REG200 ENG SAMU french IEMS Network

04/13/23 SAMUPresA M Martinez Almoyna SAMU de France International

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SAMU = OH EMS

SERVICES D’AIDE MEDICALE SERVICES D’AIDE MEDICALE URGENTEURGENTE

SERVICIOS DE ATENCION SERVICIOS DE ATENCION MEDICA URGENTEMEDICA URGENTE

OUT HOSPITAL EMERGENCY OUT HOSPITAL EMERGENCY MEDICAL SERVICESMEDICAL SERVICES


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SAMU DE FRANCEINTERNATIONAL

COOPERATION

Miguel MARTINEZ ALMOYNA (MD)Miguel MARTINEZ ALMOYNA (MD)

SAMU de ParisSAMU de Paris

Hany NEMATALA SAMU d ’EgypteHany NEMATALA SAMU d ’Egypte


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WHAT ARE THE TWO MAIN FEATURES OF THE FRENCH SAMU EMERGENCY MEDICAL SYSTEM?

forming a national emergency medical forming a national emergency medical network network

1: 106 SAMU regional centers1: 106 SAMU regional centers 2: 300 Hospital based MICU (H-MICU)2: 300 Hospital based MICU (H-MICU)


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Toulon

Angoulême

Périgueux

Bordeaux

Mont-de-Marsan

Agen

Auch

TarbesPau

Foix

Toulouse

Montauban

Cahors

Aurillac

Niort

La Rochelle

Rodez

Albi

Carcassone

Montpellier

Mende

Privas

Le Puy

Lyon

Bourg-en-Bresse

Annecy

Chambery

Grenoble

Valence

Gap

Avignon

Marseille

Perpignan

Digne

Lons-le-Saunier

MaconMoulins

DijonBèsançon

Vesoul

Épinal Colmar

StrasbourgNancy

Metz

Bar-le-Duc

ChaumontTroyes

Auxerre

BourgesNevers

Chateauroux

Poitiers

Angers

Le Mans

Alencon Chartres

Orléans

Blois

La Roche-sur-Yon

Nantes

Vannes

Quimper

St-Brieuc

RennesLaval

Saint-LoCaen

Évreux

Rouen

Amiens

Arras

Lille

Laon

Charleville-Mézières

Châlons-sur-Marne

Versailles

Beauvais

Gueret

Limoges

Tulle

Bastia

Ajaccio

Nice

St.Etienne

Clermont-Ferrand

Tours

Evry

Mulhouse

Nîmes

Bayonne

Brest

Le Havre

Calais

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

1617

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19

21

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59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

76

78

79

80

89

2A

2B

95

91

87

88

81

82

8586

84

83

Aveyron

Lot

Ariège

Gers

Garonne

(Haute)

Pyrénées

(Hautes)

Tarn

Tarn-et-

Garonne

Pas-de-Calais

Nord

Vendée

Sarthe

Maine-et-

Loire

Loire-Atlantique

Mayenne

Aisne

Oise

Somme

Charente

Charente-

Maritime

Vienne

Sevres

(Deux)

Alpes

(Hautes)

Alpes de Haute-

Provence

Alpes-

Maritimes

Bouches-du-

Rhône Var

Vaucluse

Ain

Savoit

(Haute)

Savoie

Isère

Loire

Rhône

Ardèche

Drôme

Corse-

du-Sud

Haute-Corse

Rhin (Haut)

Rhin (Bas)

Gironde

Dordogne

Lot-et-

Garonne

Landes

Pyrénées-

Atlantique

Puy-de-Dôme

Loire (Haute)Cantal

Allier

Manche

Orne

Calvados

Côte-d'Or

Niévre

Saône-et-Loire

Yonne

Eure-et-Loire

Cher

Loir-et-Cher

Indre

Indre-et-Loire

Loiret

Marne

Marne

(Haute)

Aube

Ardennes

Saône

(Haute)

Doubs

Jura

Belfort

Eure

Seine-Maritime

Val-d'Oise

Yvelines

Seine-et-

Marne

Essonne

94

93 Seine-St.Denis94 Val-de-Marne

92 Hauts-de-Seine

75 Paris

Lozère

Gard

Aude

Pyrénées-

Orientales

Hérault

Creuse

Corrèze

Vienne

(Haute)

