Le SAMU connecté - Sciencesconf.org...• Un service d’accueil, public ou privé, voit les...
Transcript of Le SAMU connecté - Sciencesconf.org...• Un service d’accueil, public ou privé, voit les...
Le SAMU connecteacute
Michel Baer SAMU des Hauts-de-Seine
Garches
1
2
Le SAMU est un service de reacutegulation des appels de deacutetresse drsquourgence et de permanence des soins Meacutetiers ARM meacutedecins En language international EMS dispatch center Meacutetiers du dispatch EMD La reacutegulation des appels au SAMU - ARM prise drsquoappel et le suivi technique - Meacutedecin deacutefinit le moyen agrave envoyer et le devenir 4 sceacutenarios bull Envoi de SMUR bull Envoi de meacutedecin ldquode villerdquo bull Envoi drsquoune ambulance bull Conseil meacutedical self traitement Le Dispatch des EMS EMD utilise des AMPDS bull Caller interrogation and pre-arrival instructions bull Closed questionnaires bull Prioritization codes bull Dispatch and response determinants
3 3
Reacutegulation du SAMU Echanges avec le public (patient tiers) les professionnels de santeacute les entreprises (services de santeacute au travail) les hocircpitaux les EHPAD les ldquoeffecteursrdquo SMUR (Ambulances du SAMU) Echanges avec leur SAMU ou les hocircpitaux Ambulances ldquonormalesrdquo Echanges avec le patient un meacutedecin le SAMU Pompiers (CTA) Echanges avec le public ses effecteurs (VSAV meacutedecins de pompiers IDE) SAMU
4
Qui communique avec qui
5
Quelques doctrineshelliphellip
Plus lrsquoambulance est pauvre plus le besoin drsquoune expertise est fort
Plus le systegraveme est meacutedicaliseacute moins le besoin est exprimeacute
En lrsquoabsence drsquoun systegraveme unifieacute de santeacute les initiatives sont plutocirct ldquobottom uprdquo que dirigeacutees
6
La transmission drsquoECG
Cardiatel Cardiotel (1977)
Sanimat (faillite 2014)
Parsys (2013) Telecardia Cardialys
Cour drsquoappel de Lyon 2012
Le projet DG Recherche HECTOR
75 M Ecus 49 partenaires
1996 - 2000
The purpose of HECTOR is to offset the general lack of a multidisciplinary approach geared to global solutions
in health care emergency activities The project will mobilise existing technology and the new capabilities of
multimedia and telecommunications to pilot an integrated interoperable solution with an optimum cost-benefit
trade off Features of the system will include prompt efficient reaction in emergencies two-way clinical data
transmission medical telesupport at the point of care and minimal intervention The system will also provide
training to professionals and information to citizens
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
2
Le SAMU est un service de reacutegulation des appels de deacutetresse drsquourgence et de permanence des soins Meacutetiers ARM meacutedecins En language international EMS dispatch center Meacutetiers du dispatch EMD La reacutegulation des appels au SAMU - ARM prise drsquoappel et le suivi technique - Meacutedecin deacutefinit le moyen agrave envoyer et le devenir 4 sceacutenarios bull Envoi de SMUR bull Envoi de meacutedecin ldquode villerdquo bull Envoi drsquoune ambulance bull Conseil meacutedical self traitement Le Dispatch des EMS EMD utilise des AMPDS bull Caller interrogation and pre-arrival instructions bull Closed questionnaires bull Prioritization codes bull Dispatch and response determinants
3 3
Reacutegulation du SAMU Echanges avec le public (patient tiers) les professionnels de santeacute les entreprises (services de santeacute au travail) les hocircpitaux les EHPAD les ldquoeffecteursrdquo SMUR (Ambulances du SAMU) Echanges avec leur SAMU ou les hocircpitaux Ambulances ldquonormalesrdquo Echanges avec le patient un meacutedecin le SAMU Pompiers (CTA) Echanges avec le public ses effecteurs (VSAV meacutedecins de pompiers IDE) SAMU
4
Qui communique avec qui
5
Quelques doctrineshelliphellip
Plus lrsquoambulance est pauvre plus le besoin drsquoune expertise est fort
Plus le systegraveme est meacutedicaliseacute moins le besoin est exprimeacute
En lrsquoabsence drsquoun systegraveme unifieacute de santeacute les initiatives sont plutocirct ldquobottom uprdquo que dirigeacutees
6
La transmission drsquoECG
Cardiatel Cardiotel (1977)
Sanimat (faillite 2014)
