Secouriste

Hey Fab,

In France it's 3 years to become a nurse, after that, depending on where you did your internships and where you work (once u get the diploma) you can choose almost any medical field to work in

I have friends who are now official nurses, I'll be happy to answer your questions if you have any.

Welshmedic: thanks! It will be very very difficult, no doubt!

Welshmedic: Yes it's about right. The weird thing in France is you basically have two numbers you can call. 15 for EMS and 18 for Fire Dept. In France the firemen are also EMTs. The same crew can be in an ambulance the first week and on a fire engine the next week.

The Fire Brigades are a true and strong lobby so even if EMS is legally ruling the whole emergency response system, the Fire Brigade has its own number, dispatching center etc...

Those two structure do communicate a lot though and it doesn't change much what number you call in the end.

So what you have 24/7 are: the fire dept ambulances + private responders + physicians (either from the fire dept or EMS)

Some days, we give either EMS of Fire Dept some ambulances they can use. Depending on which structure, we go on "15" calls or "18" calls which are almost the same.

For someone exterior it may seem there are a lot of different things, but all those ambulances are the same. Same missions, same trainings, all EMT-B. Wether it's us, Malta, red cross, private responder, fire brigade ambulance...

The physicians are either from the EMS of Fire Brigade, no other option.

Fab: I'm a student. I will try this year to get in the Military Medical School and try to specialize in the emergencies. I'd love to work in France with the Paris Fire Dept, or the Mountain Rescue units of the Gendarmerie (french police with a military status). I will also be able to do exterior missions depending where our armies are engaged.

If I don't succeed here I'll get in a med school here but it's very very difficult to go through it.

There are some place where a nurse is sent out alone (with a crew of EMT-B's already on scene) with protocols, exactly like a paramedic. This system allows savings in cases where a physician isn't needed. That remains quite rare in France and does not happen in Paris.

Hey Welshmedic! I hope you enjoyed that very well made documentary

To answer your question I have to point out that the various services you see do not have their own number you can dial for help. What we do is we make our ambulances available for the EMS to send them on calls.

There are 2 ways, either they're in a fire station or they're "free" like in the US. If the ambulance is in a fire station it's easy: when the station is requested by the SAMU to send an ambulance, we go instead of a fire dept ambulance.

If the ambulance is parked somewhere else waiting for a call, we have people at the dispatching center who will talk with dispatchers and transfer the calls directly to our ambulances instead of the fire dept. or others.

In one fire station there is only one volunteer unit at the time so it's pretty easy.

What you see in the video is a bit different, we're covering an event so the public EMS don't have to come into play. They have HQ there and they're overwatching the situation but they don't handle it directly, we do.

I hope it's clear enough

ERDoc: Thank you! I'm from Paris itself

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.

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

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"

Thank you Mike!

A chase car is exactly what we call VLM (Medical Light Vehicle. In France, every single EMS has its cars.

Here are some examples:

http://up.autotitre.com/d75d10796c.jpg

http://up.autotitre.com/0aa7865c2f.jpg

http://up.autotitre.com/ca036f67c3.jpg

http://up.autotitre.com/9ae8cae96c.jpg

http://up.autotitre.com/fdc9893f6c.jpg

http://up.autotitre.com/fbd61b733e.jpg

What are the missions of a "chase car"?

Thanks

That situation is always difficult to handle.

I see a set of factors:

1) Is the person able to make reasonable decisions?

2) Does the patient have relatives? Kids?

3) What are the extents of our legal liability?

In France, it is very tricky because you can't force someone to go to the hospital but on the other hand we aren't protected by the "responsibility discharge" paper we make people sign. So you know when it comes down to patient refusing care we think "if we leave him, can we be sued?". Who sues? Rarely the patient, but his family "How could you leave him like that?" You know what I mean? In the end, it's just the patient wishes vs my liability.

In your situation Dwayne, we would have tried like to convince him to go with us. As I supposed that wouldn't have worked, we'd call the chief doctor of EMS to see if he agrees to have the patient left like that. In this situation, he'd say "No, take him tot he hospital."

Then, if the patient tires to be smart with "I know my rights, you can't do that!" We either call a relative (son, daughter, mother...) or a psychiatrist to sign an order of forced hospitalisation.

We can then legally use every mean necessary to transport him to the adapted hospital. That mean calling the police and restraining the patient during transport.

Of course we do only what is necessary. If upon seing the cops, the patient says "ok, ok I'll go with you" then we welcome him in the ambulance and do not retrain him.

That is an argument we use sometime: "Ok sir, either you come calmly with us or the cops take you to the hospital. It's up to you."

Morally, I think that when permanent disability or death are at stake, you can't let the person fool around. I balance the patient's will with (as said above) my legal liability, but also his family's will. If the patient doesn't want me, that doesn't mean his family doesn't want me to do something.

Suicide is something else, because the person wants to die. But potentially lethal accidental injuries have to be treated. A person thinking otherwise is not able to make the right decisions. In your situation, if the guy says "I'll go alter with my wife" while knowing it will be too late then he's not logical nor consistent and thus cannot be listened to.

