Emergency medical services in France

The term SAMU may refer to either the overall integrated emergency medical service of France, or to a local organisation that coordinates the service. A law in 1986 defined SAMU organizations as hospital-based services providing permanent telephone support, choosing and dispatching the proper response for a phone call request. The service is organized based on the departments of France. Each department has a hospital-based SAMU organisation which is named with the department's unique two-digit number code. For example, SAMU 06 covers Alpes-Maritimes (including Nice) while SAMU 75 covers Paris.[2]

Additionally, two SAMU have specific tasks:

• The Paris SAMU is responsible for providing service to high-speed trains (TGV) and Air France aircraft, while in flight.
• The Toulouse SAMU is responsible for providing service to ships at sea.

In addition to the mainland French departments, SAMU also operates in most of the offshore North and South American Départements, such as Guadeloupe (SAMU 971), Martinique, Guyane or Pacific and Indian French Islands (Tahiti Reunion).

The central component of SAMU is the dispatch centre where a team of physicians and assistants answer calls, triage the patients' complaints and respond to them. Their options include:

• Dispatching an ambulance or response vehicle.
• Directing the patient to present themselves at a place of care, such as a primary care clinic or hospital.
• Offering care advice over the telephone.

This means that the SAMU controls a variety of resources within a community from general practitioners to hospital intensive care services.

Due to the triage (called medical regulation) and use of alternative options, only about 65% of calls to SAMU result in an ambulance being sent.[3] Current response time targets are for the responder to arrive at the scene within 10 minutes for 80% of responses, and within 15 minutes for 95% of responses.[4]

Private basic ambulance on the Tour de France in Saint-Rémy-lès-Chevreuse, France

Private companies are more likely to be sent to non-emergency and low-priority calls. Their vehicles are often not officially designated as an "ambulance"; relying instead on the more general term "light vehicle adapted to patient transport."

Ambulance (officially a VSAV) of the French fire service in Strasbourg, France

Local fire departments also respond to medical calls, and can send an ambulance, a multi-purpose response vehicle or even a fire apparatus.[6] Here, the cross-trained firefighters will provide on scene care and transport for injuries or illness, but are usually backed up by a SMUR unit for more serious or complex cases. Firefighters are trained to provide basic life support (BLS) level care.

Although they also transport casualties and are, in any practical sense, ambulances, their vehicles are instead called a VSAV (véhicule de secours et d'assistance aux victimes – rescue and casualty assistance vehicle).[7] Volunteer-staffed ambulances may be called a VPS (véhicules de premiers secours – first aid vehicle). The VSAV and VPS are considered to be means of bringing rescue workers and equipment onsite, with the evacuation of patients being only the logical result of the response, but not the primary duty of these response resources.

Emergency vehicles of Orléans SMUR

SAMU helicoptered MICU AgustaWestland AW109

SMUR (Service Mobile d'Urgence et Reanimation[8] – Mobile Emergency and Resuscitation Service) units are advanced medical responders which are operated by the SAMU organisation. They are typically labelled as "SAMU", though that term actually refers to either the overall system or the local EMS organization that the SMUR units are part of.

The French philosophy on emergency medical care is to provide a higher level of care at the scene of the incident, and so SMUR units are staffed by a qualified physician along with a nurse and/or emergency medical technician. This contrasts with systems in other parts of the world, notably English-speaking countries, where care on scene is conducted primarily by paramedics or emergency medical technicians, with physicians only becoming involved on scene at the most complex or large scale incidents.

The result is that a SMUR unit will typically spend a long time on scene compared with a paramedic ambulance in a different system, as the physician may conduct a full set of observations, examinations and interventions before removal to hospital.

Despite being hospital-based, SMUR units may choose to transport a patient to an alternative hospital if the latter is better suited to treating the patient.

Emergency medicine in hospitals has only recently been recognized as a distinct medical specialty in France,[10][11] and efforts to further recognise pre-hospital emergency medicine as a sub-specialty are at an early stage. Many SMUR/MICU physicians are actually in training for other specialties, such as anaesthesiology, who have special interest or are gaining experience in critical emergency medicine. The system relies on general practitioners and physicians from other specialties 'filling the gap' when emergency physicians are not available.[3]

The situation is further complicated by the fact that the physicians staffing the SMUR units are among the lowest-paid in Europe. Salaries have recently improved somewhat, in 2020 it was reported that these physicians who are, for the most part, full-time employees of public hospitals, had a salary between €3,113 gross and €16,003 gross per month i.e. an average salary of €9,558 gross per month.[12] This economic situation has resulted in high turnover and some difficulty in staffing positions. However, the recognition of emergency medicine as an in-hospital specialty in France and elsewhere in Europe is likely to result in the evolution of that system towards more comprehensive in-hospital emergency services.

This will ultimately, in turn, result in physicians becoming less likely to respond to emergencies outside the hospital, though they are still expected to play a major role in the immediate future. Since 1986, fire department-based rescue ambulances have had the option of providing resuscitation service (reanimation) using specially-trained nurses.[13] operating on protocols[14]