FRANCE

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France

About

Capital – Paris
Land Size – 640,053 sq km
Population – 64,057,792
Language(s) – French

EMS History

1995 – First Mobile Medical Intensive Care teams created in Franc

  • Provided care for road accident victims and then inter-facility transfers

1965 – Nationwide replication of teams

See also: “The Death of a Princess and the Formulation of Medical Competence”

EMS System

Lead Agency – Ministry of Health

EMS System Model

  • Centrally-based, Two-tiered response
    • First Tier
      • BLS Fire Department-based ambulances (from fire stations) – “VSAB”
    • Second Tier
      • ALS physician staffed-ambulances
  • 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

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

Dispatch

  • Single Access national telephone number
    • 112 – emerging universal European number for emergency assistance)
    • 15 for SAMU, and 18 for VSAB are legacy numbers, still in use
  • 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

References

https://www.cia.gov/library/publications/the-world-factbook/geos/fr.html

Adnet F, Lapostolle F: “International EMS Systems: France.” Resuscitation 2004;63:7-9.

Hirsch M et al. “The medical response to multisite terrorist attacks in Paris.” The Lancet (Published online: Nov. 24, 2015.)

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