France

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General

Capital – Paris

Land Size – 640,053

Population – 64,057,792

Language(s) – French


Prehospital Care

Overview

  • Centrally-based, Two-tiered, Physician-manned response
    • First Tier
      • BLS Fire Department-based ambulances (from fire stations) – “VSAB”
    • Second Tier
      • ALS physician staffed-ambulances
  • Managed by Service d’Aide Médicale d’Urgence (SAMU)
    • 105 regional SAMUs


History

  • 1955 – First Mobile Medical Intensive Care teams created in France
    • Provided care for road accident victims and then inter-facility transfers
  • 1965 – Nationwide replication of teams


EMS System Model – Franco-German

  • Centrally-based, Two-tiered response
  • Switchboard operators forward calls to dispatching physician
    • MD determines appropriate level of response:
      • Ambulances with EMTs
      • Firefighters with BLS (including AED)
      • General Practice Physician by private vehicle
      • MICU (or Helicopter)
    • MICUs stationed at Base Locations throughout region (Service Mobile d’Urgence et de Réanimation – SMUR)
      • 320 SMUR centers in France (2004)
      • Each SMUR has minimum 1 MICU stationed
    • Personnel always include:
      • Senior MD (from ED)
      • Nurse (or Nurse Anesthesiologist)
      • Medical Student (sometimes)
      • Specially-trained driver
    • Provides all rescue techniques and ALS
    • Also have specialized units – neonatal & CCT Transport
  • Response time goals
    • < 15mins


Lead Agency

  • Ministry of Health


Funding


Levels of Care

  • Physicians both dispatch resources and provide care (when necessary)
  • Benefits include (Adnet, 9):
    • Pts most urgently in need of care benefit because of availability of resources
    • Specialized medical teams intervene only in most serious cases
    • Most advanced resources – inevitably rare and expensive – are used to best advantage
    • SAMU allows bypass and transport of Pt’s to most appropriate regional facility


Education & Training


Specialty Services


Dispatch & Medical Direction

  • Dispatch Center with switchboard operators and physicians situated in major hospital in given medical region.
    • Switchboard operators forward calls to dispatching physician
      • MD determines appropriate level of response
    • Dispatcher can provide CPR/Heimlich assistance by phone
    • Dispatching MD determines destination or specialized service required.
      • Keeps track of:
        • Bed availability
        • Specialty hospitals available on predetermined schedule
      • All MDs work full-time, 24h shifts


National Emergency Telephone #

  • Single Access national telephone number – 15
    • 112 – emerging universal European number for emergency assistance)


Emergency Medicine & Emergency Care

  • Emergency Medicine is not recognized as a stand-alone specialty in medical schools.
  • Two levels
    • Level 1: SAU (200 total)
      • Continuous coverage by surgeons
      • ICU, Lab, Radiology available 24h
    • Level 2:  UPATOU (350 total)
      • Certain specialties may be available on an “on-call” basis


Disaster


References


Links

DIEMS Home Page