{"id":240,"date":"2018-09-26T01:03:06","date_gmt":"2018-09-25T23:03:06","guid":{"rendered":"https:\/\/regions-snetap-fsu.fr\/idf\/?page_id=240"},"modified":"2024-12-12T13:07:40","modified_gmt":"2024-12-12T12:07:40","slug":"sante-securite-et-condition-de-travail","status":"publish","type":"page","link":"https:\/\/regions-snetap-fsu.fr\/idf\/en-cas-de-besoin\/sante-securite-et-condition-de-travail\/","title":{"rendered":"Sant\u00e9, s\u00e9curit\u00e9 et conditions de travail"},"content":{"rendered":"<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/chlorofil.fr\/covid-19\" target=\"_blank\" rel=\"noopener\"><strong><span style=\"font-size: 18pt\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-1206\" src=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2021\/04\/chsct-image-panneau-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/span><\/strong><\/a><\/span><\/p>\n<p><strong><span style=\"font-size: 18pt\">Cong\u00e9s, Accidents, maladies :\u00a0<\/span><\/strong><\/p>\n<div class=\"listeart\"><\/div>\n<div class=\"listeart\"><span style=\"color: #ff0000\"><a style=\"color: #ff0000\" href=\"https:\/\/www.ain.gouv.fr\/guide-des-demarches-professionnels-a775.html#!\/Particuliers\/page\/F18085\" target=\"_blank\" rel=\"noopener\">Attention ! en 2022, les conseils m\u00e9dicaux remplacent les commissions de r\u00e9formes et les comit\u00e9s m\u00e9dicaux.<\/a><\/span><\/div>\n<div><\/div>\n<div><\/div>\n<div><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2022\/09\/Guide-procedures_CM-AT-MP_0513.pdf\" target=\"_blank\" rel=\"noopener\">Guide CM-AT-MP<\/a><\/span><\/div>\n<div><\/div>\n<div><\/div>\n<p><strong><span style=\"font-size: 18pt\">Face \u00e0 la souffrance au travail :<\/span><\/strong><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2021\/02\/guide_burn-out-2016.pdf\" target=\"_blank\" rel=\"noopener\">Burn-out<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2020\/10\/Charte-des-temps-MAA_0315.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">La Charte des temps<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2020\/10\/NDS-agression-ou-harcelement-sexuel_1214.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Harc\u00e8lement sexuel<\/a><\/span><\/p>\n<p><a href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2022\/09\/2022-613_final-rectif.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"color: #339966\">La cellule anti discrimination et harc\u00e8lement<\/span><\/a><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2020\/10\/Cellule-discrim-modele-lettre.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Lettre cellule discrimination<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2021\/02\/NDS-IAPR-3-fevrier-2021.pdf\" target=\"_blank\" rel=\"noopener\">Soutien psychologique<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2020\/10\/NDS_-signalement-agression_0416.pdf\" target=\"_blank\" rel=\"noopener\">Signalement agression<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2021\/02\/guide_pratique_TMS.pdf\" target=\"_blank\" rel=\"noopener\">Troubles musculosquelettiques<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2021\/02\/Guide-MAA-Prevention-Violences_2018.pdf\" target=\"_blank\" rel=\"noopener\">Violences au travail<\/a><\/span><\/p>\n<p><strong><span style=\"font-size: 18pt\">Les instances :<\/span><\/strong><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2020\/10\/NDS-CoHS-COCT_2018.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">La CoHS<\/a><\/span><\/p>\n<p><span style=\"color: #339966\">la F3SCT-REA<\/span><\/p>\n<p><a href=\"https:\/\/regions-snetap-fsu.fr\/idf\/formation-specialisee-ministerielle\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #339966\">La FS-M<\/span><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-size: 18pt\"><strong>A mobiliser dans votre structure :\u00a0<\/strong><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/www.snetap-fsu.fr\/Du-bon-usage-du-registre-Sante-et-Securite-au-Travail.html\" target=\"_blank\" rel=\"noopener\">Registre SST<\/a><\/span>\u00a0: il est conseill\u00e9 de le multiplier dans les diff\u00e9rents services pour faciliter l&rsquo;acc\u00e8s. A \u00e9voquer en CoHS.