The document discusses the French integrated emergency medical system (IEMS) for public health civil defense. It describes the IEMS as having three sub-systems: 1) a pre-hospital emergency network, 2) a hospital emergency network, and 3) SAMU call centers for medical regulation and control. SAMU refers to the French emergency medical dispatch centers. The IEMS coordinates pre-hospital emergency responders like ambulances with hospital emergency departments and ICUs. It aims to improve both the quality and equity of emergency medical care through the national SAMU telemedicine network and civil defense policies. The SAMU network acts as the key component and "nervous system" of France's integrated emergency response system for daily

1. REG900ENG 2004 SAMU IEMS Civil Defense 1
An actual exclusive Public Health Civil
Defense through a SAMU network ?
THE BACKBONE OF AN
EXCLUSIVE MEDICOSANITARY
INTEGRATED EMERGENCY
MEDICAL SYSTEM (IEMS)
Miguel MARTINEZ ALMOYNA (MD MCU)

2. REG900ENG 2004 SAMU IEMS Civil Defense 2
French IEMS
(like deffined in Declaration of Jalisco)
MOH civil defense specific
organisation
for disastrous sanitary crises
1. Pre hospital Emergency network
sub-system
2. Hospital network Emergency sub-
system
3. SAMU call centers for control and
medical regulation sub-system

3. REG900ENG 2004 SAMU IEMS Civil Defense 3
THE NATIONAL EMERGENCY CARE
PRE-HOSPITAL
SUB- SYSTEM NETWORK
= Primary Care network for GP Emergencies
= Emergency Ambulance fleet resources for
emergency transporting patients (MICU*,
Rescue Units*, Basic transport
Ambulances* )

4. REG900ENG 2004 SAMU IEMS Civil Defense 4
THE NATIONAL EMERGENCY CARE
HOSPITALS SUB- SYSTEM NETWORK
= Secondary level of care hospitals ER and MICU
(SMUR) resources are monitored by local SAMU
= Tertiary , Specialized emergency and ICU
resources are monitored by local, neighbouring and
regional SAMU
= Zonal area leading Reference Hospitals for NBC
disasters

5. REG900ENG 2004 SAMU IEMS Civil Defense 5
The French SAMU and SMUR
Network for Emergency Care
• In day to day medical individual
emergencies
• In collective public health mass
emergencies
• In France (continental and remote islands!)

6. REG900ENG 2004 SAMU IEMS Civil Defense 6
Toulon
Angoulême
Périgueux
Bordeaux
Mont-de-Marsan
Agen
Auch
Tarbes
Pau
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
Dijon
Bèsançon
Vesoul
Épinal Colmar
Strasbourg
Nancy
Metz
Bar-le-Duc
ChaumontTroyes
Auxerre
Bourges
Nevers
Chateauroux
Poitiers
Angers
Le Mans
Alencon Chartres
Orléans
Blois
La Roche-sur-Yon
Nantes
Vannes
Quimper
St-Brieuc
Rennes
Laval
Saint-Lo
Caen
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
18
19
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
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
85
86
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.Denis
94 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
Finistère
Côtes d'Armor
Ille-et-Vilaine
Morbihan
Alsace
Lorraine
Aquitaine
Basse- Normandie
Bretagne
Auvergne
Bourgogne
Centre
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
Corse
France
92
Pontoise
Melun
93
77

7. REG900ENG 2004 SAMU IEMS Civil Defense 7
THE SAMU SUB-SYSTEM IMPLANTED IN
EACH « DEPARTEMENT » CAPITAL
TOWN HOSPITALS
AS TWO ROLES IN CASE OF EMERGENCY
The responsible physician (SAMU medical regulator physician)
as the two roles
A technical medical role for deciding and organizing the initial
medical emergency care
An Administrative Authority emergency Delegated Role for
deciding alerting and initiating « plans blancs » and « plan
rouge » Public Health emergency resources involvment in the
emergency phase of the crisis

8. REG900ENG 2004 SAMU IEMS Civil Defense 8
The French SAMU emergency tele-medecine
system and network improoves not only
quality of care but also equity of resources
Through a national medical emergencies
specific and protected exclusive hotline (15)
Plus a health care tele-communication
network beetween emergency regional
integrated medical emergency hospital (ER
OR ICU) and out of hospital resources (MICU
Ambulances)
Plus a MOH national civil defense policy

9. REG900ENG 2004 SAMU IEMS Civil Defense 9
The Hospitals and SAMUs
french public Health
disasters « Plans Blancs »
Four tiered
1 local Hospital « white plan »
2 « Departemental IEMS network » SAMU + DDASS « white
plan»
3 Public Health Regional and Zonal IEMS network
« zonal white plans » ARH+DRASS+Regional Leader SAMU
4 MOH + SAMU de Paris = national and international disasters
(Foreign Office)

10. REG900ENG 2004 SAMU IEMS Civil Defense 10
Exemples:
• A mega explosion in Toulouse
• A mass casualty in a Corsica Island
Stadium or Charles de Gaule Airport
• An Paris subway attentate
• A disaster in Latin America or an Air
France aircraft terrorist attack …

11. REG900ENG 2004 SAMU IEMS Civil Defense 11
A NATIONAL SAMU NETWORK BUT
WITH 3 LEVELS
1. « Départements » SAMU (and
neighbouring
« departements »)
2. « Public Health Civil Defense
Zones » regional SAMU
3. « BMOH + SAMU of Paris »

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A NATIONAL COORDINATED (?)
AN EMERGENCY CARE PUBLIC
HEALTH SYSTEM?
A REAL INTEGRATED EMS
(IEMS)
Ministery of Health +
Military Defense
Civil Defense Fire Men Rescue (plan Rouge)
Private, ONG
Foreign Office

14. REG900ENG 2004 SAMU IEMS Civil Defense 14
For More Informations on
Public Health Civil Defense
Emergency Tele-medecine and
SAMU regulation
• migmigmig@orange.fr
• SLIDESHARE Miguel Martinez
Almoyna

15. REG900ENG 2004 SAMU IEMS Civil Defense 15
French MOH and SAMU
documents on Public
Health Civil Defense
• WWW.sante.gouv.fr
• www.samudeparis.org

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WWW.sante.gouv.fr/dossiers/planblanc2004.pdf

17. REG900ENG 2004 SAMU IEMS Civil Defense 17
The SAMU network is the key of
a actual Public Health
Integrated EMS is the nervous
system of both day to day and
disaster medicosanitary
emergencies