REG200 ENG SAMU french IEMS Network

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French SAMU network is a Public Health national system for Medicosanitary regulation of Emergencies

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  • THE FIRST STEP TOWARDS THE MODERN ORGANIZATION OF SAMU WAS TAKEN BY DOMINIQUE LAREY, THE NAPOLEON SURGEON IN 1972 HE INTERVENED WITH HIS FLYING HORSE RIDDEN AMBULANCE ON THE BATTLEFIELD TO PREVENT LETHAL GANGRENAS BY LIFE SAVING AMPUTATIONS. THE SECOND STEP COULD BE THE DRAINING OF HEMOTHORAX INVENTED BY BATTLEFIELD PHYSICANS THAT SAVED FROM SUFFOCATION THE THIRD HAS BEEN THE ORGANISATION OF A PROFESSONAL AMBULANCE SYSTEM
  • IN THE SIXTIES A HANDFULL OF PHYSICIANS WHERE STUCK BU YHE ASTONISHING DISPROPORTION BETWEEN RESSOURCES OF THE NEW HOSPITAL ICUS AND THE ARCHAIC DEGENERATED AMBULANCE SYSTEM. DURING MINUTS , EVEN HOURS PATIENTS WERE ABANDONED TO A INADMISSIBLE POOR LEVEL OF MEDICAL CARE IN A INCOHERENT MOSAIC OF HOSPITALS THEY LAUNCHED A NATIONAL ORGANISATION OF PHYSICIAN CONTROLLED REGULATION AND HOSPITAL PHYSICIAN STAFFED MOBILE INTENSIVE CARE UNITS
  • SLOWLY SAMU CENTERS AN HMICU BEGAN TO BE IMPLEMENTED AND ONLY TEN YEARS LATER WHERE , BY LAW , COMPULSORY GENERALISED IMPOSED TO ALL FRENCH «DEPARTEMENTS» THAT ARE THE POLITICAL UNIT
  • The principles of French HMICU : 1)Out of Hospital medical intensive care emergencies have to be taken in charge by physicians and their paramedical auxiliaries and by hospiatal and health authorities 2)Interventions on the field must be speedy,efficient and use suitable ressources 3)The case is to be treated at the minimum level of care local hospital. Each individual case has to benefit of the maximun of medical,opérational and human skills
  • REG200 ENG SAMU french IEMS Network

    1. 1. SAMU = OH EMS SERVICES D’AIDE MEDICALE URGENTE SERVICIOS DE ATENCION MEDICA URGENTE OUT HOSPITAL EMERGENCY MEDICAL SERVICES11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 1
    2. 2. SAMU DE FRANCE INTERNATIONAL COOPERATIONMiguel MARTINEZ ALMOYNA (MD) SAMU de ParisHany NEMATALA SAMU d ’Egypte11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 2
    3. 3. WHAT ARE THE TWO MAINFEATURES OF THE FRENCHSAMU EMERGENCYMEDICAL SYSTEM? forming a national emergency medical network 1: 106 SAMU regional centers 2: 300 Hospital based MICU (H-MICU) 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 3
    4. 4. Calais Lille 62 Pas-de-Calais Nord-Pas-de-Calais Arras Nord 59 92 Hauts-de-Seine 93 Seine-St.Denis 94 Val-de-Marne 80 Somme 75 Paris 02 Charleville- Amiens Mézières 76 Aisne Seine-Maritime Picardie Ardennes Le Havre Laon Rouen Beauvais 08 Lorraine 50 Metz Manche Haute-Normandie 60 Oise 55 Châlons- Meuse Moselle Rhin (Bas) Caen 27 Eure Pontoise 95 sur-Marne 67 Val-dOise 57 Saint-Lo Calvados 14 93 Bar-le-Duc Nancy Évreux Yvelines 51 Marne Basse- Normandie 77 Strasbourg 78 92 94 Meurthe-et- 54 61 Orne Versailles Seine-et- Champagne-Ardenne Moselle Alsace Evry Marne Brest St-Brieuc Alencon Chartres 91 Essonne Melun Ile de-10 Aube Épinal 88 Vosges Colmar 29 Finistère 22 Côtes dArmor 35 Ille-et-Vilaine 53 72 Eure-et-Loire 28 France Troyes Chaumont 68 Rhin (Haut) Mayenne 89 Bretagne Sarthe 52 Marne Quimper Rennes Loiret 45 Yonne Laval (Haute) Mulhouse Le Mans Vesoul Belfort 56 Orléans Auxerre 70 Morbihan Saône Vannes Pays-de-la-Loire Blois 21 Côte-dOr (Haute) 44 41 Bèsançon Angers Loir-et-Cher Bourgogne Dijon Loire-Atlantique Tours 25 Doubs Nantes Maine-et- Centre Franche- Indre-et-Loire Niévre 58 49 Loire Bourges 37 Nevers Comté Jura 39 Chateauroux Cher 18 71 