Reference systems REGULATORY FRAMEWORK These systems allow rapid and optimal medical care of patients on the site of the event and in the healthcare facilities, after medical regulation by the regionally competent Emergency Medical Assitance Service (SAMU). THE ORSAN PLAN The plan is developed in each region by the Regional Health Agency. It organises the scaling up of the health system: coordinated mobilisation of the medical care operators (healthcare facility) and the health professionals. It defines the medical care pathway of the victims and structures the care management routes. It complements the Orsec plan for the management of victims in the health system (see diagram 4 on page 36). THE ORSAN CRN PLAN The plan organises, on the regional scale, the management in the health system of people exposed to an RN agent, in application of the Governmental CBRN Plan and the National Response Plan for Major Nuclear or Radiological Accidents. The Orsan CRN Plan puts in place different medical management routes for the RN risk. It gives notification of the required capacities for the 1st line healthcare facilities, particularly the Regional Reference Hospitals (RRH): capacity for decontamination, radiotoxicological analyses, dosimetry, haematological intensive care unit, etc. The plan provides for appropriate hospital decontamination measures to minimise the risk of contamination transfer within the healthcare facilities and to ensure the rapid treatment of the patients. It also provides for the reception and management of non-decontaminated EU cases. It follows on from the Orsec NOVI plan activated by the Prefect. It is complementary to the Orsan AMAVI plan and the Orsan MEDICO‑PSY plan. i 6. General Directorate for Civil Security and Emergency Management (Direction générale de la sécurité civile et de la gestion des crises). Orsec departmental and zonal guide to “NOVI” (Emergency response in situations with numerous victims) (Guide G6 – November 2014). 7. The specific provisions of the National Response Plan for Major Nuclear or Radiological Accidents are implemented if a nuclear event occurs. This plan serves to ensure the medical management of the exposed persons. 8. General Directorate for Health (Direction Générale de la Santé). Orsan Guide – Organisation of the Healthcare System Response in Exceptional Public Health Situations (2019). 08SHEET In prehospital situation, for the rescue operations and emergency medical care Management of the victims is based in particular on Interministerial Circular No. 800/SGDSN/PSE/PPS of 18 February 2011 on the French national doctrine for the use of emergency rescue and medical care services in response to a terrorist attack involving radioactive materials. The organisation is based on the following plans: • the “Orsec” (Organisation of the civil security response) plan, activated by the Prefect (Off-Site Emergency Plan – PPI), Orsec NOVI plan6), • the regional application of the governmental “Chemical, Biological, Radiological, Nuclear” (CBRN) Orsec plan, • the national response plan for major nuclear or radiological accidents7. In the healthcare facilities The medical care of victims of radiological or nuclear (RN) agents comes under the Orsan plan8, and the Orsan “Chemical, Radiological, Nuclear” (CRN) plan in particular. The Orsan plan sets the framework for the organisation of the operational response of the healthcare system in exceptional public health situations and follows on from the Orsec plan as regards the medical management of victims in the health system. If there are numerous victims of an RN agent, the Orsan AMAVI plan is activated jointly with the Orsan CRN plan. It governs the reception of large numbers of casualties to be managed simultaneously and follows in line with the Interministerial Circular No. 800/SGDSN/PSE/PPS of 18 February 2011 and the Orsec NOVI (“Numerous victims”) plan. The medical management of victims suffering from psychological injuries is organised through the Orsan MEDICO‑PSY plan. H 30 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY
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