As information about the tragic event in Paris today filters out with 12 dead and many more injured .Our thoughts are with those who were killed and injured and also those who responded to the incident.RIP. It is worth looking at the model the French Authorities use in responding to medical emergencies. They use Fire Based EMS in their response to medical emergencies. This article was published in Emergency Service Ireland magazine and gives a great insight into the French SAMU system. Understanding emergency response systems at home and abroad forms a major part of UCD’s MSc in Emergency Management programme. It is only by studying other systems and what parts of them work well and not so well that we can make tweaks, or indeed major changes, to our own. When we compared the French emergency response system with our own system here in Ireland, the results proved extremely interesting and could form the basis for an overhaul of our EMS and pre- hospital service. FRENCH SYSTEM The French system, known as SAMU (Service d’Aide Medicale d’Urgence) is based upon six foundation principles, which are applicable to all emergency systems, both pre-hospital and in-hospital. The principles are important rules by which to practice. (1) Emergency medical assistance is a healthcare activity: everything relating to patient care is encompassed in this (bystanders, police, fire and ambulance services, first responders); (2) Interventions in the field must be speedy, efficient and use suitable, proportionate resources; (3) The approach to each individual case is simultaneously medical, operational and human; (4) The responsibilities and detailed arrangements for coordination between the persons involved must be regulated by a set of working rules; (5) Results depend in large measure upon the skill of those involved; (6) Preventive action must complement emergency action. 10 MILLION CALLS PER YEAR There are 100 call centres throughout The emergency medical services in Ireland use a dispatch system known as Advanced Medical Priority Dispatch System (AMPDS). Emergency Services Ireland    87 France, with each receiving calls from between 200,000 and two million people, depending on the region. There is a regulator doctor, a GP or emergency physician, at each call centre, who triages the calls and sends the appropriate service to the scene. On average, 10 million calls are taken per year. In 30 per cent of cases, advice is given over the phone; 30 per cent have a GP sent to the scene; 30 per cent require an ambulance while 10 per cent need on-scene ICU treatment. Most commonly, the fire brigade, which is run at local level, is dispatched. Most firefighters are trained in advanced first aid, which is equivalent to a cross between our Emergency First Responder and EMT levels. They do not have the different skill grades that we have in Ireland, so it is difficult to make a direct comparison between the two on this score. Instead of having advanced paramedics, they mostly use anaesthetic and emergency nurses and physicians. There is a doctor and or nurse (depending on the size) at each fire station, and they are typically sent to the scene with the first fire brigade responders. There is also a car service, usually requested by GPs after house calls. The drivers are trained in first aid. The HMICU is a mobile intensive care unit. It is run by anaesthetists, cardiologists and emergency physicians. It allows more advanced care on scene and faster stabilisation of the patient. A huge advantage of this is that it enables the patient to be taken to the most appropriate centre for their care, as The French system – SAMU (Service d’Aide Medicale d’Urgence) – has six foundation principles which areapplicable to pre-hospital and in-hospital emergency systems. EMERGENCY RESPONSE Most firefighters are trained in advanced first aid, which is equivalent to a cross between our Emergency First Responder and EMT levels. opposed to being brought to the nearest hospital. While the French system is operated with physician, ambulance and fire service cooperation and seems to work quite well, the Irish system is operated by the fire and ambulance services. Regional doctor on-call services offer back-up assistance if required. THE IRISH ANGLE Ireland’s emergency medical service is controlled by the Health Service Executive (HSE), Dublin Fire Brigade (DFB), and county councils throughout the country. The Health Boards Act 1970 allowed each of the eight health boards to introduce an ambulance into their respective areas. Today, one National Ambulance Service (NAS) is divided into three operational regions: NAS North Leinster, NAS South, and NAS West. The service is provided by 1,401 operational staff, covering an area of 68,317 sq/km with a population of 5.01 million (2011 census). There are currently nine control centres and 86 ambulance stations, not including the 10 DFB stations that provide the emergency ambulance service in the Dublin area. However, the long-term plan is to reduce the number of control centres to two, with one being the central control and command centre for the entire country. Out-of-hours GP services are provided between the hours of 6pm-8am, Monday-Friday, and 24 hours, Saturday and Sunday. DEVELOPMENT OF AMPDS The emergency medical services in Ireland use a dispatch system known as Advanced Medical Priority Dispatch System (AMPDS). AMPDS was first rolled out in Ireland 10 years ago, when it was first introduced to control centres in both Wexford and Tullamore. This system automatically prioritises calls according to the answers given to standard pre-set questions. The system enables Emergency Medical Controllers (EMCs) to prioritise the appropriate response level. For example, advanced paramedics are dispatched to life-threatening calls which are the highest priority code. Codes can be summarised as follows: �� Echo: Cardiac or Respiratory Arrest �� Delta: Chest Pain/Convulsions/ Diabetic problems �� Charlie: Headache/Overdose �� Bravo: Collapse community alert �� Alpha: Sick person no priority symptoms �� Omega: Non-priority complaints, such as sleeplessness, ear ache, sore throat. * Echo and Delta are the highest priority and are considered life threatening. * Charlie and Bravo are level two and are considered serious but not life threatening. * Alpha and Omega are level three and are considered not serious or not life threatening. Six different levels within the pre- hospital setting in Ireland: �� Cardiac First Responder �� Occupational First Responder �� Emergency First Responder (EFR) �� Emergency Medical Technician (EMT) ABOUT THE AUTHORS Dr Susanne O’Reilly is originally from Dublin. She graduated in medicine from UCD in 2011 and worked as an intern in Tallaght Hospital. She is now doing a basic specialist training scheme in medicine under the auspices of Royal College of Physicians in Ireland (RCPI). Susanne is currently working in St Vincent’s University Hospital.. “I am interested in acute medicine, both pre- and in-hospital. I hope to use the MSc in EMS to further my understanding of integration in EMS, and equip me to deal with immediate care issues that arise on a daily basis,” she says. Gavin Lyle is originally from Dublin, He has been in the ambulance service for 12 years. He moved to the north east region in 2004 and is currently based in Navan Ambulance Station. Gavin qualified as an advanced paramedic in 2009. He describes the MSc Immediate Care course as very interesting and personally rewarding. “It challenges your ideas and views of EMS in Ireland. But at the same time it gives an insight into the other professions within the structure of EMS, not just pre-hospital services.” �� Paramedic �� Advanced Paramedic WEIGHING UP THE SYSTEMS It appears that the French system has several advantages. By having a ‘regulator’ doctor at the call centre, a significant number of ambulance call-outs are reduced. Almost one third of people calling SAMU require no more than advice over the phone; if a similar system could be used in Ireland, it would remove a significant amount of the strain on our services. The formal incorporation of GPs into the emergency system is also of great use. Many GPs in Ireland would willingly go to the scene of an emergency if they were informed of it. At present, no formal notification of GPs takes place, no matter how close they are. This would be of particular use in rural areas, where the GP could often make it to the scene in advance of the ambulance service. The HMICU system works very well in France, and indeed other countries globally. However, given Ireland’s small size and relatively small number of major traumas per year, we can learn more from the other aspects of the system to begin with. As a group, we have found that through our conversations both inside and outside the classroom, that integration is key to delivering a first class pre- hospital service. The authors wish to thank Damien Gaumont and Dr Helene Rigot for information on the French EMS. ifesa.ie/images/0204132.pdf
Posted on: Wed, 07 Jan 2015 20:15:01 +0000
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