I always listen to my patients requests and try to meet them as much as I can, but never if that goes against the course of the treatment.

One thing that made me think of is what if parents refuse to have their child attended by the EMT? I know it sounds crazy but it sometime happens. Usually, we just are a bit more alarming that need be, playing on the "parent nerve" and it works.

One time though we had a kid with something serious and the parents would still refuse. We had to threaten them to call the chief prosecutor and have their parental rights suspended. That's an extreme procedure we can do to have the child placed under state protection. That will allow any necessary care to be performed even against the parents' will.

That sounds a bit harsh, but we're all human if not parents and I've never heard of any abuse with those procedures.

Can do it.

Next.

His reaction his maybe a bit aggressive, but there's no way someone would ever film my patient.

It's funny, i was on a big first aid post during a sport event. We were 15 EMTs working there. A guy pulled out a camera near the entrance of our post, and suddenly he was surrounded by 5 EMTs asking what he was doing. No tension, just politely asking: "May I help you?" which in our language means "Get the hell out!".

People are just too curious and instead of asking questions, which we would gladly answer, they just go take a look.

On a big public event, we constantly repel people off our working area and at the end of the day, we get a bit rough I admit...

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.

In France, fire-fighters do not put the helmets on until they're arrived on scene. As for our ambulances, the helmets are kept away from the back-cell, but still accessible through a little trapdoor.

Do we know what ribs were fractured? Also, what's the aspect of the skin at the elbows and knees, the lips and conjunctivas?

How is her breathing, beside the noises does she makes extra-effort to breath-in? Is there a paradoxal breathing or seesaw respiration? Does she spits during the coughing?

Is there anything abnormal on the chest upon visual inspection? Palpation?

Can she bear to lie flat on her bed?

That interesting Kiwi, could you tell me a bit more about those? Why don't you like the new ones for instance?

DFIB: Is it part of your protocol? For instance, in Japan, most EMTs wear a helmet + mask on every calla.

Hello there,

I have a little question about helmets.

Do you have some in your ambulances? If you do, for what risks? What are the criterion that made you choose the model you own?

Also, I like helmets as items. I'm not collecting them but since I was a kid I like those things. Had shipload of lego helmets So do you have a favorite helmet?

______________________________________________________

______________________________________________________

In France, the ambulances are all equipped with the same model:

The F2 Helmet. Originally designed by CGF-Gallet those where the models that replaced the old Adrian helmets, whose design originated from WW1.

The F2 is used by almost every ambulance service in France and also Most fire dept. In fact, for outdoor fire, the fire-fighters need the lightest PPE possible due to heat and the duration of the intervention!

Beside being a good quality helmet, it bears the traditional spirit of the old adrian helmets in the subtle crest and the shape of the front sticker.

http://www.hostingpics.net/viewer.php?id=982599f2xtremblanc2.jpg'>

Basically, we have for 2 reasons:

- Protection from projectiles during public events, sport games, hostile people etc...

- Protection for intervention in a crashed car.

Now, my favorite helmet is the F1 for CGF-Gallet too! Silver of course

http://www.hostingpics.net/viewer.php?id=264558315902768.jpg'>

This is used by the fire dept. that have big cities in their sector. City fires expose the fireman directly to the fire, at very close range. It provides a full head protection, but also a full face protection to very strong heat. In Paris for instance you have lot of old buildings with many twists and turns. Attacking the fire from inside the building can bring the fire-fighter to get a few meters from the raging fire. That is why the helmet is so complete. Yet it his heavy and very hot (but less hot than the actual fire ) so has to be used only when needed. This helmet is also the symbol of the acceptance of the new recruits in the fire dept. They're delivered during a very serious ceremony.

Beside being a very good helmet, I find is very stylish, mixing the old-style crest and a very modern design.

Of course no helmet ever saved the life of a reckless fireman, it remains a mere human item that cannot compete against the true forces of nature. One must always remain humble in front of danger.

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?

That's Final Destination lol

The only thing we keep with us is our uniforms. The bags are stored in a storage room.

As "EMT-B", we use these two bags:

On the left the "Treatment bag" (by Dimatex™), on the right the "O2 bag" (by Bagheera™)

I - "Treatment" bag

This bag has:

- 1 small upper pocket

- 2 medium side pockets

- 1 big front pocket

Inside:

- On the flap, 3 velcro transparent pockets.

- In the "case" 5 velcro transparent pockets.

In contains roughly:

On the outside pockets:

- Flashlight

- Handling gloves

- Signal tape

- Medical wastes bags // Trash bags

- Anti-bacterial gel

- PPE

- Unique use sheets

Inside:

- tensiometer (manual and electronic), thermometer, pulse oxymeter, hemoglucometer.

- eye light, splinter-pincers

- Hemostatic cousin, high absorbance compresses

- Compresses + NaCl- 0,9% + betadin + Dakin + plasters

- Hard-case for piercing medial wastes

- Cold packs, emergency blankets

- Medicines (paracetamol, aspirin, salbutamol... + creams)

II- O2 bag

This bag has on big front pocket. Inside, on the flap there are elastic bands that hold the cervical collars (adult size + child size). The O2 bottle in centered, on each side a smaller bag. On top, you have room for the adult BVM.

