The emergency medical service system in France

The emergency medical service system in France has a unique design where multiple departments cooperate. The SAMU system, where the physician is in the dispatched ambulance, is renowned worldwide.

The chief of local government is often the head of the emergency medical service system, and most medical centers are owned by the country, local government, or non-profit organizations. Emergency centers in hospitals have three ranks: large-scale hospitals known as SAU (Services d’accueil et de traitement des urgences) are responsible for severe traumatic patients;

POSU (Poles specialises d’accueil et de traitement des urgences) provide services for specific organs or functions; and UPA (Unités d’accueil et de traitement des urgences) are responsible for less-severe emergency patients.

Paris and Marseilles operate separate emergency medical services system different from those of the other regions. In short, the system is composed of the fire department (national), SAMU (National, Service d’aide médicale urgent), private ambulances, private medical teams (SOS, private medical doctors), and private airplane services. There are medics working at the fire departments of Paris and Marseille who are often dispatched together with ambulances for critical patients. Nonetheless, there are known issues of quality, in addition to disputes between the fire department and SAMU due to a sense of rivalry.

Since its initiation in Paris (1956), SAMU, under the regulation of the Ministry of Health, has established 105 offices in major national hospitals across the country and operates 350 SMURs (mobile ICUs: ambulances for critical patients). SAMU operates an information center for 0.2–2 million people, as well as SMUR centers at four to five local hospitals connected to the major hospital. However, because not all SAMU centers operate information centers, there are 98 information centers across the country, and all workers at the information centers are public workers. Most of the medical staff at a SAMU are trained anesthesiologists, accounting for over 50% of the entire medical staff. There are 4–5 licensed specialists and 7–12

residents affiliated with one SAMU. The specialists undergo seven years of medical school training, two years of internship, and five years of anesthesiology residency.

The fire department often cooperates with SAMU, and its key responsibility is to transport patients with mild conditions. Since there are no medical staff working at the fire department, medical doctors at SAMU are responsible for the training and management of the emergency medical service. Private medical staff, who have seven years of medical school education and two years of internship, are dispatched to the patient’s house to provide simple emergency medical treatment or prescriptions. However, if the physician decides that the patient requires hospitalization, a private ambulance or ambulance from the fire department can be requested.

In case of disaster, there are specific programs that can be applied: The ORSEC program for large-scale disaster; the White Program (Plan Blanc) and Red Program (Plan Rouge) for restricted or limited disaster; and special programs for specific cases (e.g., highway traffic accidents or subway accidents). The role of SAMU is to operate triage for the patients, provide appropriate emergency medical care based on the severity of the patient’s condition, and transport patients to a receiving facility using an appropriate method of transport. To do this, SAMU has a mobile headquarter which is equipped with a communication facility with SAMU.

The emergency telephone numbers are 15 for SAMU, 17 for police, and 18 for fire department; 15 and 18 are structurally connected. 15 is known as the “SAMU information center,” “15 Center,” or “Medical Regulation Center.”

Permanent Auxiliary Medical Dispatchers (PAMD) can provide simple information or dispatch SOS doctors or general practitioners if the patient has mild symptom but needs medical attention. If the patient simply requires

transportation, a private ambulance without medical equipment is dispatched.

However, if the patient requires emergency medical service, an SMUR is dispatched and medical oversight is provided by a physician. After the emergency medical treatment, the patient can, depending on condition, be transported to a medical center. Ambulances from the fire department, Red Cross, or a private company can be dispatched for patient transport, and a SAMU physician may go with the patients who are in critical condition. The patients who need serious medical treatment are transported with a resuscitation ambulance from SAMU.

The main advantage of pre-hospital phase emergency medical services in France is that the physician is dispatched to the site, and the patient can start receiving medical treatment as early as possible. Direct assessment allows the physician to determine whether the patient needs an ambulance.

This allows for efficient management of emergency medical service resources—a medical ambulance does not need to be dispatched for patients in mild condition, and a nearby general practitioner or SOS doctors can provide appropriate medical treatment. For severe patients, communication with the receiving facility can be made via SMUR, and follow-up treatments after arriving at the receiving facility can be performed by both the SMUR doctor and the physician at the receiving facility. This allows for less waiting time and continuous treatment for the patient. Moreover, since this system is based on the accumulation of experience over long time, there is no unreasonable, irrational, or inefficient utilization of equipment, facilities, or workforce (McHugh and Dricoll, 1999).