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

1. SAMU = OH EMS
SERVICES D’AIDE MEDICALE
URGENTE
SERVICIOS DE ATENCION
MEDICA URGENTE
OUT HOSPITAL EMERGENCY
MEDICAL SERVICES
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2. SAMU DE FRANCE
INTERNATIONAL
COOPERATION
Miguel MARTINEZ ALMOYNA (MD)
SAMU de Paris
Hany NEMATALA SAMU d ’Egypte
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3. WHAT ARE THE TWO MAIN
FEATURES OF THE FRENCH
SAMU EMERGENCY
MEDICAL SYSTEM?
forming a national emergency medical
network
1: 106 SAMU regional centers
2: 300 Hospital based MICU (H-MICU)
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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-d'Oise 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 d'Armor
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-d'Or
(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-d'Azur
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
Orientales
LES DEPARTEMENTS
Bastia
Haute-Corse
2B
Corse
Ajaccio
2A
FRANçAIS
Corse-
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du-Sud

5. FIRST : THE «BRAINS» OF THE
SAMU SYSTEM
106 SAMU centers are located in hospitals
of the regional capital cities
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6. The 4 functions of a SAMU
CENTER :
An RESPONSE CENTER for treating phone
emergency medical demands
A DISPATCH CENTER for controling mobile
emergency care resources
A real time DATA PROCESSING CENTER for
regional emergency resources
A MEDICAL REGULATING (CONTROL)
CENTER
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7. 1 A medical response center for
management of emergency calls
from:
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
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8. 2 A Dispatch Center for:
Basic Ambulances (First Aid and
Transport)
Hospital Mobile Intensive Care Units
Physicians , Nurses
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9. 3 A regional emergency resources
data processing center
receives , records and diffuses all regional
information about the available emergency
resources ; in real time.
informs health authorities about the
epidemiology of emergencies and problems
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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
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11. What responses can the SAMU
give to demands after telephone
assessment of the needs?
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12. redirecting non medical or non emergency
demands
providing medical advice through tele-
communications (Tele-medecine)
dispatching First Aid, Basic Ambulances or
H-MICU according need
orienting patients towards the most efficient
care emergency resources
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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.
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14. THEORICAL BASIS FOR
MEDICAL EMERGENCIES
CLASSIFICATION
How to evaluate priorities between
several emergencies ?
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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) ?????
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16. BUT REAL CLASSIFICATION
OF PRIORITIES IS NOT ONLY
BASED ON MEDICAL
TECHNICAL FACTORS!!!!
The Social Valency (V) factor , influences
the PRIORITY of an Emergency
particularly when resources are limited
(E) = (G)*(T)*(C)* (V)
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17. The (V) subfactors that strain and
challenge fair allocation of
resources
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
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18. WE NEED A POWERFUL
ETHICAL BASIS FOR THE
PROVISION OF EMERGENCY
MEDICAL SERVICES
LISBON DECLARATION ON ETHICS OF
EMERGENCY MEDICAL SYSTEMS (1989)
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19. LISBON DECLARATION 1989
FIRST DUTY: IMPROVE PATIENT
AUTONOMY
SECOND DUTY: IMPROVE QUALITY OF
LIFE
THIRD DUTY: REDUCE IATROGENY
FOURTH DUTY: IMPROVE EQUITY AND
JUSTICE
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20. What changes have there been in the
fluxes of demand?
phone calls
medical records
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21. Ile de France = population 10
millions = 8 SAMU centers and
40 Hospital bases of MICU
PARIS (75)
HAUTS DE SEINE (92)
Val-d'Oise 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)
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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
0
1980 1983 1986 1989 1992 1995
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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
1988
1980
1982
1984
1990
1992
1994
1996
1998
2000
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24. What has SAMU’s response
changed in Paris over the years?
télémédecine or ambulances, GP and
H-H-MICU (1 and 2) dispatched
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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
1990
1956
1962
1964
1966
1968
1972
1974
1976
1978
1980
1982
1984
1992
1994
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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
available
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27. MICU journeys /year /100000
inhabitants in 8 Ile de France SAMU 1600
1400
1200
1000
800
600
400
200
0
1980 1982 1984 1986 1988 1990 1992 1994
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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
0
1956
1961
1966
1976
1986
1991
1971
1981
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29. COSTS?
5 $/person /year?
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30. The cost of SAMU control
centers
Between 1 and 2 $/person/year?
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31. The available mobile care SAMU
resources and their cost
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32. The first aid ambulances (fire service in
France) (>400$/hour)
The transport ambulances (30$/hour)
The mobile private general practicioner
(emergency doctor cars) (40 $/hour)
The hospital based Mobile Intensive Care
Units H-MICU (400 $/hour )
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33. Non regulated First Aid
Ambulances inflation
Annual fluxes for 100000 habitantes in
Londron , Luxembourg , Tokyo , Paris (SP) , Japon, Belgica , AMBU_HANLondr
Portugal , 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
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34. 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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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.
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36. The SAMU of France
International 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,
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38. THE SAMU FATHERS :
BATTLEFIELD FLYING
DOCTORS
AMPUTATION PREVENTING GANGRENE
SUCTION AND DRAINS SALVAGING OF SUFFOCATION
TRANSFUSION AND ANESTHESIA PREVENTING SHOCK
TRIAGE , NORIA OF AMBULANCES
FIXED WING AN HELICOPTER EVACUATION
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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 d'information
Tele Diagnostic
Triage, Classification avec développement de l'Autonomie 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
d'ambulances
Ressources de
Soins Hôpitaux
Ressources des
flottes d' UTIM
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Ressources Soins
Primaires