Posted 06 November 2012 - 05:27 PM
I'm glad to join this community and I hope to learn a lot from all of you, and maybe answer a few question you may have as I'm from a country with a peculiar system
Indeed, I've been a volunteer EMT in Paris for 4 years, within the Paris Civil Protection (Protection Civile de Paris). I say EMT, but the actual french word is "Secouriste" which corresponds more or less to an EMT-basic life support qualification. I'm qualified for almost everything that is not invasive (with the only exception of blood sugar level) and my mission is to (in short):
- Assess the patient's health state
- Perform the emergency actions needed to answer the situation / Call for additional (or specialized) units if needed.
- Transmit a complete and accurate description of the patient's state to the EMS.
- Preparation and evacuation of the patient to the hospital.
I'm a "foreman" (chef d'équipe) which mean I have to coordinate my team's action and take responsibility for my crew's safety as well as the patients' and third person's.
To introduce you briefly the Civil Protection, you can easily compare it to St-John Ambulance. We have 3 fields of action:
- Medical emergencies:
>> "911 response"
>> Rescue posts on planned events (festivals, sport events...)
- Social support:
>> Disaster relief
>> Street patrols for homeless people
- First aid training:
>> EMT training
>> First aid course for people
How do we respond to a 911 call?
In France, there are no paramedics. We have either EMT-B or emergency physicians.
- The call wasn't clear
- The situation doesn't seem to require an advance life support unit
- The situation requires additional personals
- The situation require a basic life support unit on top of an advanced life support unit
We are dispatched.
We are 5 EMT in the ambulance, but we can work in crews of 4. On other missions we can be 3 or 2. Our role is to get control of the situation, assess the patient(s) health, treat the injuries/distresses and report to the EMS.
They take the decision.
Then, if needed, we transport the patient to the hospital. An advanced life support unit can also be dispatched to start a treatment on the scene?
In case of cardiac arrest: We start CPR with oxygen and defibrillator, we call the advanced life support unit. In most of the cases, the resuscitation will be performed on scene by the doctor's crew until the patient is stable. If nothing can be done, the patient is pronounced dead on the scene. If the patient is stabilized, he'll be quickly transfered to hospital.
This is the "stay and play" theory you have in France and Germany, where doctors, in mobile ER will come on scene. It's called "bring the hospital to the patient".
Why does France applied the "stay and play" system?
Before 1968, rescue missions where carried out by fire departments and police departments. Those rough ambulance services were poorly trained and equipped, as it wasn't the main mission of neither. The mortality rate was very high so doctors decided they couldn't stay in the hospital and wait for dead patients. They created vehicles equipped like hospital emergency rooms, aboard which were the doctor and nurses.
Today, those "mobile ER" still exist and board an emergency doctor, an emergency nurse (equivalent of a paramedic advanced) and a trained driver (equivalent of an EMT-. You can recognized them by the word "SAMU" written on the side.
What's new in France EMS?
The "stay and play" theory is to live long it seems, as the SAMU just created a mobile ECMO unit. This vehicle boards a specialized team (surgeon, nurses...) and all the equipment needed to set an ECMO procedure anywhere, on the street for instance.
This unit is dispatched only under very precise circumstances, and aims to reduce even more the "low flow" time. Even if this vehicle is still in experimental phase, it shows well the will of french EMS to bring more and more heavy equipments outside the hospital, directly to the patient.
Maybe one day, you'll get a scanner without leaving your bed!
I hope you found some of this interesting, if you have further questions, feel free to ask
Glad to join you all!
Posted 06 November 2012 - 06:41 PM
Posted 06 November 2012 - 07:39 PM
I'll also try to set up a gallery presenting more of the Civil Protection (people, equipments, ambulances, mobile HQ etc..) and other french emergency services
Posted 06 November 2012 - 11:07 PM
I have to go back a couple of times to read your post, because it is very interesting.
Hope to see you here a lot.
Posted 07 November 2012 - 03:15 AM
Bienvenue to the forum! I'd love to hear more about the French take on emergency medical/mobile health services. Tell us more about how you guys run your calls. What's your average scene time? What treatments do you provide on scene versus en route? Do you guys have mandatory scene times? What about for trauma calls? What is the criteria for lights and sirens use for you?
Posted 07 November 2012 - 04:57 AM
Edited by cscboulder11, 07 November 2012 - 04:58 AM.
Posted 08 November 2012 - 01:07 AM
Well, the "stay and play" system works when you have the money to have emergency specialists doctors responding with all the appropriate equipment. In France, the EMS is called the SAMU. It is a public service (free of charge) that provides that advanced medical care. In many situation, they can start a comprehensive treatment very early and hand out a clear diagnosis before even leaving the scene.
But of course, we all respond at high speed, using our lights and siren
Although it doesn't happen much that we use them to get to the hospital...
What's your average scene time?
Well, depends on what's the issue! If the cause of the problem is clear and can be treated by our simple actions, it doesn't take long to call the EMS and ask for permission to transport. That can take something like 10 or 15 minutes. Even if the problem seems minor and/or well known, we take the time to make sure it really is! We are especially on the look for psychological causes. For instance, a drunk guy or girl often has personal issues that may be helped by talking with them and listening to them. Same for all kind of minor health problems.
