![DZ SAMU](https://upload.wikimedia.org/wikipedia/commons/d/d9/DZ_SAMU.jpg)
Emergency medical services in France are provided by a mix of organizations under
public health control. The central organizations that provide these services are known as a SAMU, which stands for (Urgent Medical Aid Service). Local SAMU organisations operate the control rooms that answer emergency calls and dispatch medical responders. They also operate the SMUR ( – Mobile Emergency and Resuscitation Service), which refers to the
ambulance
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
Ambulances are used to respond to medi ...
s and response vehicles that provide advanced medical care. Other ambulances and response vehicles are provided by the
fire services
A fire department (American English) or fire brigade (Commonwealth English), also known as a fire authority, fire district, fire and rescue, or fire service in some areas, is an organization that provides fire prevention and fire suppression se ...
and private ambulance services.
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
In the administrative divisions of France, the department (french: département, ) is one of the three levels of government under the national level ("territorial collectivities"), between the administrative regions and the communes. Ninety-s ...
. 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
Alpes-Maritimes (; oc, Aups Maritims; it, Alpi Marittime, "Maritime Alps") is a department of France located in the country's southeast corner, on the Italian border and Mediterranean coast. Part of the Provence-Alpes-Côte d'Azur region, it ...
(including
Nice
Nice ( , ; Niçard: , classical norm, or , nonstandard, ; it, Nizza ; lij, Nissa; grc, Νίκαια; la, Nicaea) is the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative c ...
) while SAMU 75 covers
Paris
Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...
.
Additionally, two SAMU have specific tasks:
* The
Paris
Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...
SAMU is responsible for providing service to high-speed trains (
TGV
The TGV (french: Train à Grande Vitesse, "high-speed train"; previously french: TurboTrain à Grande Vitesse, label=none) is France's intercity high-speed rail service, operated by SNCF. SNCF worked on a high-speed rail network from 1966 to 19 ...
) and
Air France
Air France (; formally ''Société Air France, S.A.''), stylised as AIRFRANCE, is the flag carrier of France headquartered in Tremblay-en-France. It is a subsidiary of the Air France–KLM Group and a founding member of the SkyTeam global air ...
aircraft, while in flight.
* The
Toulouse
Toulouse ( , ; oc, Tolosa ) is the prefecture of the French department of Haute-Garonne and of the larger region of Occitania. The city is on the banks of the River Garonne, from the Mediterranean Sea, from the Atlantic Ocean and from Par ...
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
North and South American Départements, such as
Guadeloupe
Guadeloupe (; ; gcf, label=Antillean Creole, Gwadloup, ) is an archipelago and overseas department and region of France in the Caribbean. It consists of six inhabited islands—Basse-Terre, Grande-Terre, Marie-Galante, La Désirade, and the ...
(SAMU 971),
Martinique
Martinique ( , ; gcf, label=Martinican Creole, Matinik or ; Kalinago: or ) is an island and an overseas department/region and single territorial collectivity of France. An integral part of the French Republic, Martinique is located in th ...
,
Guyane
French Guiana ( or ; french: link=no, Guyane ; gcr, label=French Guianese Creole, Lagwiyann ) is an overseas department/region and single territorial collectivity of France on the northern Atlantic coast of South America in the Guianas. It ...
or Pacific and Indian French Islands (Tahiti Reunion).
Operations
The central component of SAMU is the dispatch centre where a team of physicians and assistants answer calls,
triage
In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ...
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
general practitioners to
hospital intensive care services.
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.
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.
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
major trauma
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Dependin ...
cases, and their crews may also carry out rescues such as
vehicle extrication
Vehicle extrication is the process of removing a vehicle from around a person who has been involved in a motor vehicle collision, when conventional means of exit are impossible or inadvisable. A delicate approach is needed to minimize injury to th ...
.
Not all ambulances follow the European standard colour scheme for ambulances (
CEN 1789
CEN 1789:2020 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of ...
), which was published by the
European Committee for Standards
European, or Europeans, or Europeneans, may refer to:
In general
* ''European'', an adjective referring to something of, from, or related to Europe
** Ethnic groups in Europe
** Demographics of Europe
** European cuisine, the cuisines of Europe a ...
. 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 basic ambulance on the _in_Saint-Rémy-lès-Chevreuse">Tour_de_France_in_Saint-Rémy-lès-Chevreuse,_France.html" ;"title="Saint-Rémy-lès-Chevreuse.html" ;"title="Tour de France in Saint-Rémy-lès-Chevreuse">Tour de France in Saint-Rémy-lès-Chevreuse, France">Saint-Rémy-lès-Chevreuse.html" ;"title="Tour de France in Saint-Rémy-lès-Chevreuse">Tour de France in Saint-Rémy-lès-Chevreuse, France
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 fire departments also respond to medical calls, and can send an
ambulance
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
Ambulances are used to respond to medi ...
, a multi-purpose response vehicle or even a
fire apparatus
A firefighting apparatus describes any vehicle that has been customized for use during firefighting operations. These vehicles are highly customized depending on their needs and the duty they will be performing. These duties can include firefigh ...
. Here, the cross-trained
firefighter
A firefighter is a first responder and rescuer extensively trained in firefighting, primarily to extinguish hazardous fires that threaten life, property, and the environment as well as to rescue people and in some cases or jurisdictions also ...
s will provide on scene care and transport for injuries or illness, but are usually backed up by a SMUR unit for more serious or complex cases. Firefighters are trained to provide
basic life support
Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians). It can be pr ...
(BLS) level care.