<\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/www.chsct-travail-sante-fsu.fr\/article.php?idrubrique=20&amp;idarticle=242\" target=\"_blank\" rel=\"noopener\">Registre Danger Grave et Imminent<\/a>\u00a0<\/span>: situ\u00e9 g\u00e9n\u00e9ralement dans le bureau du secr\u00e9tariat de direction.<\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/www.snetap-fsu.fr\/Faire-une-alerte-au-CHSCTREA.html\" target=\"_blank\" rel=\"noopener\">Droit d&rsquo;alerte<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/www.snesup.fr\/article\/le-droit-de-retrait-dans-la-fonction-publique\" target=\"_blank\" rel=\"noopener\">Droit de retrait<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/wp-content\/uploads\/sites\/11\/2021\/02\/CCHSCT-FP-Preconisations-DUERP.pdf\" target=\"_blank\" rel=\"noopener\">DUERP<\/a><\/span><\/p>\n<p><strong><span style=\"font-size: 18pt\">Les acteurs de la pr\u00e9vention\u00a0<\/span><\/strong><\/p>\n<div class=\"texte\">\n<p><strong>Le chef d\u2019\u00e9tablissement \/ chef de service<\/strong><\/p>\n<p><strong>Le chef de service est charg\u00e9<\/strong>\u00a0<strong>de veiller \u00e0 la s\u00e9curit\u00e9 et \u00e0 la protection de la sant\u00e9 des agents plac\u00e9s sous leur autorit\u00e9<\/strong> (article 2.1 du d\u00e9cret 82-453 modifi\u00e9). Il fixe les grandes orientations de la politique sant\u00e9, s\u00e9curit\u00e9 au travail (Art. L.4121-2 du code du travail). Cette obligation qui s\u2019inspire directement des dispositions de l\u2019article L.4121-1 du code du travail, s\u2019exerce cependant dans le cadre des d\u00e9l\u00e9gations qui lui sont consenties.<\/p>\n<p><strong>Les agent.es et leurs repr\u00e9sentant.es<\/strong><\/p>\n<p>Il incombe \u00e0 chaque travailleur de prendre soin, en fonction de sa formation et selon ses possibilit\u00e9s de sa sant\u00e9 et de sa s\u00e9curit\u00e9 ainsi que de celles des autres personnes concern\u00e9es par ses actes ou ses omissions au travail (article L.4122-1 du code du travail). <strong>Cette disposition n\u2019affecte pas la responsabilit\u00e9 du chef d\u2019\u00e9tablissement<\/strong>, elle vient au contraire la compl\u00e9ter. <strong>La participation des repr\u00e9sentants des agents<\/strong> au sein de la F3SCT permet une repr\u00e9sentation des int\u00e9r\u00eats des agents et d\u2019exprimer leur volont\u00e9. <strong>Ils peuvent d\u00e9clencher le droit d\u2019alerte<\/strong> au motif d\u2019une atteinte \u00e0 la sant\u00e9 physique et mentale des agents, en saisissant en premier lieu l\u2019employeur ou son repr\u00e9sentant. Le caract\u00e8re non paritaire de cette instance permet de donner plus de poids aux repr\u00e9sentants des agent.es.<\/p>\n<p><strong>Les agent.es de pr\u00e9vention<\/strong><\/p>\n<p>Dans le champ de comp\u00e9tence des F3SCT, des assistants de pr\u00e9vention et, le cas \u00e9ch\u00e9ant, des conseillers de pr\u00e9vention sont nomm\u00e9s par les chefs de service concern\u00e9s, sous l\u2019autorit\u00e9 desquels ils exercent leurs fonctions (article 4 du d\u00e9cret 82-453 modifi\u00e9). De ce fait, l\u2019agent de pr\u00e9vention doit relever directement du chef de service concern\u00e9 duquel il re\u00e7oit ses directives et aupr\u00e8s duquel il rend compte de son action. Sa mission est d\u2019assister et de conseiller le chef de service, aupr\u00e8s duquel il est plac\u00e9, dans la d\u00e9marche d\u2019\u00e9valuation des risques et dans la mise en place d\u2019une politique de pr\u00e9vention des risques, ainsi que dans la mise en \u0153uvre des r\u00e8gles de s\u00e9curit\u00e9 et d\u2019hygi\u00e8ne au travail. Il est associ\u00e9 aux travaux de la F3SCT comp\u00e9tente pour son service. il assiste de plein droit aux r\u00e9unions de ce comit\u00e9 (article 39 du d\u00e9cret 82-453 modifi\u00e9).