White plan triggered at the hospital: what is it?

The activation of the white plan in hospitals is an emergency measure to deal with a massive influx of patients. It was triggered in 2020 during the epidemic of Covidin 2022 facing the bronchiolitis and in January 2025 to cope with the increase in patients in Emergency Departments affected by the flu.

What is the white plan?

Enshrined in law since 2004, the white plan contains organizational measures intended to deal with an exceptional health situation or increased activity of a hospital. It makes it possible to organize the reception and care of a massive influx of victims an accident, a catastrophe (attacks for example), an epidemic or a deadly and lasting climatic event (a nuclear risk for example). The white plan is also triggered during crisis situations such as attackslocally or throughout France (this was the case in December 2018 after the attack on the Strasbourg Christmas market). Each public or private health establishment is responsible for developing its white plan. It must bring together the intra-hospital organization instructions for the establishment and the methods for setting up a crisis unit. The white plans of health establishments are integrated into a enlarged white plane which defines the role and place of each person, within the department, in exceptional situations. The white establishment plan is evaluated and revised each year. At each revision, the Regional Health Agency ensures the consistency of the white establishment plan with the expanded white plan.

Who triggers the white plan?

The white plan can be triggered by the director or manager of the public or private health establishment who then informs the State representative in the department, or at the request of the latter. The information is then transmitted to the director general of the regional health agency, the departmental emergency medical aid service and the representatives of the local authorities concerned. The white plane can also be triggered by the prefects defense zone and by the Prime Minister if the nature of the health situation or the scale of the influx of patients or victims justifies it, which was the case with thecoronavirus epidemic (Covid-19). Non-urgent hospitalizations can be canceled (fribroscopies, dermatological care, prosthetic fittings, etc.).

When is the white plan triggered?

From a general point of view, the white plan is triggered if the situation of tension is combined with sustained activity and restricted reception capacity. THE indicators are :

► A 20% increase in the number of visits to the emergency room for three consecutive days or,

► 10% of the number of daily patients without hospitalization for more than eight hours,

► A similar situation is observed in the department.

The choice of these thresholds may need to be weighed in light of situations of tension already observed in the establishment over time. There lifting of the white plan is pronounced by the director when the situation has stabilized.

What are the measurements of the white plan in level 1 then 2?

The white plan lists all the material and human resources likely to be mobilized and defines the conditions for their use gradually (level 1 then 2). It provides in particular the conditions according to which the necessary nursing staff can be kept on site and, where applicable, recalled its volunteer staff when the situation warrants it.

The white plan measures taken by the health establishment must include:

• The establishment of a crisis unit managed by the head of the establishment or his representative, and responsible for managing the alert or crisis.
• The organization of sorting, reception of patients, their distribution according to the nature and severity of their pathology in specialized units or, failing that, those most suited to their care. L’addition of additional beds in services.
• The methods of transmitting the alert within the establishment, as well as the internal and external connections to the establishment to ensure the circulation of information.
• A plan of confinement and a planevacuation of the establishment.
• Maintaining teams of volunteer staff on site.
• THE graduated recall of volunteer personnel on rest, in order to have sufficient resources but also to be able to organize rotations in the event of a lasting crisis.
• A patient transfer from involved services to less involved services, other establishments, or even discharge home when possible.
• A deprogramming of non-urgent activities : consultations, surgical interventions, etc.
• The inventory of resources available by medical-technical services (pharmacy, laboratories, medical imaging) and logistics (laundry, catering).
• Strengthening means of communication: the telephone switchboard is reinforced and communications are reserved for the white plan only, reinforced if necessary by a mobile health post.
• The organization of a medical triage strict in a sufficiently large room and under the responsibility of a triage doctor, distinct from the classic emergency reception, and distinct from the reception of families and the media.
• The organization of vehicle traffic on the site with additional signage and signage to facilitate internal circulation, use of reinforced surveillance and guarding measures.
• THE possible recourse to associative means : volunteers from first aid and social assistance associations for the treatment of minor care or support actions.

The flow of new arrivals must be controlled in order to prevent contamination of the entire establishment in the event of an accident: nuclear, radiological, bacteriological and chemical.

The expanded white plan: when and why?

The expanded white plan constitutes a reinforcement plan which completes the initial white plan. It is reserved for situations where the organization of the reinforced health system does not, on its own, make it possible to deal with an event. For example, when the treatment capacities of a health establishment are overwhelmed in the face of a crisis of exceptional magnitude. The Department Prefect then mobilizes other complementary resources (material and human), at the department level. The expanded white plan has been put in place in the French departments to deal with the coronavirus epidemic, with the objective of:

• To ensure the handling a high number of victims in the health establishments best suited to their condition, within compatible deadlines and under appropriate security conditions.
• Organize the reception of a influx of unregulated victims by guiding them as best as possible by means of information in order to preserve health establishments.
• Organize the functionalities of the entire system: health establishments, self-employed health professionals, other players in the health sector, medico-social sector, health authorities, with a view to overall management.
• Ensure that all establishments and sectors of activity of the health system are operational.

THE expanded white plane also includes three annexes relating to the organization of a exceptional vaccination campaignthe organization of the distribution of health products outside the pharmaceutical circuit, as well as the evacuation of one or more health or medico-social establishments when the health system’s own resources are exceeded.