"Big" situations, where the patient is in a serious state and need advanced care on the scene can take up to 1h30 or even 2 hours (that's extreme) !
What treatments do you provide on scene versus en route?
Well, I'll answer you with my level of qualification. Basically, if something is to be done, we do it prior to transport. During the "route" time, we'll carefully monitor the patient and remain vigilant to anything change of the health state. The whole meaning of our system is that nothing is supposed to happen during that time.
If it does, it means a mistake was made somewhere, or that we're in a very rare case of sudden degradation of the patient's state. In that situation, we stop the transport and call a mobile ER.
If the patient is transported by a mobile ER, they will do all the stabilizing work on scene first. If for some reason the patient's state suddenly worsens during the "route" time, they'll proceed to the appropriate treatment.
But you really have to keep in mind that beside the cases we'll see below, the patient is stable during the transport.
Do you guys have mandatory scene times?
No, we just take the time to do things right.
What about for trauma calls?
Ha ha, good question! Indeed, in case of trauma, we all know that the only outcome will be "go to the hospital". So those kind of cases are treated quicker than usual.
If the trauma is minor but needs transport, like a broken leg, wrist, head-neck-back injuries without clear sign of seriousness (like a clear deformation or complete loss of mobility...), we proceed to the immobilization then transport. The assessment we make is to be sure that there is no vital danger or potentially serious consequences if moving the victim.
If the trauma ins't vital but looks quite severe, we'll call a mobile ER for pain treatment and fracture "reduction" to be performed by the ER crew. Also, in case of doubt, we ask for a doctor's advice before doing anything, that's a legal matter.
If the trauma can cause a vital danger (gunshot, severe blood-loss, head trauma with signs of seriousness...), the mobile ER is called straight away. They start the stabilizing procedures then quickly evacuate the patient to the nearest appropriate surgery service (neuro, cardio...).
What is the criteria for lights and sirens use for you?
As soon as we respond to a call, we use ou lights and sirens!
We can also use them to quickly go back from the hospital to an event we cover, after we've transported someone. That requires to ask the permission on the radio.
Cscboulder: As you can see on those links, no our ambulances aren't big. When I said 5 I should have been more precise. We are not 5 EMT treating the victim in the same time.
See how we are organized:
- Ambulance chief: Seats on the front. He's the one in charge of the whole crew and in charge of the scene he's called to. He's responsible for everything, including his team's safety. He's an experimented EMt who received tough additional trainings to be able to work with the Fire Brigade (in France they act as an ambulance service too). During the route, he gives instructions to the driver and operates the siren and lights. The main concern of the ambulance chief is managing the third parties.
- Driver: Obviously drives the ambulance. Once on the scene, he's responsible for signposting the scene (if on the road) and managing the traffic. If some equipment is requested by other EMT who are treating a victim away from the ambulance (at home, in a shop...) the driver will get it and bring it to them.
- Team foreman: Seats on the "captain seat" on the back. In a lot of cases, the ambulance chief cannot fully dedicate himself to ensure the treatment of the patient. He transfers his prerogatives to the team foreman, who is 100% in charge of the patient. The team foreman coordinate the assessment of the patient, and all the actions of the EMTs. The ambulance chief gives the main guidelines, the team foreman is the "conductor".
- EMTs: Seat on the back. The EMTs, usually 2 are under the orders of the team foreman. They check up the vital parameters, seek signs and proceed to all the immobilization/handling techniques. They are the "hands" of the team foreman, they don't talk to the patient. What is asked to them is to execute orders quickly and correctly.
So you see, in the end, inside the ambulance there are never more than 3 people around the patient. If a mobile ER crew arrives on the scene, only the team foreman will assist them on behalf of the Civil Protection. Of course, all the immobilization/handling techniques will be performed by the EMTs only, the doctor's team not being trained to that.
To give you an accurate picture: On a bike crash:
- The ambulance chief will call the Police, go after witnesses to gather informations on the crash and seek potential "hidden" casualties, manage all the third parties and work with all needed services.
- The driver has set the traffic cones, he's in charge of traffic regulation. He can be asked to take the stretcher out of the ambulance and take part in the patient handling.
- The team foreman is assessing the victim's state. He'll decide how to proceed, he'll conducts the whole procedure and make sure everything is done right. He'll take part in the patient immobilization/handling. He's focused on the patient.
- The EMTs will check the vital parameter, perform the palpation, remove the helmet... They take part in the patient immobilization/handling. They're "bound" to the team foreman.
I know that can sound a bit weird, but it allows us to be quite independent in most situation. You have to know that Paris as a lot of old buildings with many floor, no elevator and narrow stairs. Bringing a patient down to the ambulance requires at least 4 people! You can see here that 5 isn't all that much. The 5th guy is usually the ambulance chief who will open the way and carry the heaviest bags to relieve the rest of the team.
Hope it was clear enough, please excuse my grammer mistakes.
Also please note that the examples are voluntarily simplified, I won't write down the whole checklist of each case we can encounter. I think our and yours don't differ much. For instance we too have a "PQRSTMHTA"
Which includes all the details possible on the patient's injury or sickness, history, allergies, past treatments...
Posted 08 November 2012 - 02:00 AM
As for your English, it's very good. Is knowing English a requirement to serve on the crew?
Also tagged with one or more of these keywords: EMT, volunteer, Paris, France, Civil, Civile, Protection
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