Meuse

Meurthe-et-

Moselle

Moselle

Vosges

FinistèreCôtes d'Armor

Ille-et-Vilaine

Morbihan

Alsace

Lorraine

Aquitaine

Basse- Normandie

Bretagne

Auvergne

BourgogneCentre

Champagne-Ardenne

Franche-Comté

Haute-Normandie

Ile de-

Languedoc-Roussillon

Limousin

Midi-Pyrénées

Pays-de-la-Loire

Nord-Pas-de-Calais

Picardie

Provence-Alpes-Côte-d'Azur

Poitou-Charente

Rhône-Alpes

CorseLES DEPARTEMENTS FRANçAIS

France

92

Pontoise

Melun

9377


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FIRST : THE «BRAINS» OF THE SAMU SYSTEM

106 SAMU centers are located in hospitals 106 SAMU centers are located in hospitals of the regional capital cities of the regional capital cities


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The 4 functions of a SAMU CENTER : An An RESPONSE CENTERRESPONSE CENTER for treating phone for treating phone

emergency medical demandsemergency medical demands A A DISPATCHDISPATCH CENTERCENTER for controling mobile for controling mobile

emergency care resourcesemergency care resources A real time A real time DATA PROCESSING CENTERDATA PROCESSING CENTER for for

regional emergency resources regional emergency resources A A MEDICAL REGULATINGMEDICAL REGULATING (CONTROL) (CONTROL)

CENTERCENTER


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1 A medical response center for management of emergency calls from: Citizens: through a toll-free medical hot Citizens: through a toll-free medical hot

line with a national number (15) line with a national number (15) First aid vehicles and ambulances neading First aid vehicles and ambulances neading

aid through a special telecommunications aid through a special telecommunications networknetwork

Physicians , Nurses and other care Physicians , Nurses and other care professions through public telephoneprofessions through public telephone


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2 A Dispatch Center for:

Basic Ambulances (First Aid and Basic Ambulances (First Aid and Transport)Transport)

Hospital Mobile Intensive Care Units Hospital Mobile Intensive Care Units Physicians , Nurses Physicians , Nurses


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3 A regional emergency resources data processing center

receives , records and diffuses all regional receives , records and diffuses all regional information about the available emergency information about the available emergency resources ; in real time. resources ; in real time.

informs health authorities about the informs health authorities about the epidemiology of emergencies and problemsepidemiology of emergencies and problems


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4 A medical regulation (control) center

Medical RegulationMedical Regulation consists in evaluating consists in evaluating the priorities and deciding the most the priorities and deciding the most appropriate responses for medical appropriate responses for medical emergenciesemergencies

The The regulatorregulator is a is a physician, physician, in charge of a in charge of a team of medical regulation operators team of medical regulation operators


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What responses can the SAMU give to demands after telephone assessment of the needs?


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redirecting non medical or non emergency redirecting non medical or non emergency demandsdemands

providing medical advice through tele-providing medical advice through tele-communications (communications (Tele-medecine)Tele-medecine)

dispatching First Aid, Basic Ambulances or dispatching First Aid, Basic Ambulances or H-H-MICU MICU according according needneed

orienting patients towards the most orienting patients towards the most efficientefficient care emergency resourcescare emergency resources


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THE «ARMS» OF SAMU : decentralized hospital based MICU decentralized hospital based MICU

300 Hospital SMUR services 300 Hospital SMUR services

must run one or more MICU must run one or more MICU physician manned Mobile Intensive physician manned Mobile Intensive

Care Units (H-MICU) for Care Units (H-MICU) for intervention on the spot of out-intervention on the spot of out-hospital medical emergencies.hospital medical emergencies.


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THEORICAL BASIS FOR MEDICAL EMERGENCIES

CLASSIFICATION

How to evaluate priorities between How to evaluate priorities between several emergencies ?several emergencies ?


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A multifactorial medical evaluation :Emergency = (E)

Seriousness of the case : GRAVITY (G) Seriousness of the case : GRAVITY (G) What are the delays : TIME? (T) What are the delays : TIME? (T) What are the needs and possibilities for What are the needs and possibilities for

emergency CARE? (C) emergency CARE? (C) (E) = (E) = (G)*(T)*(C)(G)*(T)*(C) ????? ?????


