SAMU de France
Dr Goldstein, Director, SAMU de Lille & President of the Societe Francaise de Medecine d'Urgence has kindly provided the following on the French doctor led emergency care system SAMU.
Why have a SAMU? The day-to-day services provided by the French SAMU bring patients the fastest and most efficient medical care, improved moral and physical relief as well as appropriate, subsequent health care orientation. In this way, the SAMU contributes to an optimal use of resources. Finally, a technically advanced medical emergency system is also most useful in implementing epidemiological and preventive research.
French skill in the medical emergency area is based on a long in-the-field experience in France and has been enriched by the partnership with several foreign teams. French physicians are present in some twenty countries, where they assist by surveying available resources, by evaluating structures, competencies and practices, by training staff, and by designing specific systems for optimal use of local resources in order to ensure that all people have an equal access to emergency medical care.
Emergency medical care in France is based on four principles:
Private general practitioners throughout the country ensure emergency care to the public and, whenever necessary, make house calls to patients.
Firemen and ambulance drivers provide emergency transportation for patients.
Health care centres, both public and private, are part of the regional emergency organisation plan.
2 - AN IN-THE-FIELD INVOLVEMENT BY HOSPITAL PHYSICIANS
Since the 1960s, the 350 hospitals equipped to receive emergencies have made use of « Mobile Intensive Care Units ». These mobile units have two main tasks:
To treat the injured on the side where the injuries occurred and during transport to the hospital, by using a « preventive treatment » such as respiratory assistance, the maintenance of haemodynamics or analgesia, an with a « curative treatment » such as thrombolysis when a patient has the onset of myocardial infarction at home.
To establish a diagnosis for on-the-spot treatment, but also to determine the patient’s destination and prepare his hospital admission.
3 - MEDICAL DISPATCHING
4 - HOSPITAL RESPONSIBILITY
In France, hospitals are the cornerstones of emergency medicine. The law gives hospitals responsibility for:
- Managing and making use of the Medical Emergency Receiving and Dispatching Centres as well as coordinating the staff involved in the pre-hospital phase and in hospital reception.
- Managing the mobile intensive care units.
- Admitting patients to emergency care.
In that way, the pre-hospital and hospital services are closely coordinated. The hospital provides the pre-hospital team with an indispensable review mechanism and the best possible on-going training. The medical intervention team optimises and facilitates the use of the hospital’s resources, for witch it is perfectly trained.
An individualised response: The dispatching physician calls appropriate resources into play depending on the seriousness of each case. Three advantages results:
1- The patient most urgently in need of care benefit without delay from the most efficient means available to them.
2- Specialised medical teams intervene only in the most serious cases.
3- The most advanced resources, which are inevitably rare and expensive, are used to their best advantage.
The most suitable orientation: The closest hospital is not always the most suitable one. SAMU allows transporting patients directly to the most appropriate regional treatment centre.
All the available resources of a region are accessible to patients through a vast coordinated emergency care network, which integrates both public and private first aid stations, primary health care units and hospitals.