The white plan is a key mechanism for managing crises in healthcare facilities, such as hospitals and university hospitals. Its objective is to quickly organize the care of a large number of patients during exceptional health situations, whether accidents, epidemics, or other emergencies.

Integrated into the ORSAN framework, it mobilizes human, material and organizational resources to maintain continuity of care despite hospital pressures. This plan is triggered by the hospital management or at the request of a representative of the State.

A crisis unit is then set up to coordinate actions: adapting the care offering, recalling nursing staff and internal reorganization. This structured approach enables critical situations to be managed more effectively, while guaranteeing the safety of patients and staff.

What is the emergency response plan?

Definition and objectives

The white plan is a mandatory crisis mechanism for all healthcare facilities, established by law since 2004. It allows a hospital facility, whether public or private, to immediately mobilize all its resources, human and material, in order to respond to a massive influx of patients or an exceptional health situation.

The main objectives of this plan are to ensure the continuity of care provision, to organize optimal patient management and to effectively manage hospital pressures that may result from such situations.

By integrating the ORSAN system, the contingency plan includes general and specific measures adapted to the nature and severity of the crisis. It relies in particular on the establishment of a crisis unit, the optimization of resource management, and a rigorous organization of hospital services to meet care needs.

In summary, the contingency plan is an essential tool for preparing healthcare facilities for any exceptional health situation, whether it is a natural disaster, a major accident, or an epidemic.

Different levels of the contingency plan

The White Plan has several activation levels, which correspond to the intensity of the crisis and the resources required to deal with it. The first level involves internal mobilization of the hospital's resources, in particular by recalling volunteer healthcare staff and temporarily increasing reception capacities by opening additional beds in the departments.

In the event of aggravation, the contingency plan can evolve to an expanded level, called the "expanded contingency plan", which applies at the departmental level. This second level is triggered when the resources of an individual hospital are no longer sufficient to manage the influx of patients or victims.

This requires enhanced coordination between several healthcare hospitals, the Regional Health Agency (ARS), and state representatives to organize a collective response adapted to the crisis.

This gradual transition between the different levels allows for a gradual and adapted management of hospital health tensions, thus ensuring optimal organization and a more effective response to situations of high pressure on the healthcare system.

Triggers for a white plan

Crisis situations justifying its activation

The white plan is designed to respond to crisis situations requiring rapid reorganization of healthcare facilities. These crises notably include:

• Severe epidemics, such as an aggressive flu or Covid-19.
• Major disasters such as mass accidents, attacks or natural disasters.
• CBRN incidents (nuclear, radiological, bacteriological, chemical).

Each exceptional health situation may require a specific adaptation of the contingency plan. For example, targeted measures such as the ORSAN-VAC plan for epidemics or ORSAN-NRC for chemical or radiological risks may be activated.

In these contexts, the emergency plan makes it possible to mobilize all hospital resources to manage a significant influx of patients or victims, while limiting the impact on ongoing care. This includes:

• The suspension or postponement of certain scheduled procedures.
• Early bed release.
• The reconfiguration of services, such as emergency departments, to better accommodate and treat patients in a context of hospital strain.

Who decides when to activate the white plan?

The decision to trigger a white plan rests primarily with the director or head of the healthcare facility concerned. They assess the severity of the situation and the ability of their facility to cope with it before officially launching the plan.

Once activated, the director immediately informs the departmental prefect, who then passes on the information to health authorities such as theAgence Régionale de Santé (ARS), the SAMU and local authorities.

In the event of a major health crisis on a larger scale or in a national emergency, a representative of the State may also order the activation of the white plan to coordinate the response over a wide geographical area. This decision often involves:

• The establishment of a dedicated crisis unit.
• Management of human and logistical resources.
• A structured organization to ensure effective communication within the hospital.

Thanks to this coordination, the contingency plan ensures consistent and optimal crisis management.

Implementing the emergency response plan

Creation of a crisis unit

When the emergency plan is activated, the establishment of a crisis unit is immediate. This operational unit brings together a multidisciplinary team responsible for coordinating the management of the exceptional situation.

It is managed by the hospital director or their representative, who ensures communication with the authorities, the Regional Health Agency, and the media. The coordinating physician is responsible for organizing the mobilization of healthcare staff and the reorganization of services, while those in charge of communication, security, logistics, and technology respectively handle information, site security, equipment management, and reception capacity.

This unit plays a central role in adapting hospital activities to the crisis and in making rapid and concerted decisions.

