Objectives SARS-Cov-2 is a respiratory virus of the coronavirus family. It is responsible for viral pneumonia. The Covid-19 pandemic started in China in December 2019 before spreading to the rest of the world. Managing this pandemic has significantly changed the way our emergency services work. The main objective of this study was to describe the organizational impact of the Covid-19 pandemic in Emergency Medicine. Methods Descriptive observational study of the “adaptation strategy” of two Parisian emergency services, during the first wave of the Covid-19 pandemic from March 01, 2020 until the end of lockdown on May 11, 2020. Results As the infectious reason is the main reason for consultation during a pandemic, prevention measures have been reinforced. In order to limit the risk of viral transmission, a segmentation of the emergency services and the entire hospital was carried out. So we were able to distinguish between Red zones (High viral density) and Green zones (Low viral density). The hospital's infectious medicine and resuscitation capacity has been increased to manage the massive influx of patients consulting the emergency room. Conclusion Our resilience strategy reinforced by the implementation of the containment system has made it possible to overcome this pandemic. It would be appropriate to assess the impact of this strategy on the occurrence of nosocomial infections later.

1. Resilience strategy in emergency
medicine during the Covid-19
pandemic in Paris
Dr Hillary MINKA, Emergency Medicine
Lariboisière Hospital, APHP, France
Global Nursing Congress Presentation

2. Introduction
 SARS-CoV-2 : Respiratory virus, Coronavirus family
 Viral pneumonia and Respiratory Disease in Covid-19 [1] [2]
 Transmission : human-to-human manner, transported by the
hands[3]
 Incubation Period : 4 and 15 days [4][5].
 Asymptomatic in 30 to 60% of cases[4]
 Non-specific symptoms : fever, headache, asthenia, cough…[4].

3. SaveDates
 December 2019 : Start of SARS-CoV-2 pandemic in
WUHAN, China city
 January 30, 2020 : “Public Health Emergency of
International Scope”
 March 11, 2020 : State of Mondial Pandemic
 March 14, 2020 : Stage "3" of the epidemic in France
 March 17 to May 11, 2020 : Lockdown Period in France

4. Reality ofour
activity in
Pandemic Period
 Covid-19 represent more than 50% of medical calls
 High Number of visits for infection reason until 300 admissions
 The emergency services are the gateway to our healthcare
system…
 However, we was not designed to accommodate all these patients.
Think about a new Organization
 To be Resilient was necessary

5. June20,2021
In France :
 Positives cases : 5 757 311
 Deaths cases : 110 767
In the Word :
 Positives cases : 174 032 728
 Deaths cases : 3 738 030

6. MainObjective
To describe the impact of Covid-19 on the
organization of our emergency services and the
resilience we had to face.

7. Methods
 Descriptive observational study of the ‘‘adaptation strategy’’ of
two Parisian emergency services: Bichat and Lariboisière.
 Focus specifically on the operation to deal with the first wave
of covid-19 pandemic in France
 Period study from March 01, 2020 until the end of lockdown
on May 11, 2020.

8. Whatisthe
Resilience
strategy
 Various architectural, functional, and human adaptations
put in place to fight the first wave of Covid-19 pandemic ;
 Importance of preventive measures to limit the spread of
this pandemic ;
 Rapid development of telemedicine ;
 And the ethical questions that had to be answered.

13. Adaptationof
human
ressources
 Human solidarity
 Volunteering : surgeons, students , residents …
 Intrahospital cooperation (infectiology, geriatric…)
 Synergy between the City and the Hospital
 Many transfers when length to stay increase in intensive care
 Restrictive criteria for admission in reanimation

14. Prevention
strategy
 No Treatment
 No Vaccine
 Only Hygiene measures : surgical masks and FFP2,
overcoats, caps…
 Recommendations for wearing masks have developed
differently for the public
 Wearing a mask was made mandatory in France in closed
spaces (July 20, 2020)

15. Telemedicine
Boom
 Between April 15, 2020 and May 20, 2020, teleconsultation
activity increased by more than 116% in public assistance
hospitals.
 Only 49% of the consultation activity had been maintained
compared to the same period in 2019.

16. Ethical
Reflection
 For COVID patients who were not eligible for resuscitation
 Care limitations were always collegial
 Difficulty in the managing families facing brutal grief (Death
announcements by telephone, no possility of visiting).

17. Discussion
 Covid-19 has been a major organizational challenge.
 Hospital response related to COVID has been very variable.
 Report different types of organization possible was essential.

18. Conclusion
 Our organizational strategy was above all the ability to
change our work habits
 Not only according to the proportion of COVID patients to be
taken care of
 But also according to the number of hospital beds available
in post emergencies.
 We continually adapt, without ever giving up
 This is the definition of Resilience !

19. References
[1] Valencia DN. Brief Review on COVID-19: The 2020
Pandemic Caused by SARS-CoV-2. Cureus
2020;12:e7386.
[2] Li H, Liu S-M, Yu X-H, Tang S-L, Tang C-K.
Coronavirus disease 2019 (COVID-19): current status
and future perspectives. Int J Antimicrob Agents
2020;55:105951.
[3] Tu Y-F, Chien C-S, Yarmishyn AA, Lin Y-Y, Luo Y-H,
Lin Y-T, et al. A Review of SARS-CoV-2 and the Ongoing
Clinical Trials. Int J Mol Sci 2020;21:2657.
[4] Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et
al. Coronavirus Disease 2019 (COVID-19): A Perspective
from China. Radiology 2020:200490.
[5] Tang D, Comish P, Kang R. The hallmarks of COVID-
19 disease. PLoS Pathog 2020;16:e1008536.

20. THANKYOU
 Corresponding authors (E-mail address) :
sally.minka@aphp.fr (S.-O. Minka)
fadi.minka@aphp.fr (F.-H. Minka)
 Link of article :
https://doi.org/10.1016/j.jeurea.2021.04.001

21. WITH LOVE