Catastrophe medicine has known an important progress in recent years and the relationships between emergency medicine and catastrophe ask to be clarified. The evolution of one and another towards a growing specialization questions, in terms of teaching and of operation, problems that arise currently in France, and that they were raised also in other places. So it seems interesting analyze the current situation, its evolution and its perspectives of the future, both in terms of performance as teaching emergency medicine in France.
The medicalization of emergencies involves two complementary points: the one of the medical performance permanent and regulation of calls, patrimony of SAMU and Center 15, and of interventions on the ground, primary or secondary transfers, made by the SMUR. The SAMU and the Center 15 have a structure in general departmental; some SAMU also ensure coordination regional. The SMUR, regulated by the SAMU, are those public hospital services of university hospital centers are equipped and major general hospitals, and they figure in a list kept by the Ministry of Health.
15 is the emergency medical call number, unique for the whole territory, such as the 17 for the police and 18 for the firemen. An automatic scale is planned between the different services public like veterinary ( ce lien ) services. The 15 is departmental. Most of the Departmental SAMUs are related to 15, or in the process of being, but few actually work in the Center 15, which implies the existence of a regulation joint with general medicine. The majority of SAMUs, with the only regulatory doctor Hospital, the total of minor emergencies over the general practitioner on duty. In general terms, the sum of calls about general medicine emergencies that are specific to their competence are all right. In some sectors, the inadequacy of the guard medical practice has led to the emergence of organizations of emergency physicians, gathered under the appellative of the SOS doctors.
The SAMU regulation, performed by a regulatory doctor, helped by “stay” (permanent, fixed) that help medical regulation (PARM), receives the set of emergency medical calls that come from individuals, doctors or other services public of urgency, police or firemen. The calls are received by phone, 15 or the particular number of the SAMU, or by radio, over a total of frequencies controlled by the Transmission Service of the Ministry of the Interior (STI).
Beside this daily activity of medicine of urgency, the SAMU has been introduced more and more in the course of recent years in catastrophe medicine in order to deal with exceptional situations which may be faced in the form of catastrophe with limited effects, but also in the prevention of major risks, both natural as technological. Several exercises are carried out each year to prove the proper functioning of the plans and the result of the teams. Important means are made available to the SAMU to deal with to eventual catastrophes. The essential is composed by second-generation Medical Aid Posts including special containers with the material and the medicines to treat 400 injured, inflatable tent that can serve as a center of classification or PMA, material and reserves (food rations) that allow the operation prolonged self-help teams, trucks and trailers for the rapid transport of the material, etc. Fifteen PSM2 are currently implanted in different French SAMUs of the thirty. They should be gifted at the end of the program.
Allied with prevention and intervention tasks, the SAMU ensures an important part of training and teaching in the university framework. This information begins first with doctors in training initial, at three successive levels in the course of medical studies; then in continuing education within the framework of the University Diploma of Medicine of Urgency, for generalists or doctors of the job. A specialized training is given in Anesthesia Resuscitation and within the framework of Capacities of Urgent Medical Assistance and
Each of them involves an exam which allows a selection of candidates to enter. These university diplomas are accessible to doctors in Medicine and they are developed in two years for urgent medical aid discipline and in a year to the medicine of catastrophe, behaving a teaching theory and practice, as well as participation in a final exercise for catastrophe medicine. The SAMU also ensures the training of personnel paramedic through the Teaching Center of the Emergency Relief, forming the school of the ambulance drivers who prepare for the obtaining driver’s certificate of Ambulance, as well as initial training and continued the urgency of the nursing staff and auxiliary.
Transportation to emergency medical assistance of the technological progress made by the latter years in the hospital, it is imposed without any doubt. Today the ventilation is no longer conceived with a mini-respirator of transport of a patient with syndrome adult respiratory distress (ARDS) of a service of resuscitation, where he was ventilated with a respirator of sophisticated resuscitation, during its transport to another service like dentists ( dentiste de garde nuit ), where it would be too. Some ambulances must therefore be equipped with permanent respirators that allow the types of more complex ventilation, and the patient will be monitored in an identical way of pulse oximetry and capnography.
Similarly, the performance of constant debit infusions by electric pumps or syringes they are obviously imposed. Some techniques more typical of medical care of urgency, such as the use of anti-aging pants G, external electro systolic maintenance or telemetry they know important developments. The utilization of extracorporeal oximetry in pediatric transport already exists in some SAMU.
The evolution towards specialization
Created more frequently at the initiative of the resuscitating anesthetists, the SAMUs are currently directed in 85% of cases by resuscitating anesthetists. The difficulties of hiring specialists, the development of SAMUs and SMURs, they no longer work with a majority of anesthetists rescuers. These are the majority in the posts of address but the intervention doctors are more and more doctors trained in the SAMU and graduates of urgent medical help capacity. Super specialized, anesthetists-resuscitators responsible for SAMUs and SMURs are dedicated only to emergency medicine.
Since the creation of the first SAMU, medicine of urgency has not stopped developing and evolve. The high degree of qualification required has progressively led to the rank of a new specialty whose limits are to be delimited.