Parsys (2013) Telecardia Cardialys
Cour drsquoappel de Lyon 2012
Le projet DG Recherche HECTOR
75 M Ecus 49 partenaires
1996 - 2000
The purpose of HECTOR is to offset the general lack of a multidisciplinary approach geared to global solutions
in health care emergency activities The project will mobilise existing technology and the new capabilities of
multimedia and telecommunications to pilot an integrated interoperable solution with an optimum cost-benefit
trade off Features of the system will include prompt efficient reaction in emergencies two-way clinical data
transmission medical telesupport at the point of care and minimal intervention The system will also provide
training to professionals and information to citizens
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
3 3
Reacutegulation du SAMU Echanges avec le public (patient tiers) les professionnels de santeacute les entreprises (services de santeacute au travail) les hocircpitaux les EHPAD les ldquoeffecteursrdquo SMUR (Ambulances du SAMU) Echanges avec leur SAMU ou les hocircpitaux Ambulances ldquonormalesrdquo Echanges avec le patient un meacutedecin le SAMU Pompiers (CTA) Echanges avec le public ses effecteurs (VSAV meacutedecins de pompiers IDE) SAMU
4
Qui communique avec qui
5
Quelques doctrineshelliphellip
Plus lrsquoambulance est pauvre plus le besoin drsquoune expertise est fort
Plus le systegraveme est meacutedicaliseacute moins le besoin est exprimeacute
En lrsquoabsence drsquoun systegraveme unifieacute de santeacute les initiatives sont plutocirct ldquobottom uprdquo que dirigeacutees
6
La transmission drsquoECG
Cardiatel Cardiotel (1977)
Sanimat (faillite 2014)
Parsys (2013) Telecardia Cardialys
Cour drsquoappel de Lyon 2012
Le projet DG Recherche HECTOR
75 M Ecus 49 partenaires
1996 - 2000
The purpose of HECTOR is to offset the general lack of a multidisciplinary approach geared to global solutions
in health care emergency activities The project will mobilise existing technology and the new capabilities of
multimedia and telecommunications to pilot an integrated interoperable solution with an optimum cost-benefit
trade off Features of the system will include prompt efficient reaction in emergencies two-way clinical data
transmission medical telesupport at the point of care and minimal intervention The system will also provide
training to professionals and information to citizens
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Reacutegulation du SAMU Echanges avec le public (patient tiers) les professionnels de santeacute les entreprises (services de santeacute au travail) les hocircpitaux les EHPAD les ldquoeffecteursrdquo SMUR (Ambulances du SAMU) Echanges avec leur SAMU ou les hocircpitaux Ambulances ldquonormalesrdquo Echanges avec le patient un meacutedecin le SAMU Pompiers (CTA) Echanges avec le public ses effecteurs (VSAV meacutedecins de pompiers IDE) SAMU
4
Qui communique avec qui
5
Quelques doctrineshelliphellip
Plus lrsquoambulance est pauvre plus le besoin drsquoune expertise est fort
Plus le systegraveme est meacutedicaliseacute moins le besoin est exprimeacute
En lrsquoabsence drsquoun systegraveme unifieacute de santeacute les initiatives sont plutocirct ldquobottom uprdquo que dirigeacutees
6
La transmission drsquoECG
Cardiatel Cardiotel (1977)
Sanimat (faillite 2014)
Parsys (2013) Telecardia Cardialys
Cour drsquoappel de Lyon 2012
Le projet DG Recherche HECTOR
75 M Ecus 49 partenaires
1996 - 2000
The purpose of HECTOR is to offset the general lack of a multidisciplinary approach geared to global solutions
in health care emergency activities The project will mobilise existing technology and the new capabilities of
multimedia and telecommunications to pilot an integrated interoperable solution with an optimum cost-benefit
trade off Features of the system will include prompt efficient reaction in emergencies two-way clinical data
transmission medical telesupport at the point of care and minimal intervention The system will also provide
training to professionals and information to citizens
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
5
Quelques doctrineshelliphellip
Plus lrsquoambulance est pauvre plus le besoin drsquoune expertise est fort
Plus le systegraveme est meacutedicaliseacute moins le besoin est exprimeacute