Although they also transport casualties and are, in any practical sense, ambulances, their vehicles are instead called a VSAV ( – rescue and casualty assistance vehicle). Volunteer-staffed ambulances may be called a VPS ( – 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 ( – 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
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
along with a
nurse
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...
and/or
emergency medical technician
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
. This contrasts with systems in other parts of the world, notably English-speaking countries, where care on scene is conducted primarily by
paramedic
A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research.
Not all ambulance personnel are p ...
s or
emergency medical technician
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
s, with physicians only becoming involved on scene at the most complex or large scale incidents.
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
emergency department
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...
() only if it is capable of treating the common trauma and illness conditions that are likely to present. This normally includes a
resuscitation
Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an acutely ill patient. It is an important part of intensive care medicine, anesthesiology, trauma surgery and emergency medicine. W ...
unit,
general
A general officer is an Officer (armed forces), officer of highest military ranks, high rank in the army, armies, and in some nations' air forces, space forces, and marines or naval infantry.
In some usages the term "general officer" refers t ...
and
internal medicine,
cardio-vascular medicine,
pediatrics
Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...
,
anesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
-resuscitation,
orthopedic surgery
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
and
oncology
Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''ó ...
, including
obstetrics
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...
. The exception would be for specialised units, which only admit specific pathologies or specific types of patients (e.g. pediatrics). These units are termed .
The hospital must have two
operating room
Operation or Operations may refer to:
Arts, entertainment and media
* ''Operation'' (game), a battery-operated board game that challenges dexterity
* Operation (music), a term used in musical set theory
* ''Operations'' (magazine), Multi-Man ...
s (and a recovery room) with personnel on duty that allow operation at any time, as well as support services that can perform additional examination or analysis at any time, such as
medical imaging
Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to rev ...
(
radiography
Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeut ...
,
medical ultrasonography
Medical ultrasound includes diagnostic techniques (mainly medical imaging, imaging techniques) using ultrasound, as well as therapeutic ultrasound, therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal ...
,
CAT scanners,
haematology
Hematology ( always spelled haematology in British English) is the branch of medicine concerned with the study of the cause, prognosis, treatment, and prevention of diseases related to blood. It involves treating diseases that affect the produc ...
,
toxicology
Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating expo ...
laboratory etc.).
The specialized service is managed by an
emergency physician
An emergency physician (often called an "ER doctor" in the United States) is a physician who works at an emergency department to care for ill patients. The emergency physician is a specialist in advanced cardiac life support (advanced life suppo ...
. An emergency physician must always be "on-call" and a specialized physician can be called at any time. In addition the team must have two
nurse
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...
s, care assistants (and possibly child care assistants), a social worker and a receptionist, with all of them having received specific education for dealing with emergency cases.
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 units are designed to cope with major incidents or epidemics.
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). In the case of disaster, they form a network that can plan the first emergency phase planned response, called , and of secondary ground or aerial transport if necessary.
Medical speciality training
Emergency medicine
Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...
in hospitals has only recently been recognized as a distinct
medical specialty
A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), ...
in France, and efforts to further recognise
pre-hospital emergency medicine
Pre-hospital emergency medicine (abbreviated PHEM), also referred to as pre-hospital care, immediate care, or emergency medical services medicine (abbreviated EMS medicine), is a medical subspecialty which focuses on caring for seriously ill or ...
as a sub-specialty are at an early stage. Many SMUR/MICU physicians are actually in training for other specialties, such as
anaesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
, who have special interest or are gaining experience in
critical emergency medicine
Critical emergency medicine (CREM) refers to the acute medical care of patients who have medical emergencies that pose an immediate threat to life, irrespective of location. In particular, the term is used to describe the role of anaesthesiologis ...
. The system relies on
general practitioners and physicians from other specialties 'filling the gap' when emergency physicians are not available.
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. 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. operating on
protocols
Protocol may refer to:
Sociology and politics
* Protocol (politics), a formal agreement between nation states
* Protocol (diplomacy), the etiquette of diplomacy and affairs of state
* Etiquette, a code of personal behavior
Science and technology
...
Public access
France, along with the rest of the continental
European Union
The European Union (EU) is a supranational political and economic union of member states that are located primarily in Europe. The union has a total area of and an estimated total population of about 447million. The EU has often been des ...
uses the
emergency telephone number
Most public switched telephone networks have a single emergency telephone number (sometimes known as the universal emergency telephone number or the emergency services number) that allows a caller to contact local emergency services for assista ...
available across all members
112 112 may refer to:
*112 (number), the natural number following 111 and preceding 113
*112 (band), an American R&B quartet from Atlanta, Georgia
**112 (album), ''112'' (album), album from the band of the same name
*112 (emergency telephone number), t ...
, 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
Funding is the act of providing resources to finance a need, program, or project. While this is usually in the form of money, it can also take the form of effort or time from an organization or company. Generally, this word is used when a firm uses ...
. France operates on a system of
universal health care
Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized ar ...
. 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.
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. 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.
Most French citizens also carry private
health insurance
Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
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
government insurance
Government spending or expenditure includes all government consumption, investment, and transfer payments. In national income accounting, the acquisition by governments of goods and services for current use, to directly satisfy the individual ...
scheme or their private insurance. Although not regarded as ambulances in France, fire department ambulances, when used, may provide transportation to hospital, albeit with a considerable charge. All requests for ambulance service are processed by the local SAMU, which will determine what type of assistance and transportation resources are sent; the patient has no choice in the matter when it is an Intensive Urgent Care Need.
See also
*
Health in France
*
SOS Médecins
Notes
References
External links
SAMU de France
{{DEFAULTSORT:Emergency Medical Services In France
fr:SMUR