, to the prefecture, to the Regional Health Agency, to the Ministry of Health… The impact will then be the updating of the European doctrine in serious burns matter. So far, it has only been written on theoretical data. With our field practice thanks to this exercise, we have seen that certain points do not stick. It was an exercise that did not cost very much because we aligned all the training or exercise needs of each partner at the same time. It just cost us a lot of work, elbow grease, phone calls and hassle!

How has the profession of emergency physician evolved in recent years?

Managing health crises has always been one of our prerogatives. In recent years, with the attacks, there has been a rise in power of damage control, that is to say that faced with an influx of seriously injured people, we will initially stabilize them with a tourniquet for example, operate without closing immediately to move on to another patient, for a cold recovery in a second time. The military doctrine of war medicine to which we were not accustomed in civilian life, the care of war victims, is making us evolve. The other major development follows the pandemic. Depending on the context, the epidemiology, the evolution of techniques and medical data, we constantly adapt, we evolve our doctrines. Samu itself has evolved a lot. Beyond vital emergencies and exceptional health situations, we respond to care that is not scheduled. We have expertise, our real job remains emergencies, we train a lot, but it must also be said that in three years, our activity has doubled in the Channel, which is a medical desert. The general public and elected officials don’t really know what we’re actually doing. In terms of emergency calls, our activity is six times higher than that of the firefighters and 80% of their activity falls on us. Samu is the guardian angel who responds day and night.

If the attacks introduced war medicine, did Covid introduce medical evacuations on a European scale?

Yes, Covid has clearly opened this path. François Braun [ancien ministre de la Santé et urgentiste à Metz, présent mercredi à Cherbourg, NDLR] is used to working with Belgium and Germany, close to him. But the scale of what we tested in Cherbourg, with a projection of injured people to other European countries, has been accentuated and structured since the pandemic. But we must not lose sight of the fact that despite all the daily difficulties for caregivers, France remains a country with an excellent level of care. In many other countries subjected to our scenario, people could not have been saved. In France, we continue to move and find solutions.

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