Réponse du service de réanimation d’un Hôpital d’Instruction des Armées à la première vague de COVID-19()

In March 2020, the intensive care unit of the French military teaching hospital Bégin (Saint-Mandé) had to make profound changes to deal with the first COVID-19 epidemic wave. First, the twelve beds of the intensive care unit (ICU) were allocated to COVID-19 patients, among them four beds usually dedicated to postoperative care. Then, on the model of the military medical-surgical facilities rolled out in external operations, a new transient intensive care unit was set up in Bégin within four days. This strategy of increasing capacities had to address a crucial challenge: to ensure safe and quality health care with limited resources. Based on precise specifications and an essential strengthening of staff and supplies, 20 additional ICU care rooms were fully equipped in the cardiology department of the hospital. Eventually, 32 ICU beds were available from March 20, performing a 300% increase in bed capacities. During the whole epidemic wave, 113 patients were managed. The evacuation of 16 stable patients with medicalized trains toward less impacted French regions helped to avoid saturation. The service has also been involved in various research activities, including the DisCoVeRy European clinical trial evaluating the effectiveness of several antiviral treatments. Leaving the operating room and the post-interventional surveillance room partially functional made it possible to quickly resume the elective surgical activity after the crisis, while keeping the transient ICU available in case of an epidemic rebound, as happened in the autumn of 2020, then in the spring of 2021.