France's Emergency Services System - EENA

COVERAGE • •

Metropolitan : 62 M / 547.000 km2 Global : 65,5 M / 671.000 km2

96 Metro districts, 5 Overseas (Administrative working unit) - very diverse • Median 0,5 M / 6.000 km2 • Population range 77000 to 2,6 M • Population density 15 to 21.000 / km2 • Surface range 105 to 10.000 km2 PM's decision 04/1995 • 112 calls are treated at the district's level • Sets aside the Police and Gendarmerie • Responsibility for allocation (15/18) & control given to the Prefects (State representative) • Financing is aimed at improving treatment capacities of incoming call volume and at multilingual management 2

ga.capitani - SAMU de l'Essonne 2011

EMERGENCY NUMBERS IN FRANCE 115 SAMU Social

17

114

Deaf & speech impaired

Law and order

119

Police / Gendarmerie

Child abuse

...

17%

15 Emergency medicine SAMU

112 112 - Knowledge Internal use 13% EU use 27% 3

83%

18 Fire department SDIS


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SERVICE INTEGRATION

18 Fire department SDIS (district)

Helpful

Unfavourable

Legislative rules Regulatory rules Local conventions

Ministerial afﬁliation (accountability)

Shared geographical operational areas Complementary practices

15 Emergency medicine SAMU (district)

Regular practice of call transferring Regularly shared information & data

Budget management Structural differences (size & culture) Services governed by two different systems (rules vs. discretion) Differences in the stringency of privacy rules

16 common PSAPs (15-18) 5


INTER DISTRICT COOPERATION Based on conventions with district and regional counterparts deﬁning conditions

18

pertaining to :

Fire department SDIS (district)

18 Fire department SDIS (district)

Territorial competence Operational competence Call transfers Data transfers PSAP Fallbacks

15

15

Emergency medicine SAMU (district)

Emergency medicine SAMU (district)

6


NATIONWIDE ACTIVITY & ACCESS

2009

18

2009

Fire department SDIS (district)

21.716.000 incoming calls 30% through the 112 (of which 75% were unwarranted)

15 Emergency medicine SAMU (district)

23.156.700 incoming calls 11.915.876 events

4 .027.800 interventions 64% exclusively health related

Access

Landlines Fixed VOIP Mobile phones Mobile VOIP

routed to the district's call centres by all operators routed to the district's call centres by all operators routed to the district's call centres by all operators not routed 7


15

LOCAL ACTIVITY Yearly events

Mean daily events per month (2000 to 2010)

Mean hourly events (3month sample)

Essonne 1.2 Million

2010

Patients

154,081

Events

159,744

Transport to a hospital

72,450

Decisions

199,210

Emergency department

66,451

Mobile Intensive Care Units

11,636

Pathology specific treatment unit

5,999

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CALL HANDLING 15 - Calls are received with a 9 sec. message. The first tone is a mock ring. The call is displayed 12 seconds after it reaches the PBX.

112 / 18 - Common process Immediate display of the call while a French & English message (15sec.) starts. First responder’s mission (front desk) •Localise & Secure the call •Determine the nature of the difficulty (non Health / Health) and forward the call accordingly.

First responder’s priorities : •Swift answer •Management of multiple calls is the rule •Localise & Secure the call •Triage (symptoms, context and history). •Forward the call to the adequate decision maker (General or Emergency practitioner) within 2 minutes.

The second operator •Single line process •Decisions go from binary (Health) to complex (non Health) •Decision by rule according to a preset guide •Time frame : 2 minutes after call display •Forwards the call and all pertinent data to the # 15 (Health related)

Medical response •Decision is discretionary •Flexibility (context, risk, patient's will...) •Follow through (updates, intervention...) •Directs patient to an adequate, available and warned unit. 9


RULES, CALL MANAGEMENT... 112 / 18 - Call takers •Recruited on specific FD tests •2 months local training •Continuous training •The structure is responsible in front of the civil law

15 - Call takers •Baccalaureat + •8 weeks local training •Continuous training •The structure is responsible in front of the civil law

Protocols (local) •One common protocol (Cardiac Arrest) •Protocols (health) made up with the SAMU •Specific protocols (technical) •Pre-arrival instructions are given Intervention times •2 minutes to the decision •7 minutes to the door ambulances)

(First

Protocols (local) •One common protocol (Cardiac Arrest) •Guidelines local (adapted from national guidelines) •Pre-arrival instructions are given Intervention times •Call taking < 1 minute •15 minutes to the door for Mobile Intensive Care Units •Door to balloon (STEMI, NSTEMI...) •Door to MRI (Strokes...) •Door to ECMO (Hypothermia...)

aid

10


MISCELLANEOUS International cooperation Yes

Psychological support Specific SAMU unit (CUMP) for post traumatic syndrome

Caller location •Caller number is pushed to the call centres •Location of fixed lines relies on a local database (regular updates) •Location of mobile phones are requested if & when necessary to telecom operators

Multilingual capacities reliance on private companies which provide language recognition and translations through conference calls Accessibility to people with disabilities (114) National call centre specialised for the deaf and speech impaired

Feedback from users Specific procedures for the different type of users (patients, ED... ) No national procedure but all services have their own.

Data transfers •Fully applied in most integrated 18/15 call centres. •Inter-district datas exchanges are projected as part of partial or total assistance plan

Public warning Is included in emergency plans controlled by the Prefect (State representative) 11


TOMORROW’S CHALLENGES Policies •Redesign allocation of resources putting the affected party at the core.

Local management •Workforce allocation Effective flow management (Register Operational Resources) •Avoid congestion in emergency wards •Scarcity of pathology specific treatment units Strengthening the ties •Inter service, Inter district •Moving towards a regional concept Quality control •Design of adequate incentives to enhance quality •Institutionalise feedback 12


THANK YOU 

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