En lrsquoabsence drsquoun systegraveme unifieacute de santeacute les initiatives sont plutocirct ldquobottom uprdquo que dirigeacutees
6
La transmission drsquoECG
Cardiatel Cardiotel (1977)
Sanimat (faillite 2014)
Parsys (2013) Telecardia Cardialys
Cour drsquoappel de Lyon 2012
Le projet DG Recherche HECTOR
75 M Ecus 49 partenaires
1996 - 2000
The purpose of HECTOR is to offset the general lack of a multidisciplinary approach geared to global solutions
in health care emergency activities The project will mobilise existing technology and the new capabilities of
multimedia and telecommunications to pilot an integrated interoperable solution with an optimum cost-benefit
trade off Features of the system will include prompt efficient reaction in emergencies two-way clinical data
transmission medical telesupport at the point of care and minimal intervention The system will also provide
training to professionals and information to citizens
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
6
La transmission drsquoECG
Cardiatel Cardiotel (1977)
Sanimat (faillite 2014)
Parsys (2013) Telecardia Cardialys
Cour drsquoappel de Lyon 2012
Le projet DG Recherche HECTOR
75 M Ecus 49 partenaires
1996 - 2000
The purpose of HECTOR is to offset the general lack of a multidisciplinary approach geared to global solutions
in health care emergency activities The project will mobilise existing technology and the new capabilities of
multimedia and telecommunications to pilot an integrated interoperable solution with an optimum cost-benefit
trade off Features of the system will include prompt efficient reaction in emergencies two-way clinical data
transmission medical telesupport at the point of care and minimal intervention The system will also provide
training to professionals and information to citizens
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
7
AMPDS des dispatch anglo-saxons Modegravele de reacutegulation des SAMU Pertinence des applications ldquogrand publicrdquo de diagnostic ou de tri La pertinence des outils drsquoaide issus de IT
Patient famille tiershellip En amont des appels au SAMU le patient se connecte agrave des applications pour auto-diagnostic - Apps de tri ou de diagnostic - Outils drsquoaide issus de la IT
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
8
AMPDS versus ldquofree dispatchrdquo
Les AMPDS ont eacuteteacute mis en place au UK en 2000
bull Relative opposition des opeacuterateurs
bull Questionnaires ouverts avec 2 hypothegraveses bull Flexibiliteacute de lrsquoappel richesse des eacuteleacutements collecteacutes
bull Meilleure adaptation agrave lrsquoappelant
bull Comparaison du taux de reconnaissance des ACR avant et apregraves implementation des AMPDS par des EMD ndash Arrecircts cardiaques en 1999 et 2002
Taux de diagnostic initial juste augmente de 200
(Heward Emerg Med J 2004) 8
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Ability to identify and directly dispatch ACS to cath-lab or ICU
AMPDS with DH call prioritization is not a tool designed for clinical
diagnosis and its extension into this field does not enable accurate
identification of patients with ACS
Deakin CD1 Emerg Med J 2006 Mar23(3)232-5
Evaluation des AMPDS Identifier un SCA
9
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Ability to identify and directly admit patient in a stroke unit
4810 patients were admitted to NHH during the study period Of these 126 patients were
subsequently diagnosed as having had a stroke
Fewer than half of all patients with acute stroke were identified using
telephone triage on the initial emergency call to the ambulance service
Less than one quarter received the highest priority of ambulance
response
Deakin CD1 Emerg Med J 2009 Jun26(6)442-5
Evaluation des AMPDS Identifier un AVC
10
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Ability to identify advice T-CPR and send ambulance
All 999 emergency calls to South Central Ambulance Service (SCAS) over a 12-month
period screened by NHS Pathways v904 were identified A total of 469 400 emergency (999)
calls
Of the 3119 CA identified by ambulance crew 753 were not initially classified (at dispatch) as
CA (241)
It accurately identifies 759 of adult CAs The remainder represents
