Emergency medical services in Italy

SAMU is the French acronym for Service d' Aide Médicale Urgente, in German: emergency medical assistance service. The name is also used in other French-and Spanish-speaking countries, such as Belgium, Argentina and Luxembourg.

SAMU in France

History

In 1956, the physician Maurice Cara at the hospital " Necker " in Paris the first intensive care transport service. At that time there were only two ICUs in France, one in Paris and one in Lyon. Due to a polio epidemic, it was necessary, in his view, to allow the transport ventilated patients. These patients then were not considered fit for transport, as they go in normal ambulances often died. The new car developed by him, which was equipped with medical personnel and material, was unique in the country.

In the following years, several mobile medical units were established. The so-called UMH ( Unité Mobile Hospitalière, " mobile hospital unit " ) were provided for both critical care transport of patients between large regional hospitals, as well as for life-threatening emergencies outside hospitals. These first mobile units were thus the ancestors of today SMUR services (Service Mobile d' Urgence et de Réanimation, " mobile emergency and resuscitation service " ) and have been developed by the physician Louis Serre in Montpellier, in 1965 they were officially approved. These services, first organized purely by the hospitals, have been developed so that an overall coordination was needed. The doctor Louis Lareng founded it in 1968 in Toulouse the first SAMU. Four doctors were the first coordination team: François Ollé, Jean -Pierre Arise, Clergue and Bauvin.

The SAMU developed, and began the first air transport to carry out. The French army lent an Alouette III helicopter to fly patients to Bordeaux, Châteauroux and Spain. This Toulouse organization from Pr Lareng was the only one in France, and was legally recognized on 19 July 1972. It was established here that the service was to be guided by a specialist in anesthesiology. Christian Virenque took over this function as the first director of the SAMU. In 1979, the population could reach the SAMU directly, because each hospital had its own " emergency number ".

Louis Lareng was now a deputy of the National Assembly has become, and brought a new law in the National Assembly. Law No. 86-11 was adopted January 6, 1986, and thus the principle of SAMU for the whole of France was introduced. A single emergency number was then chosen ( technical and practical requirements ): the 15

Former VLM at the Hospital of St. Etienne.

Former VLM SAMU 43 of

Organization

Each department has a French SAMU, the overseas départements. The number after the abbreviation SAMU is for the department, for example, SAMU 56 for the Morbihan department or SAMU 974 for the Reunion. Due to organizational issues is divided into many departments of the SAMU, such as the department of Seine -Maritime with Samus 76A and 76B. In total, there are 105 Samus for the 101 départements.

Two Samus also have special responsibilities:

  • The Paris SAMU takes the calls from the TGV trains and airplanes of the Air France
  • The SAMU of Toulouse is also responsible for medical emergencies at sea

Each SAMU provides a CRRA ( Centre de Reception et de Regulation of Appels, "central to the adoption and management of the Calls" ) at your disposal, so a control center. This CRRA are named after the emergency number and Centres 15.

Depending on the population density and the need for life-saving appliances make the SAMU, along with hospitals, SMUR (Service Mobile d' Urgence et de Réanimation ) called mobile application units. There are about 305 SMUR in France, covering the emergency medical assistance for the whole country.

The SMUR even have different emergency vehicles:

  • UMH ( Unité Mobile Hospitalière ) or sometimes AR (Ambulance de Réanimation ) called, they conform to the European standards of MICU ( Mobile Intensive Care Unit).
  • VLM ( Vehicle of Léger Médicalisé ), some easily specified otherwise, conform to the German ambulance emergency vehicle.
  • Helicopter
  • Radio link vehicles, command vehicles, trolleys for material handling of disastrous events and other vehicles.

A SMUR team is staffed by default as follows:

  • A Ambulancier (driver and paramedics ), with an additional qualification for the particular work within the SMUR teams.
  • A nurse with experience in the emergency room or intensive care unit. Some hospitals require a nurse with specialized training in intensive care medicine and anesthesia for SMUR inserts. They are IDE or IADE abbreviated ( Infirmier ( anesthésiste ) Diplôme d' Etat).
  • A physician with additional university diploma in emergency medicine, with an additional qualification as an anesthetist (MAR Doctor anesthésiste Réanimateur ), and with experience in emergency and critical care.

Despite national laws and norms occupy some hospitals due to lack of staff or budget deficit their SMUR slightly different.

Special

At the French emergency services different services participate.

In land-based emergency service you will find:

  • Own SMUR - ambulance UMH or AR, and small emergency vehicles VLM or VRM
  • The fire department, staffed by trained 3 to 5 firefighters with their ambulance VSAV ( Vehicle of de Secours et d'Assistance aux Victimes ).