Saône-et-Loire Lons-le- La Roche-sur-Yon 79 Indre 36 Saunier Sevres Poitiers Moulins Vendée 85 (Deux) Macon 74 03 Allier Bourg-en- Savoit 86 Vienne Niort Bresse (Haute) La Rochelle Poitou- Gueret 69 Ain 01 Annecy Charente Creuse 23 Auvergne Rhône Charente- 42 Clermont- Maritime Charente Limoges Loire Lyon Chambery 87 Vienne Ferrand 17 16 Rhône-Alpes (Haute) Limousin Puy-de-Dôme Savoie Angoulême 63 St.Etienne 73 Isère 38 19 Corrèze Loire (Haute) Grenoble Périgueux Tulle Cantal 15 43 Valence Le Puy Alpes 05 Aurillac Dordogne 24 (Hautes) Bordeaux Privas 26 Drôme Gap 48 Mende Ardèche Lot 46 07 Gironde 33 Lozère 06 Alpes- Lot-et- 47 Cahors Rodez 84 Aquitaine Garonne 82 Languedoc- 04 Digne Maritimes Vaucluse Agen Midi-Pyrénées Tarn-et- Roussillon Alpes de Haute- Aveyron Landes 40 Garonne 30 Gard Avignon Provence Nice 12 Montauban Albi Nîmes Provence-Alpes- Mont-de-Marsan 32 Gers 81 Tarn Bouches-du- Côte-dAzur Montpellier Rhône 13 Var Auch Toulouse 34 Hérault Marseille 83 Garonne Bayonne Toulon Pau 31 (Haute) Pyrénées- Carcassone Tarbes Atlantique 11 Aude 64 Pyrénées Foix (Hautes) 09 Ariège 65 Perpignan Pyrénées- 66 OrientalesLES DEPARTEMENTS Bastia Haute-Corse 2B Corse Ajaccio 2AFRANçAIS Corse- 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 4 du-Sud
    5. 5. FIRST : THE «BRAINS» OF THE SAMU SYSTEM106 SAMU centers are located in hospitals of the regional capital cities 11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 5
    6. 6. The 4 functions of a SAMUCENTER : An RESPONSE CENTER for treating phone emergency medical demands A DISPATCH CENTER for controling mobile emergency care resourcesA real time DATA PROCESSING CENTER for regional emergency resources A MEDICAL REGULATING (CONTROL) CENTER11/13/12 SAMUPresA M Martinez Almoyna SAMU d 6
    7. 7. 1 A medical response center formanagement of emergency callsfrom: Citizens: through a toll-free medical hot line with a national number (15) First aid vehicles and ambulances neading aid through a special telecommunications network Physicians , Nurses and other care professions through public telephone 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 7
    8. 8. 2 A Dispatch Center for: Basic Ambulances (First Aid and Transport) Hospital Mobile Intensive Care Units Physicians , Nurses 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 8
    9. 9. 3 A regional emergency resourcesdata processing centerreceives , records and diffuses all regionalinformation about the available emergencyresources ; in real time.informs health authorities about theepidemiology of emergencies and problems 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 9
    10. 10. 4 A medical regulation (control)center Medical Regulation consists in evaluating the priorities and deciding the most appropriate responses for medical emergencies The regulator is a physician, in charge of a team of medical regulation operators 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 10
    11. 11. What responses can the SAMUgive to demands after telephoneassessment of the needs?11/13/12 SAMUPresA M Martinez Almoyna SAMU d 11
    12. 12. redirecting non medical or non emergencydemandsproviding medical advice through tele-communications (Tele-medecine)dispatching First Aid, Basic Ambulances orH-MICU according needorienting patients towards the most efficientcare emergency resources 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 12
    13. 13. THE «ARMS» OF SAMU : decentralized hospital based MICU 300 Hospital SMUR services must run one or more MICU physician manned Mobile Intensive Care Units (H-MICU) for intervention on the spot of out- hospital medical emergencies.11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 13
