France

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

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

EMS System Model

• 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

Level 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 and Training

Specialty Services

Dispatch

• 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

Public Access Numbers

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

Emergency Medicine

• 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

• 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.