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Hello of an EMT from Paris, France !


50 posts in this topic

Posted · Report post

Good day everyone!

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.

When:

- 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-B). 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!

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Posted · Report post

Bonjour. Welcome to the site and thank you for an informative and interesting first post. I hope you stay and contribute. Bienvenue

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Posted · Report post

Hello and thank you for you message, I'll sure stick around and try to contribute. I don't know if there is any other french EMT around.

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 :)

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Posted · Report post

Bienvenue.

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Posted · Report post

Welcome to the City!

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.

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Posted · Report post

Bonjour Mon Ami, bienvenue à la ville

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Posted · Report post

Stay and play?! What treachery is this? If patients could be competently managed on scene for extended periods of time by ambulance services... why that would mean that all of us blazing through the streets lights and sirens have been risking our lives for nothing!

=)

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?

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Posted (edited) · Report post

Interesting to read about all of this, especially from another country. Any photos of the ambulances? Fitting 5 people in there must mean quite a hefty size.

Edited by cscboulder11
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Posted · Report post

Bieber (nice name :D) :

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 :P

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!

http://www.youtube.com/watch?v=rEZQi2taG64

http://www.youtube.com/watch?v=PA9FTwIPArM

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...

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Posted · Report post

Thanks for this insight. It's nice to learn how everything is run.

As for your English, it's very good. Is knowing English a requirement to serve on the crew?

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Posted · Report post

Well, you're the most welcome!

Thank you, and no, english isn't required for our service. We are actually only a few EMTs with a "fluent" english, but most of the others can handle english-speaking patients well ;)

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Posted (edited) · Report post

It is good to have you. You are one of the most informative new posters I have ever seen, I think.

Jump in to every discussion that tickles your fancy. I simply could not resist pitching in an idiom.

I am not familiar with Paris, France but have beet through Paris. Texas.

Our Proteccion Civil Logo from the other side of the world is very similar to yours.

Welcome!

Edited by DFIB
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Posted · Report post

Bienvenue à la ville :)

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Hey, thank you DFIB and Patton! I'm sorry I haven't seen there was new replies in here!

Well, I'm always happy to learn about other countries and I think this is a great opportunity to tell people about the french system! I really like the french-US exchange, but I'm also interested in the rest of the world.

Where are you from if I may ask?

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Posted · Report post

Bienvenue, merci de l'histoire fascinante de la médecine d'urgence français. C'est la même chose, mais très différent, oui?
J'ai hâte d'en apprendre davantage au sujet de votre travail. Merci encore!

I was wondering what you and your Colleagues think about the gun violence in America? Have the recent mass shootings been shown on French news media?

I don't know, so I ask; Can French citizens buy and own guns the way Americans can? Is there much gun violence in France?

Thank you for answering so many quesitons!

Mike

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Posted · Report post

Mike, I believe you'll find some of our French friend's views posted in this recent thread.

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Hey Mike(s),

Like it is said above, I've written quite a long post about "guns" in France and USA, you can check it out on the link provided above ;)

About the school shooting itself, it was big news, made special editions and we had live broadcast from the US. I'm going to be very blunt and cynical, but when we hear about a mass shooting in the US we think "Oh, again...". It sounds like a bombing in Middle-East: it's terrible, but it has happened before and will happen again.

For most french people, it seems logical that having so many guns around with such little control, it is not surprising that gun violence is so frequent.

One thing that shocked many people too was how the journalists hunted down the kids and asked them very precise and gruesome details on the event, shoving the camera in their faces...

I'm sorry to sound so vehement, but I'm merely translating the general opinions about it.

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Posted · Report post

Mike, I believe you'll find some of our French friend's views posted in this recent thread.

Thank you Mike.

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Posted · Report post

Bonjour Secouriste,

I thought you could help me with this... I stumbled across a documentary about SAMU de Paris, really interesting and well made (even for me with the petit peu of French that I speak). The question I've got is, what's happening from about minute 8:40 onwards. What I understand is the medecin gets 'shocked' while performing chest compressions. Yet the defibrillator (looks like an LP 15 or something, are you familiar with it?) hasn't released a shock, the patient's heart converts into a sinus rhythym or at least some sort of circulation returns. Is that correct? Seems like an interesting phenomenon...

http://www.youtube.com/watch?v=S06RpYWQRZc



Oh, and a late welcome to the forum ;) Bienvenue!

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Posted · Report post

Welcome to our madhouse!

