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Our institution, Assistance Publique—Hôpitaux de Paris (APHP), brings together 39 university hospitals in the Greater Paris area, comprising 16 endoscopy units. In the context of the COVID-19 outbreak, only urgent endoscopy acts are performed, whereby COVID-19–dedicated medical and critical care units are mobilized. We report herein on how a mobile Parisian on-call endoscopy team (POET) performs urgent endoscopy acts outside regular hours, by means of portable equipment, in a dense urban area (6.7 million inhabitants within 762 km2), thereby allowing the most effective use of manpower where and when needed.
There are 3 such on-call teams operating in Paris and its suburbs. We decided to extend the outreach of POET (usually within the Paris city limits) to the whole Greater Paris area. POET is based in the Saint-Antoine Hospital in Paris, where reprocessing and equipment storage take place. The team comprises, for each round of interventions, a senior physician and a paramedic, both specialized in endoscopy. These caregivers are used in one of the APHP hospitals, and they have clearance to perform urgent procedures in all the critical care units of these hospitals. Therefore, patients from outside hospitals or clinics in the greater Paris area are transferred for endoscopy to one of these APHP sites. The mobile team is equipped with a 7-kg portable processor (Telepack X GI, Karl Storz, Tuttlingen, Germany), 3 endoscopes (GI Silver Scope Series, Karl Storz), a 4-kg portable power source (Vio 100C, Erbe, Tuebingen, Germany), and ancillary tools (Fig. 1), carried on a foldable moving cart (Fig. 2). POET relies on transportation by taxicab from each hospital to the next to perform urgent procedures. All necessary precautions and procedures are those described in the recent publication by Repici et al.
Figure 1Endoscopic setup in the critical care unit: 7-kg portable processor, gastroscope, 3-kg portable power source with blue foot pedal for bipolar electrocoagulation.
Figure 2Attending endoscopist (right) and registered nurse (left) wearing “low-risk” personal protective equipment, at the doorstep of the critical care unit. Foldable moving cart stacked with portable equipment, stored in suitcases (from top to bottom: power source, 2 gastroscopes, ancillary tools, and processor).
This new organization allows a more optimal deployment of caregivers in other departments. A mobile team reduces the need to transport patients at a time when the ambulance system and logistics are saturated. We expect that it also probably reduces the risk of dissemination of the virus. Furthermore, street traffic is virtually nonexistent because of the restrictions on travel, which allow rapid transit between hospitals. We believe that this system simplifies how urgent endoscopies are performed at a time of crisis when smart protocols and logistics procedures are critical.
Disclosure
Dr Camus is a consultant for Boston Scientific and Cook Medical. Dr Dray is a consultant for Boston Scientific, Fujifilm, Medtronic, Pentax, Alfasigma, Bouchara, and Recordati and a cofounder of, and a shareholder in, Augmented Endoscopy. The other authors disclosed no financial relationships.
Reference
Repici A.
Maselli R.
Colombo M.
et al.
Coronavirus (COVID-19) outbreak: what the department of endoscopy should know.
Italy recorded its first case of confirmed acute respiratory illness because of coronavirus on February 18, 2020, soon after the initial reports in China. Since that time, Italy and nations throughout the world have adopted very stringent and severe measures to protect populations from spread of infection. Despite these measures, the number of infected people is growing exponentially, with a significant number of patients developing acute respiratory insufficiency. Endoscopy departments face significant risk for diffusion of respiratory diseases that can be spread via an airborne route, including aspiration of oral and fecal material via endoscopes.
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