International EMS Systems: France

doi:10.1016/j.resuscitation.2004.04.001

Resuscitation

Volume 63, Issue 1, October 2004, Pages 7-9

https://doi.org/10.1016/j.resuscitation.2004.04.001 Get rights and content

Abstract

The EMS (Emergency Medical Service) system in France is a centrally based, two-tiered, physician-manned system. The first level is composed of BLS (Basic Life Support) fire department ambulances (called “VSAB”) based at fire stations. The second level is composed of ALS (Advanced Life Support) physician staffed-ambulances. In France, there are two different levels of emergency department (ED). The first level is called “SAU” and has continuous coverage by surgeons, in Level 2 certain specialities may be available only on an “on-call” basis. Staffing patterns in the ED vary from one hospital to another. In general, EDs in university and major teaching hospitals are staffed by emergency physicians and residents from different specialties. In France medical schools are part of free public universities. The length of medical training varies from 8 to 11 years according to speciality. Emergency Medicine is not recognised as a stand alone specialty.

Sumàrio

O Sistema de Emergência Médica (EMS) em França é um sistema baseado numa central, tripulado por médicos, com dois nı́veis de actuação. O primeiro nı́vel é composto por ambulâncias do departamento de incêndios prestadoras de SBV (Suporte Básico de Vida) (chamadas “VSAB”) baseadas nas estações de incêndio. O segundo nı́vel consiste em ALS (Suporte Avançado de Vida) e é realizado por ambulâncias com pessoal médico a bordo. Em França há dois nı́veis diferentes de Departamento de Emergência (ED). O primeiro chamado “SASU” e tem cobertura contı́nua pelos cirurgiões, no nı́vel 2 algumas especialidades podem estar disponı́veis apenas numa base de chamada. O modelo de pessoal varia de uns hospitais para os outros. Em geral, os Departamentos de Emergência nas universidades e grandes hospitais de ensino têm internos de diferentes especialidades a trabalhar. Em França as escolas médicas fazem parte da universidade pública livre. O tempo de treino médico varia de 8 a 11 anos de acordo com a especialidade. A Medicina de Emergência não é reconhecida como uma especialidade isolada.

Resumen

El sistema de Servicios de emergencias médicas (EMS) en Francia esta basado centralmente, con 2 niveles de respuesta; dirigido o regulado por médicos. El primer nivel esta compuesto de ambulancias de soporte vital básico (BLS) del departamento de bomberos (llamadas VSAB) con base en las estaciones de bomberos. El segundo nivel esta compuesto por ambulancias de soporte vital avanzado (ALS) tripuladas por médicos. En Francia, hay dos niveles diferentes de departamento de emergencia (ED). El primer nivel es llamado “SAU” y tiene cobertura continua por cirujanos, en el Nivel 2 ciertas especialidades pueden estar disponibles solo en base a especialistas “de llamada”. Los patrones de personal en los ED varı́an entre un hospital y otro. En general, los hospitales universitarios y hospitales clı́nicos mayores están atendidos por residentes de diferentes especialidades. En Francia las escuelas de medicina son parte de hospitales públicos gratuitos. La longitud del entrenamiento medico varia de 8 a 11 años de acuerdo con la especialidad. La medicina de emergencia no es reconocida como especialidad aislada.

Introduction

France lies in the southwest corner of Europe. It has a surface area of 550,000 km² and sustains a population of 60 million. France is divided into 95 “départements”, similar to regions in the UK [1]. Seventy-five percent of total health expenditure and 94% of hospital costs are covered through national social-security programmes [1]. Health care facilities are administered through the Ministry of Health, although control is devolving to regional health councils. In 1999 the life expectancy was 76 years for males and 83 years for females. There are 194,000 physicians giving a doctor:inhabitant ratio of 3.2:1000.

Section snippets

Pre-hospital care

The emergency medical service (EMS) system in France is a centrally based, two-tiered, physician-manned system. The first level is composed of basic life support (BLS) fire department ambulances (called “VSAB”) based at fire stations. The second level is composed of advanced life support (ALS) physician staffed-ambulances. The first French Mobile Medical Intensive Care teams were created in 1955 [2]. They first provided medical assistance to road accident victims and inter-hospital transfer of

Emergency department

In France, there are two different levels of emergency department (ED). The first level is called “SAU” and has continuous coverage by surgeons, with ICU, laboratory and radiology facilities available on a 24 h basis. Level 2 EDs are called “UPATOU”. In these units certain specialities may be available only on an “on-call” basis. There are 200 hospitals with level 1 ED and 350 hospitals with level 2 ED.

Specific features of EMS in France

A key feature of the French EMS system is medical dispatch. This system allows a physician to use his or her medical experience to take a call and determine an appropriate response. The choice of response is wide and this system goes some way to prevent unnecessary use of scarce resources, e.g. MICUs and helicopters. The French EMS places great value on the knowledge and skills of physicians and, unlike many EMS systems, makes them the key component of the service [2]. The system aims to

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