You said "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"

As someone who started in a community based Volunteer ambulance Corps, I'd say you're a designated "Crew Chief", kind of like a patrol sargent for your team.

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Posted (edited) · Report post

Fab: Bonjour! You found a great video here! You can see our teams working during a big event coverage from 20:55 to 27:10 :D

This video is so awesome I actually tried to subtitle it, but all I can do it make a translation script, I'm completely unable to do the whole synch process...

To answer your question, the doctor gets shocked by the pacemaker (internal defibrillator) the patient is wearing. He explains the pacemaker interpreted the chest compressions like a shockable rythme and delivered a shock. As you noticed, it's this shock that restores a stable circulation. It's the first time in his career that he experienced such thing :)

Richard: Hello and thank you! Yes, thank you for giving the right term. It's quite hard to translate the first aid vocabulary we use here, especially regarding the organisation and roles of everyone.

A "crew chief" seems like the right word, except I wasn't designated. To access these responsibilities you have to go through a test and then an additional training. There is one evening of tests, then 2 days of theoretical training then, if you succeed all this, there is a field training during which you have to complete objectives. Once you've completed all your objectives you become an actual "crew chief" ;)

Edited by Secouriste
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Posted · Report post

"Crew Chiefs" duties and responsibilities can and do vary by town, county, prefecture, parrish, county, state, provence and country, due to "Local Protocols". I always tell new EMT City people to follow their local protocols.

By the way, may I suggest a translator program, like Google Translate, which I now use to translate this into French?


«Chefs d'équipe« devoirs et responsabilités peuvent et doivent varier selon la ville, le comté, préfecture, parrish, département, région, provence et du pays, en raison de «protocoles locaux". Je dis toujours aux gens des villes nouvelles EMT de suivre leurs protocoles locaux.

Soit dit en passant, je propose un programme de traduction, comme Google Translate, qui j'utilise maintenant de traduire cela en français?

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I France we have national protocols. If you're curious you can have a look here:

http://secourisme34.fr/referentiels_en_telechargement.html

I'll explain the names:

PSC1: It's the basic first aid training everyone should know about. It takes about 10 hours with an instructor prior to which an e-learning course is requested.

PSE1: That's the first part of the professional EMT protocols. It describes most emergency non-invasive procedures.

PSE2: That's the second part of the professional EMT protocols. It describes mainly the signs an EMT should look for in order to achieve a good assessment and the immobilization procedures.

DPS: This text is the ground rule to organize any event first aid coverage.

PAE3: This is the reference document to teach PSC1 to people.

PAE1: This is the reference document to teach PSE1 and PSE2 to future EMTs

All these documents gather the knowledge required to pass the tests, except the "DPS" one which is only a legal frame without exam.

_____________________________

In addition we, the Protection Civile of Paris have these internal trainings:

PSE2+ (or Crew Chief): This training provides additional medical knowledge over precies conditions, organization and management skills and legal knowledge (basically, you learn that you're not protected whatsoever).

CEPS: This training is quite similar to the one provided to the Fire Dept. supervisors. It is management and crisis handling only. The CEPS training provides skills to handle any kind of situation where an ambulance is involved. The theoretical part lasts a full week, it's a very concrete and intense training.

SH: Basic training to deal with homeless people.

CESH: Safety rules training to be in charge of a street patrol for homeless people.

Use of BGL device: It is not part of the national frame texts but our close partnership with the EMS and the Fire Dept. led to expand our skills and perform this simple yet important measure.

In dark red, the emergency medical trainings. PSC1 being the most basic (1/5) and CEPS the most advanced (5/5).

Now, I'm not fond of the automatic translators. They're fine for basic sentences and translating but when things get complex or when the idioms are not common to both langages, it fails. The main issue is that the very organisation of first aid here and in english-speaking countries leads to words that have no equivalent elsewhere.

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Posted · Report post

Secouriste,

I watched the film and I noticed that the SAMU dealt with at least three different EMS organisations: you guys, the fire department and the Red Cross. Are all of these organisations involved in 112 calls in Paris and if so, who decides which organisation goes to which call?

I love Paris, by the way, have been there a few times in the past few years (I'm only about 4 hours away in Holland). It must be pretty busy there for EMS, I would have thought.

I know it's already been said, but I also think your english is absolutely amazing! My compliments!

Carl

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Posted · Report post

Bonjour Secouriste! Welcome to the site (yeah, I'm a little late. What else is new?) What part of France are you from?

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