Emergency medical services in France
Emergency medical services in France are provided by a mix of organizations under
Organization
SAMU organizations
The term SAMU may refer to either the overall integrated emergency medical service of France, or to a local organisation that coordinates the service. A law in 1986 defined SAMU organizations as hospital-based services providing permanent telephone support, choosing and dispatching the proper response for a phone call request. The service is organized based on the departments of France. Each department has a hospital-based SAMU organisation which is named with the department's unique two-digit number code. For example, SAMU 06 covers Alpes-Maritimes (including Nice) while SAMU 75 covers Paris.[2]
Additionally, two SAMU have specific tasks:
- The Paris SAMU is responsible for providing service to high-speed trains (TGV) and Air France aircraft, while in flight.
- The Toulouse SAMU is responsible for providing service to ships at sea.
In addition to the mainland French departments, SAMU also operates in most of the offshore
Operations
The central component of SAMU is the dispatch centre where a team of physicians and assistants answer calls, triage the patients' complaints and respond to them. Their options include:
- Dispatching an ambulance or response vehicle.
- Directing the patient to present themselves at a place of care, such as a primary care clinic or hospital.
- Offering care advice over the telephone.
This means that the SAMU controls a variety of resources within a community from
Due to the triage (called medical regulation) and use of alternative options, only about 65% of calls to SAMU result in an ambulance being sent.[3] Current response time targets are for the responder to arrive at the scene within 10 minutes for 80% of responses, and within 15 minutes for 95% of responses.[4]
Ambulance provision
While the term ambulance is generally used in France for any type of ambulance, not all are officially called ambulances. For example, fire service ambulances are usually referred to as a VSAV (Rescue and Casualty Assistance Vehicle). The main three providers of ambulances are the SMUR service, fire services and private providers.
SMUR provides the more advanced emergency treatment, though all three providers can transport patients. Fire service ambulances have a crew of three or four, while SMUR and private company ambulances have a crew of two or three. The three types providers have different specialities. Fire service ambulance have training to provide first aid to
Not all ambulances follow the European standard colour scheme for ambulances (CEN 1789), which was published by the European Committee for Standards.[5] Most private company ambulances are white. The fire service ambulance are red but since 2010 they have often had yellow markings added.
Private ambulance services
Private companies are more likely to be sent to non-emergency and low-priority calls. Their vehicles are often not officially designated as an "ambulance"; relying instead on the more general term "light vehicle adapted to patient transport."
Fire department services
Local
Although they also transport casualties and are, in any practical sense, ambulances, their vehicles are instead called a VSAV (véhicule de secours et d'assistance aux victimes – rescue and casualty assistance vehicle).[7] Volunteer-staffed ambulances may be called a VPS (véhicules de premiers secours – first aid vehicle). The VSAV and VPS are considered to be means of bringing rescue workers and equipment onsite, with the evacuation of patients being only the logical result of the response, but not the primary duty of these response resources.
SMUR
SMUR (Service Mobile d'Urgence et Reanimation[8] – Mobile Emergency and Resuscitation Service) units are advanced medical responders which are operated by the SAMU organisation. They are typically labelled as "SAMU", though that term actually refers to either the overall system or the local EMS organization that the SMUR units are part of.
The French philosophy on emergency medical care is to provide a higher level of care at the scene of the incident, and so SMUR units are staffed by a qualified
The result is that a SMUR unit will typically spend a long time on scene compared with a paramedic ambulance in a different system, as the physician may conduct a full set of observations, examinations and interventions before removal to hospital.
Despite being hospital-based, SMUR units may choose to transport a patient to an alternative hospital if the latter is better suited to treating the patient.
Hospital standards for SAMU
French hospitals (whether publicly or privately run) must operate an
The hospital must have two
The specialized service is managed by an
The service is organized in three zones:
- a reception zone,
- a zone for examination and treatment (including intensive treatment).
- a zone for monitoring over short duration (patients waiting to go out or for a transfer to another service).