In an inner bag you'll have the adult oxygenation masks, pieces of the adult BVM, adult suction tubes. In the other bag, you'll have the same things for children. You also have a manual suction device.

On the front pocket, you have the AED and a blanket. An EMT carry the automatic suction device.

Is this like "The Onion"?

HEAD-BUTT

That pic was found on a medical stuff retailer, so I guess they wanted to "label" that product witht he helmet to imply "look, the fire dept. use it!".

By the way, this is a F1 helmet. The silver is the traditional color of the Paris Fire Brigade Helmet. Those where designed by the french of CGF-Gallet, which was sold to the US company MSA. That design became very popular over the world and if the F1 wasn't always bought, it was copied a lot.

http://www.hostingpics.net/viewer.php?id=147509LecasqueF1duLoiret45.jpg'>

I only had one time to restrain a patient for transport, we used this fellow:

http://www.hostingpics.net/viewer.php?id=567644MatelasMFR1005.jpg'>

We do not use the backboard, because the hands are still free...

On the more global matter of psych patients, I live in an area where we have enough facilites. When dealing with the patient, we always think "safety first" and try the person to agree with us and follow our advice.

If the person is dangerous for him/herself and the others, we call the police and a physician who can issue an order of forced transport. Then, depending on the patient we take police officers with us in the ambulance.

I remember that violence psych guys, who was transported on the ambulance floor, pinned down by 3 cops and a fellow-EMT...

Yup that was shot in the "Hotel-Dieu" Paris hospital

Kiwiology: Yes SMUR refers to "Mobile Emergencies and Resuscitation Service". What's the difference between SAMU and SMUR then? They're two level of the same apparatus.

- SAMU is the dispatching center, but also the decision-making entity in the area of emergency response.

- SMUR is the service attached to an hospital, gathering the administrative services, the medical crews, the vehicles and equipments.

There is one SAMU, but ambulances are scattered among the different SMUR of the zone. For instance, Paris is the département (territorial subdivision) #75, if you take the ambulance attached to Necker Hospital is will say:

You have both mentions

The main audience knows only about SAMU. SMUR is for professionals to know where the ambulance comes from.

In France, we have a 2-tier response:

I- First reponse

II - Medical response

NB: In France, "Medical" labels only real emergency physicians. For instance, what you call "EMTs" could never have "medical" in there french name. If it's "medical" only a doctor can do/operate it, or nurse instructed by a physician.

In France we have 4 great kinds of EMS strustures:

- The proper EMS, the SAMU (Service d'Aide Médicale Urgente = Emergency Medical Assistance Service)

- The Fire Brigade

- The Volunteer units

- The "private" responders

To help you see clearer, see table:

http://www.hostingpics.net/viewer.php?id=361189Capturedcran20130107155801.png'>

I - First response:

The role of the first responders are:

- Assessing the patient's state with:

_clinical signs

_vital paramaters (blood sugar-level included)

_relevant questioning

- Apply the appropriate gestures (automated defib // immobilization etc..)

- Transmit the assessment to the EMS

- Apply the medical decision

The first responders do not perform any invasive gesture.

Who's in the ambulance? It depends on the responding structure:

http://www.hostingpics.net/viewer.php?id=964996Capturedcran20130107160812.png'>

What drugs can be used? Do some of them need the authorization of a physician?

First responder do not deliver any drugs. Also, they do not possess what they're not allowed to used by themselves.

Yet, the volunteer units of the Protection Civil have a little protocol to deliver basic medicines like:

- Paracetamol

- Aspirin

- Salbutamol (Ventolin™)

And other little things like anti-nausea, anti-diarrhea...

This applies only to the Protection Civile. The Protection Civile is a "volunteer unit".

Also, oxygen is consider a medicine which is allowed for every first reponder. Glucose is available in several forms in every ambulance.

None of the above requires physician authorization.

II - Medical response.

The role of the medical team:

The medical teams are dispatched by the SAMU only. Most of the vehicles and crews belong to the SAMU itself, but in big city, the fire brigade has its own dispatcher and medical ambulances.

The medical team perform any procedure that can be done outside the hospital. They issue a diagnosis, start a comprehensive treatment and give instructions to the first responders.

They perform a fully medicalized CPR in cooperation with the first responders.

The ECMO unit can perform an... ECMO procedure anywhere, a surgeon and two trained nurses are on board.

Who's in the ambulance?

What drugs can be used? Do some of them need the authorization of a physician?

Of course I'm not qualified to tell you what's used by the medical crew except from the classic stuff i've seen being used many times (adrenaline etc...), but as a physician is there I guess the only limitation is to actually have the drugs in the ambulance

I hope it's clear enough

That is something that we have to see coming!

They're currently developing a lot of equipments for smartphone, that will soon be able to do most of the monitoring.

Will this have consequences for EMTs and paramedics?