Humanity has entered the climate “era of boiling”, warned Antonio Guterres, the Secretary General of the United Nations, this Thursday, July 28, 2023, exactly 20 years after the 2003 heat wave. What measures have been taken since in hospitals and nursing homes? Will they be sufficient for the future. Two health professionals from the Nancy CHRU answered our questions.
July 2023 will be “hottest month ever measured“, surpassing the previous record of July 2019 according to the UN. Humanity has entered “the era of climate boiling“, warned the Secretary General of the United Nations, Antonio Guterres, this Thursday, July 28, 2023, exactly 20 years after the 2003 heat wave.
The summer of 2003 made a lasting impression on people’s consciences. France and Europe discovered a phenomenon hitherto quite rare and reserved for areas accustomed to high temperatures: the heat wave. A heat wave of exceptional intensity occurred during the first fifteen days of August with temperatures well above normal day and night.
According to Public Health France : ” The excess mortality affected the whole of France, even in the departments in which the number of scorching days was low. At the beginning of August 2003, an anticyclone covered two thirds of Europe.” For more than two weeks, a mass of tropical air settled over our heads and the thermometers went crazy.
“The number of deaths that took place at home and in retirement homes were multiplied by approximately 2 compared to their usual value.”
According to one INSERM study : 14,800 people died between August 1 and August 20, 2003, an excess mortality of +60% compared to this period in previous years. The report states: “The number of deaths that took place at home and in retirement homes were multiplied by approximately 2 compared to their usual value, 42% of excess deaths occurred in hospitals, 35% at home, 19% in homes retirement and 3% in a private clinic.
Excess mortality was particularly high in the Center (+103%) and Île-de-France (+134%) regions, particularly in the Paris metropolitan area (+127% in Paris, +147% in Essonne, +161 % in Hauts-de-Seine, +160% in Seine-Saint-Denis and +171% in Val-de-Marne)“.
Isabelle Castin, who is now senior manager of the Medical Resuscitation Emergency Unit at CHRU de Nancy, experienced the heat wave of 2003. She was then working in a completely different department. “It was a complicated period that we had not anticipated at the time. We didn’t have a lot of means to cope: no fans, no sufficient equipment.“
Since the end of 2003, “there is a heat wave plan. We can anticipate for good care of our patients. We have equipment that can be distributed quickly: fogger, fans, and even air conditioners for the old part of the buildings. There have been works to improve the situation. In some places, air conditioning has been installed, such as some corridors for example. In case of strong heat, we open the doors of the rooms while closing the windows and the shutters. Of course, the whole hospital cannot be air-conditioned.“
“When a heatwave plan is triggered”adds Sylia Mokrani, who is director in charge of heat wave plans for the CHRU de Nancy“Pop-up windows open on all the Hospital’s computers. In this way, all staff are informed. They have a reminder of all the measures to be applied for patients, but also for people who work in the hospital. Water distributions are organised. The most vulnerable people receive special attention.“
The security PCs of the various establishments store foggers and emergency fans if equipment were to be missing during a weekend. “There is a seasonal watch that runs from June 1 to September 15 and can be extended.” tells us Sylia Mokrani. “In the event of an orange or red alert, we are organized into a crisis unit. It is managed by a medico-administrative pair. He is a crisis doctor. Since 2003, the “dry plan” within each establishment under the authority of the prefect. All the actors of the territory are in the loop. There is a departmental heat wave committee. It met in early January 2023. It ensured that everyone was ready for the “seasonal watch” phase. Since 2003, this red level heat wave plan has been activated three times at the national level 2007, 2019, 2022. With the covid, we were already in an episode of crisis management since 2020“.
The heat wave plan has four alert levels (green, yellow, orange and red) depending on weather conditions. The most vulnerable to the heat wave are the elderly at home. They can arrive in the emergency room in a current situation already under tension with the removal of beds for the summer period linked to staff vacations. 220 beds were cut this summer at the Nancy CHRU.
“Since 2022, there has been an increase in the number of elderly people coming from home in the emergency room. Geriatricians and emergency physicians tell us that there is a delayed effect of the covid crisis. People who have not consulted and who arrive in a more degraded state.“Sylia Mokrani clarifies:”in the event of a heat wave, there are vulnerable people who can arrive in our services. But it is the whole population that can be concerned in reality.”
The IPCC (Intergovernmental Panel on Climate Change) published its sixth report in the spring of 2023. In it, it forecasts more significant weather phenomena. “It attests to an increase in risks (heat waves, extreme precipitation, droughts, melting of the cryosphere, change in the behavior of many species, etc.)“
According to Météo France, the summer of 2022 was the 2nd hottest summer since 1900. 2,816 excess deaths (+ 16.7%) were observed. The over 75 age group is the most affected (Santé Publique France).
“Since 2004, EHPADs have been required to have an air-conditioned collective space to protect residents from the heat.“, reminds us of the website “Little Brothers of the Poor”, who adds:a majority of older people want to stay at home. However, the new modes of housing for the elderly in full development such as senior residences or shared habitats are not subject to the obligation of an air-conditioned room. In 2003, 35% of heat wave deaths occurred at home. A trend that continues today. Moreover, in 2022, the Little Brothers of the Poor have identified more than a dozen elderly people who died alone in their homes and were found weeks, months or even years after their death.
The association launched the movement “Osasi solidaire.” This involves asking individuals, businesses and municipalities to report their cool space and share it.
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