“The loss of chances is increasing for the management of strokes in Ile-de-France”: the warning of caregivers

In the week of December 10, a man suddenly had difficulty speaking and paralysis on his left side. Signs suggestive of a stroke. He lives 1.5 km from Bicêtre hospital (Assistance publique-Hôpitaux de Paris, AP-HP), in Kremlin-Bicêtre (Val-de-Marne). Supported by the firefighters, they immediately called the Neurovascular Unit (UNV) of Bicêtre, then the two other closest UNVs. No space. This man is finally transferred to another specialized structure more than 15 km away.

For the firefighters and the SAMU, such situations have become daily. And for good reason, in Ile-de-France, many UNV beds have closed. Considered an absolute emergency, stroke – one every 4 minutes – affects 150,000 people in France every year, it is the leading cause of acquired disability. The accident occurs when one of the arteries that supply the brain becomes blocked (in 80% of cases), we speak of “cerebral infarction”.

In practice, in the event of a suspicion of stroke, the fire brigade or the emergency medical services refer the patient directly to a UNV, without going through the emergency services to save as much time as possible. Every minute counts. “The benefit of these specialized units is clearly established, preventing 1 death for every 20 hospitalized patients and reducing the complications of stroke”, indicates l’Inserm.

“Degraded procedures”

In a letter sent on December 10, the neurology service of Bicêtre challenged the health authorities, the ministry and the AP-HP. 34 beds of this service (70% of the total beds) are closed, including 6 intensive care, for lack of nurses, while this UNV was until now a flagship service, with 1,300 stroke supported per year. “We are very worried, we can no longer meet the demand”, deplores Doctor Olivier Chassin, neurologist in this hospital. “The examples of loss of chances have multiplied in recent weeks and continue to grow”, challenge the caregivers of Bicêtre in this letter. They have no choice but to select the patients.

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This situation affects the whole of Ile-de-France. It is a real cry of alarm and despair, even causing some to say that“It is better not to have a stroke in Paris or Ile-de-France”. At the beginning of November, the nurses of the Ile-de-France UNV had denounced, in The world, the inability to keep many beds open due to a lack of sufficient staff – which affects all hospital departments. A month and a half later, “The situation has worsened and 50% of nursing positions are not filled in these services”, abounds Sophie Crozier, neurologist at the UNV de la Pitié-Salpêtrière. Asked by The world, the management of the AP-HP replied, Tuesday, December 21, that “The alert was taken seriously from the start”, meetings have been held and will continue, with “Avenues of work”, especially on recruitment.

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“The loss of chances is increasing for the management of strokes in Ile-de-France”: the warning of caregivers