Small but Nimble: Measures Taken to Face the COVID-19 Pandemic in Small French Military Hospitals

ABSTRACT

Objectives: To describe a complete panel of actions of the Service de Santé des Armées (SSA) (ie, French Military Health Service) that together contributed to prevent French health system saturation during the coronavirus disease 2019 (COVID-19) pandemic.

Study Design: Observational retrospective study.

Methods: Actions taken by military practitioners in the Parisian military hospitals, which contained 500 beds, to fight COVID-19 were listed and described.

Results: The Parisian military hospitals were fully reorganized to offer 147% more intensive care unit beds and took care of 665 inpatients with COVID-19 while continuing their core mission of war-wounded military care. A strategy to prioritize the use of medicine and medical devices was designed to avoid shortages. Field intensive care unit deployment and airborne collective medical evacuation by the SSA’s MoRPHEE system avoided hospital saturation.

Conclusions: Key facets of this achievement were interunit collaboration, esprit de corps, and health workers’ adaptability. Small hospitals can provide a coherent answer to the COVID-19 pandemic, as long as they organize and prioritize the patients’ care.

Am J Manag Care. 2021;27(4):e135-e136. https://doi.org/10.37765/ajmc.2021.88623

The Service de Santé des Armées (SSA) (ie, French Military Health Service) trains and employs military physicians, pharmacists, and nurses, who prepare together in the Écoles de Santé des Armées (ie, SSA medical school), where they develop strong camaraderie links to be united on the operational field. These health workers are used to dealing with infectious diseases, due to frequent French Armed Forces (FAF) deployment in tropical areas and a task force against Ebola virus disease in Guinea in 2015.¹ They are also used to taking care of massive amounts of casualties on the battlefield and at home.² A description of how the SSA’s experience was mobilized during the coronavirus disease 2019 (COVID-19) pandemic in France may be useful for the French health system and beyond. This article was authored by the Parisian Military Anti–COVID-19 Group; names of the members are listed in the eAppendix (available at ajmc.com).

Hospital Reorganization

The Parisian military hospitals (PMH), namely Percy and Bégin Military Hospitals, are of relatively small size, containing 500 beds in total. Due to the remarkable commitment of support services, the number of PMH intensive care unit (ICU) beds increased from 34 to 84 (+147%) between March and May 2020, including the addition of 14 beds for ventilatory weaning. Health care providers serving in other departments, in the French National Guard, and in the Paris Fire Brigade were incorporated, including medical specialists as junior intensivists and nurses from medicine and emergency wards as ICU nurses. All ICUs were nearly or fully saturated during the pandemic. Building upon military expertise during wartime, a prioritization strategy was developed for ICU treatments during the COVID-19 pandemic with scarce resources.³

The conventional hospitalization wards were reorganized into COVID-19 and COVID-19–free units. The COVID-19 unit included 96 beds and employed physicians of many medical specialties to assure 24/7 care. Eligible inpatients were included in clinical trials such as DISCOVERY, PlascoSSA, and ICARE.⁴ The personnel of the emergency wards created dedicated areas for patients with COVID-19, including an outside area under tents for infected outpatients.

PMH microbiologists provided reverse transcription polymerase chain reaction for testing and then serology for patients, as well as for epidemiological investigations in the field and in military units. Mental health practitioners set up innovative practices, which were based on operational practice in forward operational fields, to provide consistent support for the health care community. Embedding clinical psychologists in ICU units for informal interventions appeared to be the most effective method.

Medicines and Medical Devices

An emergency stock of critical health products (CHPs) was quickly built up with the Army Health Products Supply Department. PMH also used alternative suppliers and daily physician-pharmacist collaboration to optimize patients’ care to avoid any shortage of CHPs.

EMRSSA

Service members from the PMH participated in the Élément Militaire de Réanimation du Service de Santé des Armées (EMRSSA) mission. Within 6 days, the EMRSSA (ie, the field ICU of the SSA) offered 30 ICU beds under tents to support the Emile Muller hospital in Mulhouse, France,^5,6 and treated more than 40 patients with COVID-19–associated acute respiratory distress syndrome (ARDS), providing the best standard of care without endangering caregivers for 7 weeks.^7,8

Exceptional Transfer of Patients

Service members from the PMH also took part in the deployment by the French Air Force and the SSA of a collective airborne medical evacuation plane named MoRPHEE,⁹ transferring 36 ICU patients with COVID-19 to regions with ICU availability during 6 missions, the first ever under the pressure of a viral risk and for patients with ARDS.¹⁰

Non–COVID-19 Activity

Core medical operational capability was maintained but downsized: patients with trauma, burns, and other non–COVID-19 critical illnesses, including combat-injured soldiers, were treated without interruption.

Telemedicine was useful in providing counseling to armed forces deployed abroad facing COVID-19, and it also maintained sufficient care for patients with chronic diseases. Among patients with cancer, 39% had a change in their usual treatment to reduce immunosuppression and hospital admissions. No patient without COVID-19 who required chronic infusions or care was left untreated. However, only 6% were included in a clinical trial vs 35% under usual circumstances.

FAF Biomedical Research Institute/Centre Borelli

The FAF Biomedical Research Institute (IRBA) and Centre Borelli designed immunity studies and clinical trials and provided training and tutorials for biosafety. To counter the shortage of CHPs, the IRBA and Percy Military Hospital’s biology department developed, produced, and validated a culture medium for a new nasal swab. IRBA also provided specialists trained in biosafety and epidemiological investigations to help on the field (EMRSSA, MoRPHEE, aircraft carrier Charles de Gaulle).

Conclusions

The PMH cared for 665 inpatients with COVID-19 while maintaining their core mission of war-wounded military care. Key factors of this achievement were interunit collaboration, esprit de corps, and health workers’ adaptability (Table). Small hospitals can provide a coherent answer to the COVID-19 pandemic, as long as they organize and prioritize the patients’ care.

Author Affiliations: Hôpital Bégin, Saint-Mandé, France; Hôpital Percy, Clamart, France.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (N. Vayatis, D. Ricard); assembling the first draft of the manuscript (H. Nielly). All other members of the Parisian Military Anti–COVID-19 Group acquired the data, wrote the first draft regarding their field, and contributed to the critical revision of the manuscript.

Address Correspondence to: Hubert Nielly, MD, Hôpital Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France. Email: hubert.nielly@intradef.gouv.fr.

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