Catherine Lemorton, head of the Health Reserve, explains how the Health Reserve operates and clarifies some common misconceptions circulating during the COVID-19 crisis.
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Today, amid this unprecedented COVID-19 crisis, the Health Reserve is playing a full role alongside other response mechanisms. All healthcare professionals called in as reinforcements are fully committed to combating this epidemic. The Health Reserve and the mechanisms put in place work together to support the healthcare system during this exceptional health crisis.
>1,000
reservists mobilized by mid-April
By mid-April, more than 1,000 reservists had been mobilized in response to the coronavirus outbreak since late January.
This figure represents more than 8,000 person-days and more than 35 missions in mainland France and the overseas territories.
It is the ARS that decide to mobilize the Health Reserve when local resources are insufficient to handle the situation. The Health Reserve intervenes to supplement local or regional reinforcements and in response to very specific requests (e.g., 10 intensive care nurses, 3 anesthesiologists-intensivists over a two-week period).
The Health Reserve mobilizes reservists for extended periods. Health reservists can be mobilized for up to three weeks at a single facility. This is why it is more meaningful to look at the number of person-days rather than the number of mobilized reservists to understand the scale of the Health Reserve’s mobilization. Missions dedicated to COVID-19 account for more than 8,000 person-days. This is an unprecedented mobilization for the Medical Reserve, which, for example, carried out 6,709 person-days of missions throughout 2019.
The Health Reserve handles all administrative paperwork in advance and manages the deployment of reservists across the country, as well as their travel and accommodations. It is indeed essential to verify diplomas, licenses to practice, registrations with various professional associations, etc. For this reason, a contract is drawn up between the professional and Santé publique France. Facilities then simply need to welcome the reservists into their departments.
It is important to distinguish between “being registered” with the Medical Reserve and “being a reservist.”
In fact, 40,000 people have begun the registration process on the Medical Reserve website, but this does not mean that they are all in demand, willing, or available for the missions offered. For example, of the 40,000 registered, there are 7,800 doctors (public health, occupational health, general practitioners, intensivists, infectious disease specialists, internists, emergency physicians, dermatologists, surgeons, pediatricians, etc.). If we look at the specialties currently in demand—general practitioners, intensive care specialists, and emergency physicians—the number of registrants is 3,200. Depending on the assignment, we may have fewer volunteers than the available pool. For example, for a call to mobilize to bolster healthcare services in Mayotte, 120 doctors volunteered, including 110 general practitioners, 3 intensive care specialists, and 7 emergency physicians. It should be noted that the number of reinforcements requested by the Mayotte Regional Health Agency (ARS) for this role was only 12 doctors—10 times fewer than the number of available volunteers.
To become a medical reservist, one must have completed their application online and signed their commitment contract (for a term of 3 years). Currently, 3,800 medical reservists have signed this commitment contract, but it is important to note that more than half are currently on active duty. These active reservists therefore do not respond to the calls for mobilization, as they are already deployed at their home institutions.
Individuals who have not yet completed their application are still recipients of our alerts (calls for mobilization) and may apply if they are available and interested in the mission. If selected, their application is then urgently completed and the enlistment contract signed before they depart on the mission.
Having a complete file with up-to-date documentation is essential to be a medical reservist and immediately deployable. These checks ensure that medical reservists are qualified and authorized to perform the duties assigned to them on mission. Even in an emergency, there is no question of risking putting professionals in a difficult position or endangering patients.
The various backup systems do not meet the same criteria. In the context of COVID-19, as in other exceptional health situations, the Health Reserve steps in when local resources cannot cope with the situation.
At the local and regional levels: short supply chains between hospitals and healthcare professionals available in their department, along with platforms established by the Regional Health Agencies (ARS), are the two primary mechanisms for reinforcing facilities in need.
At the national level: the national platform managed by the Ministry of Solidarity and Health reinforces these two other mechanisms if necessary.
In addition: the Health Reserve, for its part, is mobilized when these local and regional resources are insufficient. It is the ARS that decide to call upon the Health Reserve and assess the necessary reinforcements in consultation with the crisis center of the Ministry of Solidarity and Health.
All these mechanisms are complementary and enable us to meet the need for reinforcements in healthcare facilities. The idea is not to pit them against one another. The Health Reserve is indispensable for exceptional health situations, particularly in the face of COVID-19. It is the strength and complementarity of each that will help us defeat COVID-19.
Reservists are contacted and deployed based on the needs expressed by the Regional Health Agencies (ARS) in consultation with the Ministry of Solidarity and Health. For each mission, specific profiles of healthcare professionals are determined. The Health Reserve does not independently determine the needs for healthcare professionals in the field.
Certain professions are in lower demand in the context of COVID-19. At this stage, the professions in almost exclusive demand are the following: nurses with expertise in intensive care, nurse anesthetists, nurses with experience in long-term care facilities, nursing assistants, emergency room nurses, and anesthesiologists-intensivists. This explains why some mobilizable healthcare professionals are not contacted.
Reservists are never forced to go on a mission or undergo training. Similarly, there is no guarantee of being called up or selected for a mission; it depends on current events, the type of skills sought, and the number of candidates available. For missions related to COVID-19, there are currently many volunteers. But once again, we can only mobilize those whose profiles currently match the requests made by the ARS. The goal is not to disrupt local healthcare services by sending more reinforcements than requested.
For several weeks now, the Health Reserve team has been extremely busy and has already processed a large number of the requests received—approximately 25,000 emails and more than 3,000 Facebook messages. In addition to processing these thousands of messages, the Santé publique France Health Reserve unit, composed of a permanent team of 10 people, must also design “alerts” for reservists, select reservists, assemble a team with a balanced mix of skills and experience, and prepare all the administrative files for the selected reservists. It must also handle all logistics related to transportation and accommodation, organize on-site reception arrangements, ensure support for reservists during their mission, and finally reimburse expenses and compensate reservists and/or their employers.
In light of this exceptional health situation, the Medical Reserve team has been reinforced, but it is clear that wait times are longer than usual. However, everyone who contacts the Medical Reserve will receive a response as soon as possible.
Once registered with the Health Reserve, the volunteer receives a confirmation email. This email provides their login ID and registration number. The volunteer must then complete their application. To do so, they must fill out all the tabs in their personal account, upload all required documents, and then print, complete, sign, and mail their contract.
Documents are not processed as they are uploaded but only when they need to be verified, i.e., upon receipt of the contract by mail or if the application is selected for immediate deployment.
Once a volunteer has a registration number, they will receive alerts regarding their profession and can apply for positions. If they are selected and called for an assignment, our team will follow up with them to help them finalize their application more quickly.
In March 2020, because the server for our website www.reservesanitaire.fr was not designed to handle thousands of simultaneous connections, our site was only partially operational for several days. Nevertheless, 19,000 volunteers managed to register during that time.
Subsequently, a national platform was established by the Ministry of Solidarity and Health in partnership with Santé publique France. The Health Reserve website was therefore temporarily closed to prioritize this national platform, which aims to allow regional health agencies to “draw from” the pool of professionals potentially available in their region.
Today, healthcare professionals wishing to join the Health Reserve can once again register on our website, but a “traffic calming measure” has been implemented to ensure priority access for reservists selected to deploy on a mission.
