1. LECTURE N°2 in SAMU Medical
Regulation for Nigeria
Miguel MARTINEZ ALMOYNA SAMU de Paris
Elisabeth ODUWOLE, LASEMS Lagos (NIGERIA)
François EK, C.H.U. de BREST
These slides have been produced in French,
English, Spanish , Japanese, Portuguese,
Yoruba, and Pidgin english for international
co-operation by the SAMU de Paris
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2. The study of human
communication (Semiology)and
the classification of disease
(Nosology) in the situation of
Medical Control in the SAMU
Centre
Emergency Operational Syndromes
and signs ORS and ORs
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3. ‘Regulation’ Operational
Syndromes and signs - ROS and
Ros
These are operational Syndromes and signs for
improving the process of medical evaluation in
SAMU control centres. They will be labelled ®
They are different from «clinical syndromes»
because what is communicated in an emergency
situation and the needs of «telemedecine» are
not the same as in «clinical medicine»
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4. The First Level of Regulation
Operational Syndromes
ROS 1: The first level of diagnosis.
Based on the initial expression of the
problem by the caller demanding
emergency medical aid .
e.g.. «E don faint O !»
«Sometin de for in troat O !»
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5. Some ROS 1 require the immediate
dispatch of a MICU based on our
formula
E = G * T * C * V
if G +++
and/or need of Advanced Medical Care
and/or there is a need to transfer a patient to
another location so that they can receive a
superior level of care.
or V+++
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6. Typology of the ROS 1 that
would merit dispatch of a MICU
High Social Value :HV
Potential Gravity because of
Etiology- mechanism of injury:
PGE
Potential Gravity because of what
has been communicated
(Semiology):SPG
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7. ROS 1 FOR « HIGH SOCIAL
VALUE » (ROS 1 HV)
e.g.. « The king don fall down from the top
of in palace O ! » - not discussed here
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8. ROS 1 BECAUSE
«POTENTIAL GRAVITY OF
THE ETIOLOGY» (ROS 1 PGE ® )
N don fall under train O!
N don fall from de tod flo window O!
These are not discussed here
We will discuss the ROS relating to caller /
receiver communication
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9. The initial words of a caller to
the Emergency Services are often
simple phrases which transmit an
idea of distress.
e.g. « E don faint O!» ®
ROS 1 SPG Example -
« E don faint O !» ®
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10. The next level of medical
diagnosis. From ROS 1 to ROS 2
Careful questioning of the caller by the EMS
personnel produce vital information and reveal
relevant signs.
Pertinent operational «signs» will be called Ros =
Regulation operational signs
Make you do this and that for in tell me yes or no if….for
example : you look in chest…. E de move ? »
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11. Example of moving on to a
diagnosis: from ROS 1 to ROS
2
« E don faint o ! » ®
is the first level of
diagnosis ROS 1 but it is possible to move
on rapidly -for example if we find that the
patient is known to have an inoperable
aortic aneurysm, is not reacting and has not
breathed for many minutes we can make the
diagnosis of ‘death’ ;
We should not make the diagnosis of cardiac
arrest!!
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12. Regulation Operational Signs = Ros
Ros are additional signs that combine to
establish a higher level of ROS
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13. «N no breat again », « In chest
no move » is an example of a
Ros which is shared by several
syndromes ROS 2
«VENTILATORY ARREST» ®
«CARDIAC ARREST » ®
«DEATH» ®
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14. "He has collapsed" = faint O ! »
« E don "Overdose" = ROS 1
ROS 1 PGS1 PGS
ROS PGE
No reaction = Ros
No breathing = Ros
Perceptible Pulse= Ros
NO YES
Cardiac Arrest Ventilatory Arrest =
= ROS 2 ROS 2
Deceased® V.A. = Ros yes Coma®
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15. IN IT IA L E X P R E S S IO N S
H IG H V A L U E P O T E N T IA L L Y G R A V E
ROS 1 S Y N D R O M E S (R O S 1 S E M IO L O G Y S Y N D R O M E S
HV) (R O S 1 P G S )
P O T E N T IA L L Y
G R A V E E T IO L O G Y
S Y N D R O M E S (R O S 1 R E G U L A T IO N O P E R A T IO N N A L
Ros
PGE) s ig n s (R o s )
ROS 2 L IF E T H R E A T E N IN G E M E R G E N C Y
S Y N D R O M E (R O S 2 S P G )
MICU
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16. The Regulation Operational
Syndrome
« Sometin de forin troat O!»®
O!»
The two other principal Ros 1 PGS « E
don faint O! » ® and «N de struggle O!»
® will be discussed in lecture n° 2
Ros 1 PGE in lecture n°3
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17. The ROS 1 «Sometin de forin
troat O ! » ®
The names of these ‘syndromes’ relate to the
initial expression of the problem by the layman.
They imply that the patient has great difficulty
breathing and that there are dramatic respiratory
efforts. The patient may still be standing but
unable to speak or even that he can make no
sound at all.
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18. Management of ROS 1
« Sometin de forin troat O !» ®
the urgency is to diagnose quickly the most
dangerous of the ROS 2 that is «Total
Obstruction of the Airway»: Help must get
there in less than 10 minutes
the Ros we have to ask about is whether
there are any audible breath sounds - if no
then the diagnosis is total obstruction.
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19. «"he iEchocking"®
s don faint O !
YES noise
NONE
Stridor? Total obstruction of
airway ®
NO + spitting
treatment
YES
NO +abnormal
noise reappears
asthma YES
APO attack
Incomplete Obstruction
NO
of Airway ®
Emboli, etc
Life threatening asthma Last gasps
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