French white plan

The French white plan (plan blanc) is, in France, the emergency plan to face a sudden increase of activity in an hospital, such as a massive arrival of casualties due to an accident or a disaster (who may come by their own means to the emergency department or are evacuated by a red plan), an epidemic or a lasting climatic event that becomes deadly for fragile people such as a heatwave.

Description

The French Disaster "White plans" are the new trend for the Samu national network and Integrated EMS (IEMS) towards a modern Medico Sanitary Civil Defense. These Sanitary Disaster plans are mandatory and implememented by each Public Health Agency, public or private, by a person chosen by the institution. The plan is submitted to the consultative and deliberative authorities of the institution (board of directors, medical committee, technical committee, hygiene, security and working conditions committee) and by Regional Public Health Authorities. The scheme of the White plans for the département is made by the Director of public health (directeur départemental des affaires sanitaires et sociales), with the technical collaboration of the SAMU (French emergency medical service) and the Regional Public Health Authority. Public Heath White Plans are integrated with (Red) Comprehensive Disaster Plans.

Once it is started, by the Medical Regulator Doctor decision of the SAMU who alerts Public Heath Authority for extension. Samu sends on the first line of the site a Samu Command Post and an Advanced Medical Post for prehospital Medical triaging. The Samu implements a specific Extension of its daily Medical Regulation task. Neighbouring Samu and even national Samu network and Public Health Ministry are connected with the local organisation and bring assistance to the local organization.

White plans can be started in local Prehospital, Hospital site or Air Evacuation site or in Regional or Higher levels.

The actions performed by the White Plans include:

• a crisis management cell at each level (cellule de crise) is set up
• the Care professional teams are maintained on duty (especially when the crisis happens at the shift change)
• the off-duty personnel are gradually called back, in order to have sufficient means, but keeping a reserve to take over if the crisis lasts;
• the transfer of patients from the strongly involved services to less involved services, and possibly to other less involved health institutions or even to home under Samu regulation aid.
• the non-emergency operations are cancelled from the schedule;
• the available means are listed by the medical-technical services (pharmacy, laboratories, medical imaging) and the logistics services (laundry, catering) ;
• the switchboard is strengthened, the communications are exclusively reserved for the white plan;
• if necessary, the hospital is strengthened by a mobile sanitary kit (poste sanitaire mobile, PSM) ;
• in case of massive arrival at the emergency department, a strict triage is organized at the entrance of the hospital under the charge of a sorting physician; it is performed in a big room that is different from the usual emergency entrance and from the reception for the relatives and the press;
• a reception for the relatives and for the press is organized; the priests of the different religions are requested to help the relatives (morale);
• the traffic on the site is organized, to allow the emergency transfers and the norias ("scoop noria" (noria de ramassage) or "small noria");
• additional signs and boards are placed to allow an easy foot traffic inside the building; the watch and security are increased;
• when necessary, volunteers from associations can be requested (first aid or social aid associations), to deal with the small cares and support actions.

In case of a contaminating event (nuclear, radiological, biological or chemical — NBC), the flow of incoming patients must be strictly controlled to avoid the contamination of the rest of the institution.

The terrorist acts are likely to happen at the end of the afternoon, to "benefit" from the mass media coverage of the evening news (at 8 PM, "le 20h"). In this case, keeping the day shift allows to have two shifts at the same time when the evening shift arrives.

Bibliography

• ministerial instruction (circulaire) DHOS/HFD n°2002/284 from the 3 May 2002 related to the organization of the health system in case of massive flow of casualties [1] (replaces the instruction DH/DGS from the 24 December 1987 — in French)