A private medical rescue service, the SSSM (Service de Santé et de Secours Médical, " health service and medical assistance " ), was made ​​available due to a partial lack of use means the SAMU, and relieved or replaced the local SMUR unit, for example, in rural areas. Small emergency vehicles are usually called VRM ( Vehicle of radio Médicalisé ) when a fire doctor occupied the vehicle, or VLI / VRI ( Vehicle of de Liaison / Radio Infirmier ) when only a trained nurse is on board.

  • Ambulance from private firms ASSU (Ambulance de Secours et de Soins d' Urgence ) with two trained staff.
  • Ambulance of aid organizations (among Red Cross, White Cross, Protection Civile ) as part of major events or regularly on weekends as part of the Paris rule rescue service. The so-called VPSP ( Vehicle of de Premiers Secours à Personnes ), as ambulance of the fire brigade, equipped with at least three trained assistants.

The Lifeboat is taken on the high seas by the French Navy and carried out in the coastal area by the charity SNSM, in cooperation with the Maritime SAMU medical emergencies.

In the air ambulance can be found:

  • Own SAMU helicopter; they are operated by private companies and the pilot is an employee of the company. The medical staff (doctors, nurses) is provided by the hospital or by SMUR.
  • Helicopter of civil protection ( radio call "Dragon" with the department number); The crew consists of a pilot and a flight engineer of civil defense. The helicopters have different missions, from police surveillance to the sea and altitude rescue. A basic medical equipment is attached if necessary.
  • Police helicopter, they belong to the police and have similar missions such as the civil defense machinery. However, they are not primarily intended for the transport of patients and only in certain environments equipped for them (eg in the Alps).
  • SAR service by the Air Force and Navy air squadron ( for rescue ). The medical staff comes from the army. In certain cases, these helicopters can but also accept orders for the SAMU and take hospital staff for the patient on board, such as in the overseas départements.
  • Private firms in the mountains as the "SAF " ( Secours Aériens Français)

Concept and tasks

The French specificity of prehospital care of casualties is due to the presence of a medical monitoring of deployment, from the reception of emergency calls, until the transfer of the patient, the target hospital. " The hospital is the patient " is the basic concept of the SAMU.

The inserts are performed according to the " regulatory principle " Régulation médicale. The input of an emergency call in the SAMU - Centre follows a specific sequence:

Take the call specially trained employees of the SAMU. A so-called PARM ( Personnel Assistant de Regulation Médicale ) directs the caller picks up the important data such as phone number and address and defines the situation by means of precise and targeted questions. All this information is recorded in an electronic data system. The PARM already thereby decides whether it is a life-threatening emergency situation and sends for internal control may go even appropriate rescue equipment.

The call including electronically captured data is forwarded to the Doctor régulateur when needed. This is an emergency physician at the SAMU, which is responsible for the emergency call center. After a brief analysis and possible consultation with the caller, the doctor decides on the further course of the insert. If it is a medical emergency (acute heart problems, difficulty breathing, loss of consciousness, road traffic accident with injuries ... ), adequate resources should be sent, and agreed other support services such as firefighters or police.

In 28 percent of cases, however, it comes to general medical problems. The caller is thus advised by the physician of the emergency call center and it is agreed a GP in 22 percent of cases. Partial sit doctors of general medicine ( " GPs ") in the emergency call center. Then you take the call to find a solution together with the caller.

The PARM schedules the skillful use of resources and maintains contact with them via radio and / or telephone. His task here is to compare with that of a German control center dispatcher of the emergency services.

The rescue personnel employed must provide feedback to the SAMU after arrival and assessing the patient's condition. Be it from the fire department, use units of SAMU, private ambulances and emergency transport services, or paramedic by aid agencies, this rule is a principle of emergency response training in France, and accounting calls (such as " Summary "). This gives the physician the SAMU emergency call center additional information and may thus make an image of the patient and his complaints. When necessary advanced medical measures SMUR team for further treatment of the patient is sent. It also clarifies the hospital in which the patient is being driven to the best therapy and space.

On site, the physician of the SMUR team takes over the operational command, and initiates advanced medical procedures, along with the nurse. The medical staff of the team accompanied the patient during transport in the first inge implemented recovery means ( ambulance ) or in the own means of transport of the SMUR ( UMH or helicopter ). Thus, close medical monitoring of the patient is allowed up to the hospital.

Mechanical ventilation Ambulance emergency response vehicle
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