    14. 14. THEORICAL BASIS FOR MEDICAL EMERGENCIES CLASSIFICATION How to evaluate priorities between several emergencies ?11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 14
    15. 15. A multifactorial medical evaluation :Emergency = (E) Seriousness of the case : GRAVITY (G) What are the delays : TIME? (T) What are the needs and possibilities for emergency CARE? (C) (E) = (G)*(T)*(C) ????? 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 15
    16. 16. BUT REAL CLASSIFICATIONOF PRIORITIES IS NOT ONLYBASED ON MEDICALTECHNICAL FACTORS!!!! The Social Valency (V) factor , influences the PRIORITY of an Emergency particularly when resources are limited (E) = (G)*(T)*(C)* (V) 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 16
    17. 17. The (V) subfactors that strain andchallenge fair allocation ofresources age attractivness (gender , psychological gain for appaearence, etc.) those who decide number of people social gain for those involved who decide location of the material gain for those incident who decide fear and anxiety SAMUPresA M Martinez Almoyna SAMU d 11/13/12 17
    18. 18. WE NEED A POWERFULETHICAL BASIS FOR THEPROVISION OF EMERGENCYMEDICAL SERVICESLISBON DECLARATION ON ETHICS OFEMERGENCY MEDICAL SYSTEMS (1989) 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 18
    19. 19. LISBON DECLARATION 1989 FIRST DUTY: IMPROVE PATIENT AUTONOMYSECOND DUTY: IMPROVE QUALITY OF LIFE THIRD DUTY: REDUCE IATROGENYFOURTH DUTY: IMPROVE EQUITY AND JUSTICE 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 19
    20. 20. What changes have there been in the fluxes of demand? phone calls medical records 11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 20
    21. 21. Ile de France = population 10millions = 8 SAMU centers and40 Hospital bases of MICU PARIS (75) HAUTS DE SEINE (92) Val-dOise 95 SEINE ST DENIS (94) 93 Yvelines 78 75 VAL DE MARNE (94) 92 94 SEINE ET MARNE (77) Seine-et-Marne 77 ESSONNE (91) Essonne 91 YVELINES (78) VAL D’OISE (95)11/13/12 SAMUPresA M Martinez Almoyna SAMU d 21
    22. 22. Evolution of phone calls to the 8 SAMU of Ile de France for a population of 100000 inhabitants/year 25000 20000 15000 10000 5000 01980 1983 1986 1989 1992 1995 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 22
    23. 23. Annual fluxes of registered medical records generated for 100000 of population in the 8 SAMU of Ile de France 10000 8000 6000 4000 2000 0 1986 19881980 1982 1984 1990 1992 1994 1996 1998 2000 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 23
    24. 24. What has SAMU’s responsechanged in Paris over the years? télémédecine or ambulances, GP and H-H-MICU (1 and 2) dispatched 11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 24
    25. 25. Evolution of Paris SAMU responses since 1956 100% TELM_AN75 MGEff_AN75 AMBEff_AN75 50% UMH2_AN75 UMH1_AN75 0% 1958 1960 1970 1986 1988 19901956 1962 1964 1966 1968 1972 1974 1976 1978 1980 1982 1984 1992 1994 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 25
    26. 26. SAMU H-MICU at least 3 personnel = Ambulance Technician + Nurse + Emergency Physician Hospital based and hospital staffed Mobile Intensive care equipment range = 25 - 50 Km helicopters or fixed wing aircraft are available11/13/12 SAMUPresA M Martinez Almoyna SAMU d 26
    27. 27. MICU journeys /year /100000 inhabitants in 8 Ile de France SAMU 1600 1400 1200 1000 800 600 400 200 01980 1982 1984 1986 1988 1990 1992 1994 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 27