approximately 7500 treatable CAs in the UK annually where the
diagnosis is missed
Deakin CD1 Heart 2016 Dec 23 pii heartjnl-2016-310651
Evaluation des AMPDS Identifier un Arrecirct Cardio-respiratoire
11
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Evaluation de la reacutegulation meacutedicale
Medical coordination-like decisional process Huber Goldstein JEUR 2000
Pertinence du meacutedecin reacutegulateur Le SAMU reacutepond agrave lrsquoensemble des appels drsquourgence et de PDS
Il deacutecide
bull Un diagnostic supposeacute
bull La reacuteponse
bull Le degreacute drsquourgence
bull Le parcours patient
Lrsquoeacutetude adresse 4 ldquomodegraveles de reacutegulationrdquo
bull Conseil meacutedical (self tt)
bull Consultation Visite meacutedecin geacuteneacuteraliste
bull Ambulance ldquosimplerdquo (BLS)
bull SMUR (ALS)
Le seul modegravele robuste valideacute est lrsquonvoi de SMUR
12
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
13
Etude Prospective en 2004 2005 compare les diagnostics du meacutedecin reacutegulateur lors de lrsquoappel du meacutedecin transporteur et du meacutedecin hospitalier (agrave la sortie) 1292 transports SMUR
Meacutedecin reacutegulateur
Meacutedecin transporteur
Diagnostic hospitalier
Nolwenn Ribes Thegravese 2005 Univ Nantes
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Discussion ldquoAMPDS EMD et meacutedecin reacutegulateurrdquo
bull ldquoEMD-AMPDSrdquo est supeacuterieur agrave ldquoEMD seulrdquo au moins dans ACR
bull Limites des eacutetudes Un seul auteur DATA inhomogegravenes
differents registres diffeacuterents 999
bull Triage effectueacute par des meacutedecins reacutegulateurs est de bonne
qualiteacute avec un sur-triage dans les SCA et un sous triage dans
la traumatologie
bull Le systegraveme baseacute sur un AMPDS pourrait un jour ecirctre ldquoconnecteacuterdquo
alors que le systegraveme francais resterait inconnectable
14
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
15
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU I Dossiers meacutedicaux
bull Lors de lrsquoappel Patients connus (deacutesirables indeacutesirables)
bull Consulter en ligne
bull Recevoir des dossiers de
bull HAD
bull EHPAD
bull Services de santeacute au travail
bull Recevoir et envoyer de vers
bull SMUR et les effecteurs (meacutedecins MMGhellip)
bull Services hospitaliers
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
16
Recevoir des dossiers meacutedicaux simplistes
bull Transmissions par FAX
bull Dossiers simplifieacutes (Services de santeacute au
travail EHPAD)
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
17
Echanger des dossiers meacutedicaux eacutelaboreacutes
bull Reacutegions PACA et Midi-Pyreacuteneacutees
bull Solution eacutelaboreacutee
bull Dossier SMUR deacutemateacuterialiseacute
bull Accegraves partageacute (fins opeacuterationelles statistiques)
bull Partage SAMU SMUR effecteurs (wwworumipfroutilssamusmur)
bull Pas de remonteacutee du dossier SMUR dans le dossier SAMU mais
transmission vers les Services hospitaliers (PACA)
bull Un service drsquoaccueil public ou priveacute voit les patients en route pour son
SU quel que soit le SAMU srsquoil est limitrophe de 2 SAMU (Midi Pyr)
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
18 18
Les expeacuteriences drsquoeacutechanges de donneacutees au SAMU II ECG
bull Lors de lrsquoappel Fax mail
bull Services de santeacute au travail
bull 3 types drsquoECG
bull ECG classique feuille A4 faxeacutee
bull ECG du pauvre
bull ECG du geek connecteacute
bull Envoi du SMUR vers SAMU ou SI Cardiologie
bull Teacuteleacutetransmission ECG via LIFENET Alert
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
19
ECG classique feuille A4 faxeacutee
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif ldquoManipulationrdquo
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
20 20
ECG du pauvre
Connaicirctre les emplacements des eacutelectrodes ECG valideacute reproductif mais moins lisible ldquoManipulationrdquo deacutecoupage collage respecter lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
21
ECG du geek
Faciliteacute de reacutealisation Pas de manipulation ECG reproductif uniquement sur le mecircme patient Respect de lrsquoordre D1 D2 D3 aVR aVL aVF V1 agrave V6 D2 long ECG non valideacute
