August 31, 2012, marked the 15-year anniversary of the death of Princess Diana of Wales after a motor vehicle crash in Paris, France. And while the mainstream press was busy re-visiting the salacious tales surrounding her death, Notes From The Go-Around was busy trying to doing what we like to do whenever a celebrity dies before their time – we re-visited the EMS system surrounding their death. In this case, we were re-acquainted with France’s Service d’Aide Médicale Urgente (SAMU) and the Franco-German EMS model, but ended up learning far more than we expected.
ERRORS OF COMMISSION
Shortly after her death, the Paris Bureau Chief for TIME magazine co-authored a book, “Death of Princess: The Investigation” [ref], in which interviews with American and British physicians implied that perhaps the death could have been avoided, were it to have happened in the U.S. or UK, and not in France.
In a not-so-subtly follow-up article entitled, “Death Of A Princess, Did Princess Diana Have To Die?: A Case Study In French Emergency Medicine”, Sancton wrote, “While not accusing any individual medical worker of professional errors in treating Diana – indeed, they clearly followed standard French procedures – Dr. Wasserman argues that the fault lies with the whole French approach to emergency medicine” – namely, a tendency for the “stay and play” approach to prehospital care common in physician-staffed ambulance services in the Franco-German model. IN any case, Sancton and MacLeod’s book, and Sancton’s follow-up article, was successful in eliciting strong reactions from all parties involved – French, British, and American physicians alike.
At the root of this debate is an argument between the Anglo-American and Franco-German approaches: paramedics and EMTs vs. physicians and nurses; “load and go” vs. “stay and play”; and to a certain extent, BLS vs. ALS. However, while these arguments are increasingly debated on outcomes, we came across an article by Michel Nurok that took another approach to this debate – one that resonated much more loudly with Trek Medics’ experiences in the field:
YOU ARE WHAT YOU SUFFER
In his article, “The Death of a Princess and the Formulation of Medical Competence”, Michael Nurok uses the 1997 death of Princess Diana as a launching point from where he presents emergency medical care as a societal undertaking that reflects the shared cultural and political experiences of an entire people – in this case, the experiences of the U.S.A. and France.
If that claim sounds about as realistic to you as a patient telling you straight to your face that they’re having a seizure, we won’t argue with you. But we would at least ask you to let M. Nurok have a few words in his own defense:
“Paris SAMU physicians argue that because there is so little trauma in general – especially penetrating trauma – French surgeons are not as accustomed to its treatment as their American counterparts.[cross-ref] Taking patients to the nearest emergency department is similarly unfeasible because they are staffed by generalist physicians, who are no better equipped to handle serious trauma than their SAMU colleagues. For this reason, SAMU physicians are often forced to stabilise patients in MICUs while the base physician-regulator finds a trauma centre that can competently manage major trauma.
“Looked at another way, penetrating trauma, which is almost exclusively a result of urban violence, has not been a medical-scientific object that French physicians have had to construct. Whether the lack of such pathology may be due to a social system that takes better care of the disadvantaged is a question beyond the scope of this paper. In America, urban violence is highly politicised and therefore it is in the interests of many to have an EMS that can address this problem.” 
We’d love to hear from anyone who has something to add, so let us know how you see your culture reflected in your emergency medical care system by commenting below, or sending us an email: [email protected]
Read the articles here:
Scanton, Thomas A: “Death Of A Princess, Did Princess Diana Have To Die?: A Case Study In French Emergency Medicine.” The Internet Journal of Rescue and Disaster Medicine. 2000;1(2). DOI: 10.5580/268a
Nurok, Michael: “The Death of a Princess and the Formulation of Medical Competence.” Soc Sci Med 20011;51:427-38
Abstract: This study outlines a genealogy of the French and United States’ Emergency Medical Service (EMS) systems. This is done to contextualise claims that Princess Diana could have survived had her crash taken place in the USA, and to enrich the EMS debate regarding field-treatment vs. rapid hospital admission for trauma victims. A historical analysis is offered for the disproportionate amount of available data on penetrating trauma, and proportionate deficit of data on blunt trauma with respect to total North American and Western European trauma epidemiology. The impact of US biomedical knowledge and culture on French medical practice is evaluated and used to understand how foreign knowledge is negotiated in local medical practice. The paper concludes by showing how, in response to a challenge by American biomedical standards of practice and formulation of competence, French pre-hospital Emergency Physicians have contextualised the origins of these standards as well as their local relevance in order to preserve an integrated notion of competence.