The french SAMU network and Public Heath Integrated EMS is the begining of a Sanitary Civil Defense

1. M Martinez Almoyna 2004 French Public Health Intergrated EMS 1
A Public Health Civil Defense network
for french hospitals and SAMU:
TOWARDS AN INTEGRATED
NATIONAL EMERGENCY
MEDICAL SYSTEM (IEMS) AND
NETWORK
Miguel MARTINEZ ALMOYNA (MD MCU)

2. M Martinez Almoyna 2004 French Public Health Intergrated EMS 2
French IEMS
(like deffined in Declaration of Jalisco)
MOH civil defense specific
organisation
for disastrous sanitary events
1. Pre hospital network sub-system
2. Hospital network sub-system
3. SAMU control and medical
regulation sub-system

3. M Martinez Almoyna 2004
French Public Health
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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*, Ambulances**)

4. M Martinez Almoyna 2004
French Public Health
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THE NATIONAL EMERGENCY CARE
HOSPITAL
SUB- SYSTEM NETWORK
= Secondary hospital emergency and MICU
(SMUR) resources are monitored by local
(and neighbouring SAMU)
= Tertiary , Specialized emergency and ICU
resources are monitored by neighbouring
and regional SAMU
= Zonal leading Hospitals for NBC disasters

5. M Martinez Almoyna 2004
French Public Health
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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 islands!) and
even in foreign countries

6. M Martinez Almoyna 2004 French Public Health Intergrated EMS 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
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02
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04
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89
2A
2B
95
91
87
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81
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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. M Martinez Almoyna 2004 French Public Health Intergrated EMS 7
THE SAMU SUB-SYSTEM 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

8. M Martinez Almoyna 2004
French Public Health
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The French SAMU emergency tele-medecine
system and network improoves not only
quality of care but also equity of resources
distribution!
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. M Martinez Almoyna 2004
French Public Health
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The Hospital and SAMU
« Plan Blanc » emergency
care IEMS sub-system
Four tiered
1 local Hospital « white plan »
2 « Departement network » SAMU + DDASS « white
plan blanc »
3 Civil Defense Zone regional network
« zonal white plan » ARH+DRASS+Regional SAMU
4 MOH + SAMU de Paris = national and
international disasters (+Foreign Office)

10. M Martinez Almoyna 2004 French Public Health Intergrated EMS 10
Exemples:
• An 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. M Martinez Almoyna 2004 French Public Health Intergrated EMS 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 »

12. M Martinez Almoyna 2004 French Public Health Intergrated EMS 12

13. M Martinez Almoyna 2004
French Public Health
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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. M Martinez Almoyna 2004 French Public Health Intergrated EMS 14
For More Informations on
Public Health Civil Defense
Emergency Tele-medecine and
SAMU regulation
• migmigmig@orange.fr
• SLIDESHARE Miguel Martinez
Almoyna

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

16. M Martinez Almoyna 2004
French Public Health
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WWW.sante.gouv.fr/dossiers/planblanc2004.pdf

17. M Martinez Almoyna 2004 French Public Health Intergrated EMS 17
SAMU network in a real Public
Health Integrated EMS is the
nervous system of both day to
day and disaster medicosanitary
emergencies