SAMU DES HAUTS DE SEINE - European Emergency Data Project

EMS
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SAMU DES HAUTS DE SEINE
Anna Ozguler, Michel Baer
GARCHES FRANCE
[email protected]
French social security & budget
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Set up in 1946
Insure 100% of the population since 1999
Financed by workers, employers and government (10%)
Ruled by trade unions (independently but with strong
connection with government)
• Covers 4 domains: health, family, elderly and unemployment
• Total medical budget per year:
– 111 061 million € (1895€/ inhabitant)
– 1 600 million € for patients' transportation
– 9.6% Gross product.
(Comptes Nationaux de Santé -SESI)
Overall view of access to EMS
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• France : 100 provinces (departements), incl 4 overseas.
– Administrative unit : common denominator
• Public rescue services :
1
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3
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2
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4
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N/A –
15 (health) EMS (SAMU)
17 (M. Inter) Police
18 (M. Inter/Army) Firemen
112 (SAMU/Firemen)
115 (Social emergencies)
• Patient access scenarios
– Call GP for visit
– Go by own mean of transport to :
• Hospital E D (Publ, Priv)
• GP
Profile of EMS (I)
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• SAMU 92 is a public medical emergency call
center for the province of Hauts de Seine.
• It is a service of AP/HP, first European
hospital group (50 Hls, 750 wards, 85000
employees)
• Set up in 1974, actually 200 employees, incl
60 physicians.
• Hauts-de-Seine : 176 Km2, 1.4 million
inhabitants, 36 districts.
Profile of EMS (II)
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1.4 M inh
Young population
21% of Gross Product of IDF
Lower unemployment rate: 8.9%
Lower mortality rate:
– 13% for men
– 17% for women
• Higher life expectancy:
– 76.5 y for men
– 83.4 y for women
http://www.fnors.org
Profile of EMS (III)
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• SAMU is a multi tiers system* which sends the most
appropriate resource on the scene (non medic or
medic)
• The resource is chosen accordingly to the degree of
severity of the patient, depending on the analysis of
the incident by on line physicians (procedures)
• SAMU directly manages the medic mobile units
(SMUR) and coordinates other public or private
resources
• SAMU is managed by anesthesiologists (for how
long ?? >> emergency medicine)
* Leo Bossaert ERC 1999
Processing of emergency calls
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• Out of 700 000 calls /y, 160 000 are registered
• 2 to 4 on line physicians analyse all calls
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Medical advice
Visit of GP's
BLS resource
S M U R (Medic Mobile Unit)
Management of available beds
Medical advice
Psy emerg
unit
51%
Mobile Emergency Forensic medicine
• Disasters' plans
• Home care for elderly and disabled
GP
15%
SMUR
10%
Basic rescue
resource
24%
Medical advice, GPs
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• GP's :
• 15%
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• Medical advice :
• > 50 %
• Risk of false diagnosis ?
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B L S resources
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• Volunteers (RC, CD)
• Private ambulance companies,
• Firebrigade,
• Personnel :
• Paramedic level 1 : 6 months
• Volunteers : trained by RC
• Police : no training
• BLS incl AED
• First responders when no severity suspected
• Transportation of patients (non life threatening)
• Reinforcments in case of mass casualties / disaster
• Extricating, fire, chemical, toxic, nuclear, biological accidents
• Police & similar
• Protection, beaconing, escort.
S M U R (medic mobile units)
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• 15 MU for 1,5 M habitants, from 5 stations
• Ambulances and small vehicles
• Helicopters (1 SAMU, 1 Firemen)
• Chartered airplanes
• Personnel :
• Emergency Physicians : (2 years study)
• Nurse
• Paramedic level 2 (driver)
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Activity of 1 SMUR (Garches)
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• 5150 interventions/year
– 2/3 Pre-hospital care (on scene)
– 1/3 Inter-hospital transportation
Other
20%
respiratory
disease
10%
trauma
11%
neurologic
disease
11%
cardio vascular
37%
intoxication,
drug abuse
11%
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Available beds management
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• All life threatening emergencies transported to
hospital after agreement of the receiving physician
(ED or Operating Room or ICU).