<\/p>\n<p><strong>La m\u00e9decine de pr\u00e9vention<\/strong><\/p>\n<p>Le d\u00e9cret 82-453 modifi\u00e9 pose le principe de la cr\u00e9ation, dans toutes les administrations et tous les \u00e9tablissements publics entrant dans son champ d\u2019application, d\u2019un service de m\u00e9decine de pr\u00e9vention. Le texte pr\u00e9voie la possibilit\u00e9 d\u2019adh\u00e9rer, par voie de convention, \u00e0 un service de m\u00e9decine du travail. Le service de m\u00e9decine de pr\u00e9vention a pour r\u00f4le de pr\u00e9venir toute alt\u00e9ration de la sant\u00e9 des agent.es du fait de leur travail.<\/p>\n<p>Le m\u00e9decin du travail &#8211; le terme de <em>m\u00e9decin de pr\u00e9vention<\/em> n&rsquo;existe plus depuis le 27 mai 2020 &#8211; est le conseiller de l\u2019administration, des agents et de leurs repr\u00e9sentants en ce qui concerne : l\u2019am\u00e9lioration des conditions de vie et de travail dans les services, l\u2019hygi\u00e8ne g\u00e9n\u00e9rale des locaux , l\u2019adaptation des postes, des techniques et des rythmes de travail \u00e0 la physiologie humaine, la protection des agents contre l\u2019ensemble des nuisances et les risques d\u2019accidents de service ou de maladie professionnelle ou \u00e0 caract\u00e8re professionnel, l\u2019hygi\u00e8ne dans les restaurants administratifs, l\u2019information sanitaire (article 15 du d\u00e9cret 82-453 modifi\u00e9).<\/p>\n<\/div>\n<blockquote><p><span style=\"color: #339966\"><strong>Surveillance m\u00e9dicale<\/strong><\/span><br \/>\n<span style=\"color: #339966\">La surveillance m\u00e9dicale consiste en\u00a0:<\/span><br \/>\n<span style=\"color: #339966\">&#8211; un examen de surveillance m\u00e9dicale, effectu\u00e9 une fois <strong>tous les cinq ans<\/strong> lorsque l\u2019agent ne rel\u00e8ve pas d\u2019une surveillance particuli\u00e8re et s\u2019il n\u2019a pas demand\u00e9 \u00e0 b\u00e9n\u00e9ficier d\u2019un examen m\u00e9dical annuel,<\/span><br \/>\n<span style=\"color: #339966\">&#8211; une surveillance m\u00e9dicale particuli\u00e8re, r\u00e9alis\u00e9e au moins <strong>une fois par an<\/strong> pour les agents affect\u00e9s \u00e0 des postes soumis \u00e0 des risques professionnels particuliers, ainsi que pour les agents r\u00e9int\u00e9gr\u00e9s apr\u00e8s un cong\u00e9 maladie, pour les femmes enceintes, pour les personnes handicap\u00e9es et pour les agents souffrant de pathologies pr\u00e9existantes.<\/span><\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<div class=\"texte\">\n<p><strong>L\u2019inspecteur en Sant\u00e9 et S\u00e9curit\u00e9 au Travail<\/strong><\/p>\n<p>Les ministres d\u00e9signent dans les administrations de l\u2019\u00e9tat les fonctionnaires qui sont charg\u00e9s d\u2019assurer les fonctions d\u2019inspection en mati\u00e8re de sant\u00e9 et de s\u00e9curit\u00e9 au travail (ISST). Les ISST contr\u00f4lent les conditions d\u2019application des r\u00e8gles d\u00e9finies dans la 4\u00e8me partie du code du travail et proposent au chef de service int\u00e9ress\u00e9 toute mesure qui leur parait de nature \u00e0 am\u00e9liorer l\u2019hygi\u00e8ne et la s\u00e9curit\u00e9 du travail et la pr\u00e9vention des risques professionnels. En cas d\u2019urgence, ils proposent au chef de service concern\u00e9, qui leur rend compte des suites donn\u00e9es \u00e0 leurs propositions, les mesures imm\u00e9diates jug\u00e9es par eux n\u00e9cessaires (article 5.2 du d\u00e9cret 82-453 modifi\u00e9). Au sein du minist\u00e8re, la note de service n\u00b01088-2013 du 3 mai 2013 d\u00e9finit les missions et les comp\u00e9tences. <span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/intranet.national.agri\/Le-reseau-des-Inspecteurs-sante-et\">Voir l\u2019annuaire..