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
22
ECG transmis SMUR vers SAMU USIC
Systegraveme proprieacutetaire SAMU 53 SAMU 80
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
23
Le patient connecteacute avant lrsquoappel au SAMU
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
Evaluer
La reacutealiteacute des produits
La pertinence
La fiabiliteacute
24
Le recours des patients aux applications de diagnostic ou de tri en urgence
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
25
The iTunes App Store contains approximately 20000 apps in its Medical category
Les applications pour smartphone sont-elles cliniquement pertinentes
Review finds 7699 apps from the 21 search terms (ie ldquoemergency medicinerdquo ldquocritical carerdquo ldquoproceduresrdquo) Two physicians independently classify these applications in 5 categories
Results 649 were considered not relevant 69 of the App Storersquos ldquoMedicalrdquo Category is relevant
Warren Wiechmann West J Emerg Med 2016 Mar 17(2) 191ndash194
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
26
Revue de la litteacuterature sur la qualiteacute des eacutetudes publieacutees sur les Apps
Search in PubMed and MEDLINE EMBASE the Cochrane Central Register of Controlled Trials Web of Science and the NTIS Bibliographic Database published from 2008 to 2015 175 studies Populations targeted by apps included obesity physical handicaps diabetes older age and dementia Only 303 (53175) of the apps studied were identifiable and
available to the public through app stores
Studies were small (median number of participants=31)
Only 36 studies (206 36175) evaluated a clinical outcome
Karandeep Singh JMIR Mhealth Uhealth 2016 Oct-Dec 4(4)
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
45 standardized patient vignettes were compiled and equally divided into 3 categories of triage emergency care required (ALS) non-emergency care reasonable (BLS) self-care reasonable (Medical advice)
Dg Apps Main outcomes were the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations) Triage Apps Main outcomes were whether the App correctly recommended one of the 3 above responses (n=532 standardized patient evaluations)
Hannah L Semigran BMJ 2015351h3480 27
Etude de 23 Apps de Diagnostic or de Tri
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
28
Results Correct Dg first 34 [31 to 37] Mean Appropriate triage advice 57 Appropriate triage advice depending on category
Emergency cases 80 [75 to 86]
Non-emergency cases 55 [47 to 63]
Self-care cases 33 [26 to 40]
p lt 0001
Hannah L Semigran BMJ 2015351h3480
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
29
- Diagnostic initial hautement probable
- 2 diagnostics alternatifs possibles
Reacutesultats
bull Diagnostic initial correct dans 72 des cas (34 pour les Apps)
bull 84 de Dg corrects parmi les 3 Dg possibles (51pour les Apps)
45 ldquovignettesrdquo (cas cliniques) revues par 234 meacutedecins
JAMA Internal Medicine Oct 10 2016
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
30
ldquoConnecterrdquo lrsquoappel de deacutetresse
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
31
ldquoLife savingrdquo Apps
- Localisation des deacutefibrillateurs en PA
- Aide agrave la RCP
Outils drsquoaide IT
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
32
The European Parliament voted in favour of eCall regulation which requires all new cars be equipped with eCall technology from April 2018 In the event of a serious accident eCall automatically dials 112 - Europes single emergency number
Envoi automatiseacute de donneacutees en cas drsquoimpact La localisation du veacutehicule Lrsquoheure exacte de lrsquoincidentaccident Le sens de conduite (sur Autoroutes)
Outils drsquoaide IT eCall
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
eCall to 112
Source EENA
33
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois
34
Conclusion en attendant Watsonhellip
La reacutegulation meacutedicale agrave la francaise
LrsquoIDF est tregraves en retard
ldquoPlus crsquoest grave plus le dg est fiablerdquo pourrait inciter agrave connecter les appels pour deacutetresse Facteur humain
Taille reacutegionale contre village gaulois