SAMU
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SAMU (Service d'Aide Médicale d'Urgence, "Emergency Medical Assistance Service") is the French hospital based emergency medical service. It was founded in 1968 by coordinating the existing SMUR teams (prehospital care units).
The name SAMU is also used by several French-speaking countries as well as Spanish-speaking countries such as Argentina; it then stands for Sistemas de Atencion Médica de Urgencias y Emergencias (sometimes SAME).
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SAMU in France
SAMU missions
SAMU missions are defined in a law of 1986. SAMU are defined as hospital services providing permanent phone support, choosing and dispatching the proper response for the call in the swiftest delays. These responses can range from
- Medical advices (28% of the calls)
- Sending ambulances, from the fire department for street accident or disease or absolute emergencies at home (24% of the calls), or from private companies for relative emergency transportation from home (8% of the calls)
- Sending a generalist physician at home (22% of the calls)
- Sending a ressuscitation ambulance (H-MICU: hospital mobile intensive ressuscitation unit, called UMH-Unité Mobile Hospitalière), fast intervention vehicle or medical helicopter for the most serious cases
- Management of crisis with large numbers of casualties (plan rouge, plan blanc), they maintain the mobile sanitary kits (postes sanitaires mobiles, PSM).
The French philosophy for medical emergencies allows the reanimation units to be dispatched only in life-threatening cases.
SAMU are also in charge for the training of emergency physicians.
SAMU organisation
All French Départements hold one SAMU (that is roughly one for 500 000 people), which makes a total of a hundred units, and 350 SMUR in the whole France.
Additionally, two SAMU have special tasks :
- The SAMU de Paris is in charge for emergencies in fast trains (TGV) and flying Air France aircrafts.
- The SAMU de Toulouse is in charge for ships at sea.
The main component of the SAMU is the dispatch, called Centre 15 (15 is the emergency number for medical emergency) or CRRA (centre de réception et de régulation des appels: calls reception and dispatch center). The CRRA received about 10 million calls in 2004, with a regular increase of 10% per year:
- 57% from individuals (witnesses or victims of an accident or disease);
- 27% from the firefighters (NB: in France, firefighters are in charge of emergency ambulances, as certified first responders)
- 5% from the hospitals (usually life threatening emergencies in a department)
- 5% from a general practitioner (usually visiting a patient at home)
- 5% rest (police, ambulance - in France, private ambulance society mainly act as transport for programmed acts, a kind of paramedical taxi).
Prehospital Care Strategy
The French doctrine relies on the hopes of survival for a critically injured patient decreasing exponentially with time, which explains why so many patients die during transportation. To maximise the chances of recovery, it is believed important to cut down on tansportation time, and bring a fully equipied and qualified team to the patient, rather than sending an ambulance to pick up the patient and double the travel back to hospital. To this effect, Mobile Emergency Units (SMUR) are equiped with both a fully qualified emergency physician and medical equipment.
This doctrine also simplifies greatly the Emergency department of hospitals (eliminating the need for a "smaller hospital within the hospital"), and ensure that the stabilised patient will receive care from a specialist rather than an emergency generalist.
In extreme cases, heart operations have been performed on the street (resulting in surviving patients). Overall, the French SAMU is arguably one of the very best in the world, innovating in lots of areas (the French SAMU are the only emergency teams to have tested portable succion cardiopumps on scene) and inspiring equivalent services in other countries.
The French emergency system is very different from emergency systems from the USA and the United Kingdom, for instance : one notable difference is that intervention units (ambulance or SMUR) may decide to stay on the scene for a long time (much more than the typical 10 minutes that ambulances spend on a scene before picking up a patient in most other countries).
This is often described as stay and play, opposed to the scoop and run strategy performed in the United States and in the United Kingdom. This is not totally true as in most cases, the patient is at the hospital within the golden hour, the best description would be play and run.
This feature is often misunderstood among the American public or British public. For instance, when Diana, Princess of Wales died in Paris, some British tabloids took outrage that the patient had stayed on the scene for two hours, leaving the impression that the delay might have caused the death. Actually, the SAMU doctrine allowed the patient to receive extensive care during these two hours, including cardiac ressucitation in the ambulance [1] (http://www.wethepeople.la/chron.htm).
See Emergency medical service: Prehospital Care Strategies for more details .
Miscelaneous information
The emergency number for SAMU is 15, in addition to the 112 (European Emergency_telephone_number), 17 (police) and 18 (Fire department)
SAMU should not be mistaken with SAMU Social, which is a service for rescuing homeless people.
External links
- SERVICES D'AIDE MEDICALE URGENTE - SAMU, SMUR (http://www.samu.org/)
- SAMU de France (http://www.samu-de-france.com/)
- SAMU de Paris (http://www.samudeparis.org/)
- System of Emergency Medical Assistance in France (http://www.samu-de-france.com/default_zone/fr/html/page-271.asp)