    28. 28. Fluxes of H-MICU secondary interhospitals tranfers for the 4 SAMU of «Great Paris» (75-92-93-94) 25000 UMH2_AN94 20000 UMH2_AN93 15000 UMH2_AN92 10000 UMH2_AN75 5000 01956 1961 1966 1976 1986 1991 1971 1981 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 28
    29. 29. COSTS? 5 $/person /year?11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 29
    30. 30. The cost of SAMU control centers Between 1 and 2 $/person/year?11/13/12 SAMUPresA M Martinez Almoyna SAMU de France International 30
    31. 31. The available mobile care SAMUresources and their cost 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 31
    32. 32. The first aid ambulances (fire service inFrance) (>400$/hour)The transport ambulances (30$/hour)The mobile private general practicioner(emergency doctor cars) (40 $/hour)The hospital based Mobile Intensive CareUnits H-MICU (400 $/hour )11/13/12 SAMUPresA M Martinez Almoyna SAMU d 32
    33. 33. Non regulated First Aid Ambulances inflation Annual fluxes for 100000 habitantes inLondron , Luxembourg , Tokyo , Paris (SP) , Japon, Belgica , AMBU_HANLondrPortugal , Alemanha AMBProt Civ_HANL 8000 AmbSP_HANTok 7000 VSAB_HANGPar 6000 RTW_HAND 5000 4000 AMBSP_HANJ 3000 AMBU_HANP 2000 AMBUSec_HANB 1000 0 1959 1963 1967 1971 1975 1979 1983 1987 1991 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 33
    34. 34. The French SAMU network has avital rôle in the management ofmajor collective medicalemergencies both , in France,and abroad11/13/12 SAMUPresA M Martinez Almoyna SAMU d 34
    35. 35. The SAMU is involved in developing major incidents plans for events that could generate mass casualties Neighbouring SAMU are contacted for assistance when one is overwhelmed by demands At a national or if necesary at an international level , SAMU de Paris coordinates the whole SAMU system under the authority of Health Ministery.11/13/12 SAMUPresA M Martinez Almoyna SAMU d 35
    36. 36. The SAMU of FranceInternational Cooperation America : Nicaragua, Orient : Turkey, Caraib Islands, Irak, Lebanon, Colombia, Equador, Cambodge, China, Bolivia, Peru, Chile, Japan Viet Nam Brazil, Argentina, Africa: Tunisia, Mexico Egypt, Ivory Coast, Europ: Spain, Nigeria, etc Portugal, Poland, Rumania, Italia,11/13/12 SAMUPresA M Martinez Almoyna SAMU d 36
    37. 37. 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 37
    38. 38. THE SAMU FATHERS : BATTLEFIELD FLYING DOCTORSAMPUTATION PREVENTING GANGRENESUCTION AND DRAINS SALVAGING OF SUFFOCATIONTRANSFUSION AND ANESTHESIA PREVENTING SHOCKTRIAGE , NORIA OF AMBULANCESFIXED WING AN HELICOPTER EVACUATION 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 38
    39. 39. 11/13/12 SAMUPresA M Martinez Almoyna SAMU d 39
    40. 40. Conseil Consultatif Médical Autorité Sanitaire Régionale DEMANDE EXPRIMEE (DAMU) Si non compétence réoriente ou non vers d’autres systèmes de soins ou d’information non urgents, d’aide sociale, de police , etc. epidemiologie-administration- recherche-formation Dispatche et oriente vers la solution la plus MEDECIN REGULATEUR efficiente PARM Systèmes dinformation Tele Diagnostic Triage, Classification avec développement de lAutonomie des patients , Equité et Efficience de la prescription des Ressources de soins urgents Informent sur en fonction des BESOINS (BAMU) leurs Ressources disponibilités Hôpitaux Soins en temps réel Complexes Ressources des flottes dambulances Ressources de Soins Hôpitaux Ressources des flottes d UTIM11/13/12 SAMUPresA M Martinez Almoyna SAMU d 40 Ressources Soins Primaires

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