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BUT REAL CLASSIFICATION OF PRIORITIES IS NOT ONLY BASED ON MEDICAL TECHNICAL FACTORS!!!!

The Social Valency (V) factor , influences The Social Valency (V) factor , influences the PRIORITY of an Emergency the PRIORITY of an Emergency particularly when resources are limitedparticularly when resources are limited

(E) = (G)*(T)*(C)* (E) = (G)*(T)*(C)* (V)(V)


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The (V) subfactors that strain and challenge fair allocation of resources

ageage attractivness (gender , attractivness (gender ,

appaearence, etc.)appaearence, etc.) number of people number of people

involvedinvolved location of the incidentlocation of the incident fear and anxietyfear and anxiety

psychological gain for psychological gain for those who decidethose who decide

social gain for those social gain for those who decidewho decide

material gain for those material gain for those who decidewho decide


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WE NEED A POWERFUL ETHICAL BASIS FOR THE PROVISION OF EMERGENCY MEDICAL SERVICES

LISBON DECLARATION ON ETHICS OF LISBON DECLARATION ON ETHICS OF EMERGENCY MEDICAL SYSTEMS (1989)EMERGENCY MEDICAL SYSTEMS (1989)


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LISBON DECLARATION 1989

FIRST DUTY: IMPROVE PATIENT FIRST DUTY: IMPROVE PATIENT AUTONOMY AUTONOMY

SECOND DUTY: IMPROVE SECOND DUTY: IMPROVE QUALITY OF QUALITY OF LIFELIFE

THIRD DUTY: THIRD DUTY: REDUCE IATROGENYREDUCE IATROGENY FOURTH DUTY: IMPROVE FOURTH DUTY: IMPROVE EQUITYEQUITY AND AND

JUSTICEJUSTICE


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What changes have there been in the fluxes of demand?

phone calls phone calls medical recordsmedical records


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Ile de France = population 10 millions = 8 SAMU centers and 40 Hospital bases of MICU

Seine-et-Marne 77

Val-d'Oise 95

Yvelines 78

Essonne 91

9492

9375

PARIS (75)PARIS (75) HAUTS DE SEINE (92)HAUTS DE SEINE (92) SEINE ST DENIS (94)SEINE ST DENIS (94) VAL DE MARNE (94)VAL DE MARNE (94) SEINE ET MARNE (77)SEINE ET MARNE (77) ESSONNE (91)ESSONNE (91) YVELINES (78)YVELINES (78) VAL D’OISE (95)VAL D’OISE (95)


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Evolution of phone calls to the 8 SAMU of Ile de France for a population of 100000

inhabitants/year

0500010000

150002000025000

1980 1983 1986 1989 1992 1995


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Annual fluxes of registered medical records generated for 100000 of population in the 8

SAMU of Ile de France

0

2000

4000

6000

8000

10000

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000


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What has SAMU’s response changed in Paris over the years?

télémédecine or ambulances, GP and télémédecine or ambulances, GP and H-H-MICU (1 and 2) dispatchedH-H-MICU (1 and 2) dispatched


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Evolution of Paris SAMU responses since 1956

0%

50%

100%

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

TELM_AN75

MGEff_AN75

AMBEff_AN75

UMH2_AN75

UMH1_AN75


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SAMU H-MICU

at least 3 personnel = Ambulance at least 3 personnel = Ambulance Technician + Nurse + Emergency Physician Technician + Nurse + Emergency Physician Hospital based and hospital staffedHospital based and hospital staffed

Mobile Intensive care equipmentMobile Intensive care equipment range = 25 - 50 Km range = 25 - 50 Km helicopters or fixed wing aircraft are helicopters or fixed wing aircraft are

availableavailable


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MICU journeys /year /100000 inhabitants in 8 Ile de France SAMU

0

200

400

600

800

1000

1200

1400

1600

1980 1982 1984 1986 1988 1990 1992 1994


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Fluxes of H-MICU secondary interhospitals tranfers for the 4 SAMU of «Great Paris»

(75-92-93-94)

0

5000

10000

15000

20000

25000UMH2_AN94

UMH2_AN93

UMH2_AN92

UMH2_AN75

195

6

196

1

196

6

197

1

197

6

198

1

198

6

199

1


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COSTS?