• Saturation of E D. (lack of available beds)
Psychological emergency unit
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• 1 Psychiatrist (head of unit)
• Help of others
• Nurses and psychologists
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Disasters,
Hostages
Conflicts
Terrorism attack
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Mobile Emergency Forensic medicine
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3 mobile units
22 000 cases / year
Visit to victims of rape,
attack, prosecuted citizen in
police stations before being
sent to justice department
(murders, violent deaths,…)
Disasters' plans
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• ORSEC
• province level
• Red plan
• localised event
• White plan
• hospital level
• province level
• BIOTOX
• chemical,
• biological,
• nuclear,….
Mobile HQ
Disaster medical equipment
Home care
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4 500 registered : 30 000 calls per year incl 3 200 resources sent
Other activities
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• Answer to complaints within legal
delay
• Bio-procedure for all vehicles
•…
• R & D projects, cooperation with
developing countries
(www.samu.org)
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• Emergency care training center
for teaching and training
• Med evac (long range world wide
for private assistance and insurance
companies)
• Quality assessment :
• Review of feed back of in patients
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Budget & costs
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• Average cost of medic transport = 500 €
• Billed 250 € / 30 mn
• Average cost of basic ambulance = 100 €
• Average cost of GP's visit = 40 €
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• SAMU
• 2 M € /year [soc secur]
• 0.6 M € /year [general council]
• Home care
• 0.3 M € /year [general council]
• SMUR (3 stations)
• 6.5 M € /year [soc secur]
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Legal framework
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• Law & decrees on EMS : 6/1/86, 16/2/87, 30/11/87
• Decrees on SMUR : 30/5/97
– Qualification of personnel :
• Staff per vehicle, physician, nurse, paramedic
• Accreditation of SMUR
• Decrees on interconnection between 15, 18 & 112
– 1992 & 1998
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– SAMU is a health service (in a hospital)
– Provide appropriate answer
– Budget from SS, State AND/OR regional councils
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French population
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Total French Population by gender and age in 1999
Male
0 - 19 years old
20 - 39 years old
40 - 59 years old
60 - 74 years old
> 75 years old
Total
%
Number 28
Female
25,90%
29,00%
26,60%
12,90%
5,70%
100,00%
419 419 30
23,30%
27,40%
25,40%
14,30%
9,60%
100,00%
101 269 58
Total
24,60%
28,10%
26,00%
13,60%
7,70%
100,00%
520 688
EU
23.1%
29.8%
25.7%
21.4%
100.0%
Insee 1999
Mortality rate: 8.9 for 1000 inhabitants
Life expectancy :
9 Male 75.5 years old
9 Female 83.0 years old
Ined 2001
Activity of SAMUs
France 1997
10.7 million calls received
(15 dialled)
Medical Advice
1.3 million (30%)
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6.6 million
inappropriate
(false calls…)
File opened
4.1 million
Allocation of
resource
2.9 million
Non medical transport
1.5 million (36%)
0.505 million (14%)
Transport to hospital :11.2%
Hospitalisation: 86%
GP visit
Medical transport
(SMUR or similar)
Not hospitalised: 14%
0.83 million (20%)
Left on scene: 2.8%
DREES n°55 - march 2002
Activity of SMUR
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France, Ile-de -France 1997
• France (58 millions inh)
– 347 SMUR (medical transport)
– 634 892 interventions :
– 1830 interventions per SMUR
– 11 interventions/1000 inhabitants
• Ile-de-France (11 millions inh)
– 37 SMUR (10.7%)
– 93 768 interventions (14.8%)
– 2534 interventions per SMUR
– 8 interventions/1000 inhabitants
DREES n°55 - march 2002
Activity of emergency departments
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France - 1990 to 1998
• Increase (+ 43%) of consultation (out-patients) in public hospitals:
– 7.2 million in 1990
– 10.3 million in 1998 incl 21.5% admissions (only 14% in large
cities)
• Decrease (- 8.4%) of GP's visits at home, with increasing # of calls
on week end & at night
– 78.5 million in 1990
– 71.9 million in 1998
DREES - n°72 - July 2000
Main pathologies in France
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14.2 million stays in 1997 (61% public hospital)
1) gastrointestinal tract disease (1.7 million)
2) follow up, detection or diagnosis
3) cardio-vascular disease (1.3 million)
4) traumas, poisoning
5) cancer
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Hospital (DREES n°41 - December 1999)
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Mortality data
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cardio-vascular
32%
alcohol
2%
respiratory
7%
sudden violent
deaths
9%
cancer
28%
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other
22%
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