Reorganization of services and care

The white plan imposes a rapid reorganization of hospital services in order to optimize patient care. This includes the suspension or postponement of non-urgent activities to free up capacity, the reallocation of beds, and the creation of areas dedicated to victims in certain services, particularly emergency and intensive care.

This reorganization also aims to prioritize critical care related to the exceptional health situation while maintaining the quality of other essential care, such as that of chronically ill or cancer patients.

The objective is to ensure a smooth organization, limiting the risk of service saturation and facilitating the flow of patients and staff.

Mobilization of human and material resources

Human mobilization is a key point in the implementation of the emergency plan. The plan provides for the systematic recall of caregiving personnel on site or as reinforcement, the increase in teams, as well as the management of overtime and shift changes to prevent caregiver burnout.

In terms of resources, the crisis unit coordinates the availability of medical equipment, beds, medications, and protective equipment.

In the event of a particular incident, such as a CBRN accident, specific measures such as the establishment of buffer zones or the distribution of protective equipment are deployed. This complete mobilization ensures a rapid and appropriate response to the needs related to the hospital crisis.

The stakes and challenges of activating the contingency plan

Internal and external communication

Communication is a major issue when activating the emergency response plan. Internally, it must ensure a fluid and rapid flow of information between the crisis unit, care teams, managers, and hospital staff.

Clear communication helps to avoid misunderstandings, coordinate the mobilization of resources and maintain caregiver morale. caregiver morale in the face of heightened tension. Externally, it involves informing health authorities, government representatives and the general public, in order to manage expectations and ensure transparency about the hospital situation and the measures taken. External communication often relies on authorized spokespeople and institutional media, particularly those of the Ministry of Health.

Managing patient influx

One of the key challenges lies in managing the massive influx of patients, which puts a strain on the reception and care capacities of our facilities. Patients need to be referred quickly and appropriately, depending on the seriousness of their condition, to avoid saturating emergency departments and operating theatres.

This management also involves reviewing the provision of care in real-time to adapt staffing levels, available beds, and necessary equipment, while ensuring continuity of care for patients already hospitalized. Hospital pressures result in complex trade-offs that must protect patient safety throughout the healthcare system.

Specific Family Support

Finally, welcoming patients' families is a delicate but essential issue. In a crisis context, providing psychological support and regular information to victims' relatives helps to defuse the situation and strengthen trust in the hospital. Setting up dedicated reception areas, with trained staff, makes it possible to meet their needs for understanding and presence.

This human aspect of the emergency response plan is sometimes underestimated, even though it plays a key role in the overall management of the hospital crisis.

Conclusion

The white plan is an essential tool to guarantee effective management of hospital crises. It allows for rapid mobilization of resources as well as an adapted organization of care within healthcare facilities.

In a context of exceptional health tensions, this mechanism plays a key role in preserving the quality and continuity of care for all patients, especially the most vulnerable. It is therefore essential that each hospital and actor in the healthcare system fully masters this mechanism, tests it regularly, and actively engages in its implementation.

Acting today is essential to strengthen collective resilience in the face of future crises.

FAQ

How is a mass casualty plan organized?

The white plan allows for the management of an exceptional health crisis in a healthcare facility through two main levels: internal mobilization and the crisis plan. It relies on the coordination of human and material resources, the establishment of a crisis unit, the reconfiguration of services, as well as the mobilization of personnel according to the ORSAN scheme.

Plant management is responsible for triggering and coordinating the plan.

What are the levels of the white plan?

The White Plan is generally divided into two levels:

• The hospital's emergency response plan, activated to manage a massive influx of patients.
• The extended emergency response plan, triggered at the departmental level when local capacities are exceeded.

Each level activates a crisis unit to organize a response adapted to the situation.

What is the emergency response plan and how is it structured? Who triggers it?

The White Plan is an emergency system designed for healthcare facilities, activated during major events causing a massive influx of victims or an exceptional health situation. It is structured around several key elements:

• The establishment of a crisis unit.
• Operating room release.
• The recall and reinforcement of personnel.
• Emergency coordination.

It is triggered by plant management, depending on the seriousness of the threat.

What is the purpose of the white plan?

The white plan is intended to organize and coordinate the intra-hospital response to an exceptional situation, such as a mass influx of victims related to an accident, disaster, or health crisis. It mobilizes the human and material resources necessary to ensure effective care.

This system provides organizational instructions, personnel mobilization, and management of strategic sectors to ensure continuity of care. The hospital director can trigger it in conjunction with the health authorities.