5 $/person /year?5 $/person /year?


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The cost of SAMU control centers

Between 1 and 2 $/person/year?Between 1 and 2 $/person/year?


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The available mobile care SAMU resources and their cost


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The first aid ambulances (fire service in The first aid ambulances (fire service in France) (>400$/hour)France) (>400$/hour)

The transport ambulances (30$/hour)The transport ambulances (30$/hour) The mobile private general practicioner The mobile private general practicioner

(emergency doctor cars) (40 $/hour)(emergency doctor cars) (40 $/hour) The hospital based Mobile Intensive Care The hospital based Mobile Intensive Care

Units H-MICU (400 $/hour )Units H-MICU (400 $/hour )


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Non regulated First Aid Ambulances inflation

Annual fluxes for 100000 habitantes inLondron , Luxembourg , Tokyo , Paris (SP) , Japon, Belgica , Portugal , Alemanha

010002000300040005000600070008000

1959

1963

1967

1971

1975

1979

1983

1987

1991

AMBU_HANLondr

AMBProt Civ_HANL

AmbSP_HANTok

VSAB_HANGPar

RTW_HAND

AMBSP_HANJ

AMBU_HANP

AMBUSec_HANB


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The French SAMU network has a vital rôle in the management of major collective medical emergencies both , in France, and abroad


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The SAMU is involved in developing major The SAMU is involved in developing major incidents plans for events that could incidents plans for events that could generate mass casualties generate mass casualties

Neighbouring SAMU are contacted for Neighbouring SAMU are contacted for assistance when one is overwhelmed by assistance when one is overwhelmed by demandsdemands

At a national or if necesary at an At a national or if necesary at an international level , SAMU de Paris international level , SAMU de Paris coordinates the whole SAMU system under coordinates the whole SAMU system under the authority of Health Ministery.the authority of Health Ministery.


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The SAMU of France International Cooperation

America : Nicaragua, America : Nicaragua, Caraib Islands, Caraib Islands, Colombia, Equador, Colombia, Equador, Bolivia, Peru, Chile, Bolivia, Peru, Chile, Brazil, Argentina, Brazil, Argentina, MexicoMexico

Europ: Spain, Portugal, Europ: Spain, Portugal, Poland, Rumania, Poland, Rumania, Italia, Italia,

Orient : Turkey, Orient : Turkey, Irak, Lebanon, Irak, Lebanon, Cambodge, China, Cambodge, China, Japan Viet NamJapan Viet Nam

Africa: Tunisia, Africa: Tunisia, Egypt, Ivory Coast, Egypt, Ivory Coast, Nigeria, etcNigeria, etc


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THE SAMU FATHERS :BATTLEFIELD FLYING DOCTORS

AMPUTATION PREVENTING GANGRENE AMPUTATION PREVENTING GANGRENE SUCTION AND DRAINS SALVAGING OF SUFFOCATIONSUCTION AND DRAINS SALVAGING OF SUFFOCATIONTRANSFUSION AND ANESTHESIA PREVENTING SHOCKTRANSFUSION AND ANESTHESIA PREVENTING SHOCKTRIAGE , NORIA OF AMBULANCESTRIAGE , NORIA OF AMBULANCESFIXED WING AN HELICOPTER EVACUATIONFIXED WING AN HELICOPTER EVACUATION


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DEMANDE EXPRIMEE (DAMU)

RessourcesHôpitaux Soins

Complexes

Ressources SoinsPrimaires

Tele DiagnosticTriage, Classification avec développement de l'Autonomie des patients

, Equité et Efficience de la prescription des Ressources de soins urgentsen fonction des BESOINS (BAMU)

epidemiologie-administration-recherche-formation

Systèmes d'information

MEDECIN REGULATEUR

PARM

Conseil Consultatif Médical Autorité Sanitaire Régionale

Ressources deSoins Hôpitaux

Ressources desflottes

d'ambulances

Ressources desflottes d' UTIM

Si non compétence réoriente ounon vers d’autres systèmes de soins ou d’information nonurgents,d’aide sociale, de police , etc.

Informent surleursdisponibilitésen temps réel

Dispatche etoriente vers lasolution la plusefficiente

REG200 ENG SAMU french IEMS Network

Health & Medicine

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