How are seniors treated in France

Patients over 80 years of age are no longer ventilated : German disaster doctors write an alarm report on Strasbourg

Infected doctors continue to work with coronavirus patients, people over 80 are no longer ventilated, the risk of "medical collateral damage": Employees of the German Institute for Disaster Medicine (DIFKM) have an alarming report for the Baden Ministry of the Interior after a visit to the University Clinic in Strasbourg -Württembergs wrote about the situation in the French coronavirus epicenter.

And they drew conclusions from this for the situation in the Federal Republic. In the document available to the Tagesspiegel, the German doctors describe the sometimes drastic measures taken by their colleagues in Alsace.

After the visit there, “there is now a detailed, tangible danger from the Sars-CoV-2 virus”. This makes "further consistent measures by the state governments, hospitals and emergency services in Germany" indispensable.

More than 1,000 people have already died in France as a result of the coronavirus 19 pandemic, and around 22,300 people tested positive. (As of Wednesday). A week ago, the government in Paris imposed strict exit restrictions, which are monitored by the police. Citizens who go outside must be able to show a pass and indicate where they are going.

The doctors at DIFKM continue to write, assuming that the development, as it is in Alsace, will soon also take place in Germany, is an optimal preparation of "the utmost urgency" - it is important to see that "the eye of the needle the patients to be ventilated are ". The ambulance service and intensive care medicine in the clinics would then have "the absolute key role".

The German doctors underline this with the sentence about the visit to Strasbourg: "On March 23, 2020, one patient requiring ventilation was admitted per hour." Normally, the clinic has intensive care units with a total of 40 ventilation beds in single rooms, where the prone position, which is therapeutically effective proven to be most effective.

On the day of the visit, 90 such places were available. According to the DIFKM report, another 110 beds were expected for March 25, which should be accommodated in a large room.

The DIFKM report states that there must be a clearly defined special role for specialist staff in Germany too, deviating from the rules set up by the Robert Koch Institute in Germany, because: “The failure of every single person in these areas will ultimately cost people their lives. "

Background about the coronavirus:

In the neighboring country this has led to a decision that was previously unimaginable in Germany. "France therefore allows this group of people to work in all cases, regardless of an assumed or existing infection."

Strict protective measures would of course apply for this. All emergency services personnel wear simple surgical face masks. If there is suspicion of contact with an infected person or an existing infection of their own, the staff continues to work with the so-called FFP-2 masks. "Work is only interrupted for a few days if the infection is confirmed AND your own symptoms."

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The DIFKM report then lists shocking facts that apply in the fight against the coronavirus in Alsace and the university clinic:

  • Since March 21, patients older than 80 years have not been ventilated. Instead, there is “dying care with opiates and sleeping pills”.
  • Because of the crisis, the ethics committee was appointed, which sets guidelines in each individual case.

The University Hospital of Strasbourg denies that age is the only criterion for intensive care. This was reported by the dpa news agency late on Thursday evening. The practices applicable at the university clinic correspond to the recommendations of the current professional societies, it said in a message. In addition, new capacities would be made available in the field of intensive care medicine, so far there has been no overload.

Politician in Strasbourg confirms triage procedure

In contrast, the President of the Department of Strasbourg, Brigitte Klinkert, confirmed to the newspaper “Die Welt” that the triage procedure had already been practiced for two weeks, for example by the doctors at the University Hospital in Strasbourg. Patients over 80, over 75, some days over 70 could no longer be intubated because the ventilators were simply missing, said the politician. It could not be said often enough because not only the German neighbors but also the French outside Alsace did not realize the seriousness of the situation.

According to the DIFKM report, chronic obstructive pulmonary disease (COPD), asthma, pneumonia, diabetes, obesity and high blood pressure were identified as typical previous illnesses of patients requiring ventilation in Strasbourg. The duration of ventilation for patients in the university clinic is currently 14 to 21 days.

Weaning patients from ventilators has proven difficult overall. At the slightest urge to cough, immediate reintubation is necessary.

The age of the patients who have to be ventilated is between 19 and 80 years. Three out of 90 patients were younger than 50 and had no previous illnesses. All the others would have had such different degrees of severity.

Other measures taken against the coronavirus in Alsace and Strasbourg:

  • Logostically, the entire university hospital has been switched to treating coronavirus patients.
  • All available ventilators are collected in the university clinic.
  • There is only one bypass operation per day.
  • No surgery for tumors.
  • Fractures would no longer be operated on.
  • Outpatient operations have been canceled.
  • Private clinics were closed, so that freed staff supported the university clinic.
  • All ambulatory patients and patients for whom it is medically justifiable will be discharged from the clinic.
  • Detailed guidelines on what the crisis management looks like when accepting suspected cases or coronavirus patients.

The DIFKM doctors close their report with the urgent appeal to “think about avoiding substantial medical collateral damage at all times”. People would have medical emergencies even during this time. "In the end, we mustn't lose all of these patients in order to have saved all Covid 19 patients."

In the worst case, there would have to be pure coronavirus clinics, as in Strasbourg, but also others that guarantee the standard care of other emergencies. "Organizing this in the area of ​​our country will certainly be more than challenging."

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