Most services also have a massive crowd room that are designed to allow care of a large number of patients, outside of the normal levels of presenting patients. These
A local SAMU organisation carries out the day to day monitoring of response vehicles and hospital emergency departments, and coordinates with the SAMU organisations of the neighbouring departments. It also acts as the regional medical emergency response center (MERC).[a] In the case of disaster, they form a network that can plan the first emergency phase planned response, called Plans blanc, and of secondary ground or aerial transport if necessary.
Medical speciality training
The situation is further complicated by the fact that the physicians staffing the SMUR units are among the lowest-paid in Europe. Salaries have recently improved somewhat, in 2020 it was reported that these physicians who are, for the most part, full-time employees of public hospitals, had a salary between €3,113 gross and €16,003 gross per month i.e. an average salary of €9,558 gross per month.[12] This economic situation has resulted in high turnover and some difficulty in staffing positions. However, the recognition of emergency medicine as an in-hospital specialty in France and elsewhere in Europe is likely to result in the evolution of that system towards more comprehensive in-hospital emergency services.
This will ultimately, in turn, result in physicians becoming less likely to respond to emergencies outside the hospital, though they are still expected to play a major role in the immediate future. Since 1986, fire department-based rescue ambulances have had the option of providing resuscitation service (reanimation) using specially-trained nurses.[13] operating on protocols[14]
Public access
France, along with the rest of the continental European Union uses the emergency telephone number available across all members 112, which gives access to police, fire and ambulance services. However, the legacy emergency number of "15" for SAMU and "18" for fire department VSAV are still in use.
Funding and costs
The use of SAMU is free, but abuse is punishable by law.
In France, the 100 or so SAMUs (one for each Département) are all operated by public hospitals. Public hospitals (unlike private hospitals, and France has both) receive government funding. France operates on a system of universal health care.[15] Patients have freedom to choose physicians, hospitals etc., and there are prices set for each type of service.
When operating in the public system, patients are asked to co-pay a portion of the cost for each type of care that they receive. To illustrate, a patient requiring hospitalization is liable for 20 percent of costs for the first month, and nothing thereafter.[16]
What this means in terms of funding is that the SAMUs and their SMUR response teams are funded by the government, by means of the hospital funding scheme. They do charge a fee for service, and for a typical patient, 65% of this cost will be covered by the government health insurance scheme and the balance covered by optional additional private insurance.[17] By French law, in an emergency any French hospital or SAMU must treat any patient, regardless of their ability to pay.
As a measure against system abuse, the SAMU physician may refuse to sign the patient's "treatment certificate", resulting in the patient being liable for the full cost of services provided, although in practice, this is rarely done.[18] Most French citizens also carry private health insurance in order to cover all co-payment charges.
In some circumstances, particularly on low-priority calls, patients being transported to hospital may be asked to pay for service in advance, and then seek reimbursement from the
See also
Notes
References
- ^ "National SAMU website". Retrieved 2008-09-18.
- ^ "SAMU Numbers". Archived from the original on October 24, 2007. Retrieved 2008-09-18.
- ^ PMID 9437354.
- S2CID 31020961.
- ^ "European Committee for Standards website". Retrieved 2008-09-19.,
- ^ "Paris Fire Department". Retrieved 2008-09-18.
- ^ "French Fire-based VPS". Archived from the original on March 14, 2008. Retrieved 2008-09-18.
- ^ "freedictionary 2". Retrieved 2008-09-18.
- ^ Callaway p 137-138 in Hogan Burstein Disaster Medicine Lippincott Ed. 2007
- PMID 16244329.
- S2CID 30840664.
- PMID 12217987.
- ^ "Infermier Sapeur-Pompiers" (PDF). Retrieved 2008-09-19.
- ^ "'Reanimation' Ambulance-Paris". Archived from the original on March 14, 2008. Retrieved 2008-09-19.
- ^ "National Coalition on Health Care website" (PDF). Archived from the original (PDF) on May 16, 2008. Retrieved 2008-09-19.
- ^ "The French Lesson in Health Care". Business Week. July 9, 2007. Archived from the original on July 3, 2007.
- ^ "Parisvoice website". Archived from the original on July 3, 2007. Retrieved 2008-09-19.
- ^ "French Property website". Retrieved 2008-09-19.