<\/a><\/span><\/p>\n<p><strong>Les assistants de service social (ASS)<\/strong><br \/>\nLes ASS interviennent pour l\u2019ensemble des agents du minist\u00e8re sur une circonscription g\u00e9ographique d\u00e9finie, pour toute question relative \u00e0 l\u2019environnement professionnel et personnel. Ils assurent une aide individuelle aux agents qui les sollicitent et participent \u00e0 la gestion des ressources humaines des services. Ils alertent les responsables sur les<br \/>\nsituations \u00e0 risque dans les services et peuvent proposer des actions de pr\u00e9vention. Ils participent \u00e0 l\u2019organisation d\u2019actions collectives d\u2019information et d\u2019\u00e9changes et \u00e0 l\u2019orientation de la politique d\u2019action sociale en fonction de l\u2019\u00e9volution du contexte professionnel.<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<p><strong><span style=\"font-size: 18pt\">Autres LIENS :<\/span>\u00a0<\/strong><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/www.gouvernement.fr\/risques\/tutos-risques\" target=\"_blank\" rel=\"noopener noreferrer\">Videos infos Risques majeurs<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/www.lesondesmobiles.fr\/\" target=\"_blank\" rel=\"noopener noreferrer\">Infos sur les ondes<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/www.radiofrequences.gouv.fr\/\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.radiofrequences.gouv.fr\/<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/agriculture.gouv.fr\/securite-des-machines-agricoles-et-forestieres-fiches-pratiques\" target=\"_blank\" rel=\"noopener noreferrer\">Fiches pratiques machines agricoles et foresti\u00e8res<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/agriculture.gouv.fr\/renversement-des-tracteurs\" target=\"_blank\" rel=\"noopener noreferrer\">Infos renversement tracteurs<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"http:\/\/www.seirich.fr\/seirich-web\/index.xhtml\" target=\"_blank\" rel=\"noopener noreferrer\">Portail risque chimique<\/a><\/span><\/p>\n<p><span style=\"color: #339966\"><a style=\"color: #339966\" href=\"https:\/\/www.fonction-publique.gouv.fr\/cmr-dont-amiante\" target=\"_blank\" rel=\"noopener\">Amiante<\/a><\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Cong\u00e9s, Accidents, maladies :\u00a0 Attention ! en 2022, les conseils m\u00e9dicaux remplacent les commissions de r\u00e9formes et les comit\u00e9s m\u00e9dicaux. Guide CM-AT-MP Face \u00e0 la souffrance au travail : Burn-out La Charte des temps Harc\u00e8lement sexuel La cellule anti discrimination et harc\u00e8lement Lettre cellule discrimination Soutien psychologique Signalement agression Troubles musculosquelettiques Violences au travail Les [&hellip;]<\/p>\n","protected":false},"author":104,"featured_media":0,"parent":76,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"0","footnotes":""},"folder":[],"class_list":["post-240","page","type-page","status-publish","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Sant\u00e9, s\u00e9curit\u00e9 et conditions de travail - \u00ceLE-DE-FRANCE<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/regions-snetap-fsu.fr\/idf\/en-cas-de-besoin\/sante-securite-et-condition-de-travail\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sant\u00e9, s\u00e9curit\u00e9 et conditions de travail - \u00ceLE-DE-FRANCE\" \/>\n<meta property=\"og:description\" content=\"Cong\u00e9s, Accidents, maladies :\u00a0 Attention ! en 2022, les conseils m\u00e9dicaux remplacent les commissions de r\u00e9formes et les comit\u00e9s m\u00e9dicaux. 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