REG900ENG 2004 SAMU IEMS Civil Defense 1

An actual exclusive Public Health Civil Defense

through a SAMU network ?

THE BACKBONE OF AN EXCLUSIVE MEDICOSANITARY INTEGRATED EMERGENCY MEDICAL SYSTEM

(IEMS)

Miguel MARTINEZ ALMOYNA (MD MCU)

REG900ENG 2004 SAMU IEMS Civil Defense 2

French IEMS (like deffined in Declaration of Jalisco)

MOH civil defense specific organisation

for disastrous sanitary crises

1. Pre hospital Emergency network sub-system

2. Hospital network Emergency sub-system

3. SAMU call centers for control and medical regulation sub-system

REG900ENG 2004 SAMU IEMS Civil Defense 3

THE NATIONAL EMERGENCY CARE PRE-HOSPITAL SUB- SYSTEM NETWORK

= Primary Care network for GP Emergencies = Emergency Ambulance fleet resources for

emergency transporting patients (MICU*, Rescue Units*, Basic transport Ambulances* )

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THE NATIONAL EMERGENCY CARE HOSPITALS SUB- SYSTEM NETWORK

= Secondary level of care hospitals ER and MICU (SMUR) resources are monitored by local SAMU

= Tertiary , Specialized emergency and ICU resources are monitored by local, neighbouring and regional SAMU

= Zonal area leading Reference Hospitals for NBC disasters

REG900ENG 2004 SAMU IEMS Civil Defense 5

The French SAMU and SMUR Network for Emergency Care

• In day to day medical individual emergencies • In collective public health mass emergencies• In France (continental and remote islands!)

REG900ENG 2004 SAMU IEMS Civil Defense 6

Toulon

Angoulême

Périgueux

Bordeaux

Mont-de-Marsan

Agen

Auch

TarbesPau

Foix

Toulouse

Montauban

Cahors

Aurillac

Niort

La Rochelle

Rodez

Albi

Carcassone

Montpellier

Mende

Privas

Le Puy

Lyon

Bourg-en-Bresse

Annecy

Chambery

Grenoble

Valence

Gap

Avignon

Marseille

Perpignan

Digne

Lons-le-Saunier

MaconMoulins

DijonBèsançon

Vesoul

Épinal Colmar

StrasbourgNancy

Metz

Bar-le-Duc

ChaumontTroyes

Auxerre

BourgesNevers

Chateauroux

Poitiers

Angers

Le Mans

Alencon Chartres

Orléans

Blois

La Roche-sur-Yon

Nantes

Vannes

Quimper

St-Brieuc

RennesLaval

Saint-LoCaen

Évreux

Rouen

Amiens

Arras

Lille

Laon

Charleville-Mézières

Châlons-sur-Marne

Versailles

Beauvais

Gueret

Limoges

Tulle

Bastia

Ajaccio

Nice

St.Etienne

Clermont-Ferrand

Tours

Evry

Mulhouse

Nîmes

Bayonne

Brest

Le Havre

Calais

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

1617

18

19

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

76

78

79

80

89

2A

2B

95

91

87

88

81

82

8586

84

83

Aveyron

Lot

Ariège

Gers

Garonne

(Haute)

Pyrénées

(Hautes)

Tarn

Tarn-et-

Garonne

Pas-de-Calais

Nord

Vendée

Sarthe

Maine-et-

Loire

Loire-Atlantique

Mayenne

Aisne

Oise

Somme

Charente

Charente-

Maritime

Vienne

Sevres

(Deux)

Alpes

(Hautes)

Alpes de Haute-

Provence

Alpes-

Maritimes

Bouches-du-

Rhône Var

Vaucluse

Ain

Savoit

(Haute)

Savoie

Isère

Loire

Rhône

Ardèche

Drôme

Corse-

du-Sud

Haute-Corse

Rhin (Haut)

Rhin (Bas)

Gironde

Dordogne

Lot-et-

Garonne

Landes

Pyrénées-

Atlantique

Puy-de-Dôme

Loire (Haute)Cantal

Allier

Manche

Orne

Calvados

Côte-d'Or

Niévre

Saône-et-Loire

Yonne

Eure-et-Loire

Cher

Loir-et-Cher

Indre

Indre-et-Loire

Loiret

Marne

Marne

(Haute)

Aube

Ardennes

Saône

(Haute)

Doubs

Jura

Belfort

Eure

Seine-Maritime

Val-d'Oise

Yvelines

Seine-et-

Marne

Essonne

94

93 Seine-St.Denis94 Val-de-Marne

92 Hauts-de-Seine

75 Paris

Lozère

Gard

Aude

Pyrénées-

Orientales

Hérault

Creuse

Corrèze

Vienne

(Haute)

Meuse

Meurthe-et-

Moselle

Moselle

Vosges

FinistèreCôtes d'Armor

Ille-et-Vilaine

Morbihan

Alsace

Lorraine

Aquitaine

Basse- Normandie

Bretagne

Auvergne

BourgogneCentre

Champagne-Ardenne

Franche-Comté

Haute-Normandie

Ile de-

Languedoc-Roussillon

Limousin

Midi-Pyrénées

Pays-de-la-Loire

Nord-Pas-de-Calais

Picardie

Provence-Alpes-Côte-d'Azur

Poitou-Charente

Rhône-Alpes

Corse

France

92

Pontoise

Melun

9377

REG900ENG 2004 SAMU IEMS Civil Defense 7

THE SAMU SUB-SYSTEM IMPLANTED IN EACH « DEPARTEMENT » CAPITAL TOWN HOSPITALSAS TWO ROLES IN CASE OF EMERGENCY

The responsible physician (SAMU medical regulator physician) as the two roles

A technical medical role for deciding and organizing the initial medical emergency care

An Administrative Authority emergency Delegated Role for deciding alerting and initiating « plans blancs » and « plan rouge » Public Health emergency resources involvment in the emergency phase of the crisis

REG900ENG 2004 SAMU IEMS Civil Defense 8

The French SAMU emergency tele-medecine system and network improoves not only quality of

care but also equity of resources Through a national medical emergencies specific and

protected exclusive hotline (15)Plus a health care tele-communication network

beetween emergency regional integrated medical emergency hospital (ER OR ICU) and out of

hospital resources (MICU Ambulances)Plus a MOH national civil defense policy

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The Hospitals and SAMUs french public Health disasters « Plans Blancs »

Four tiered1 local Hospital « white plan »2 « Departemental IEMS network » SAMU + DDASS « white plan»3 Public Health Regional and Zonal IEMS network« zonal white plans » ARH+DRASS+Regional Leader SAMU4 MOH + SAMU de Paris = national and international disasters

(Foreign Office)

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Exemples:

• A mega explosion in Toulouse• A mass casualty in a Corsica Island

Stadium or Charles de Gaule Airport• An Paris subway attentate• A disaster in Latin America or an Air

France aircraft terrorist attack …

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A NATIONAL SAMU NETWORK BUT WITH 3 LEVELS

1. « Départements » SAMU (and

neighbouring « departements »)2. « Public Health Civil Defense

Zones » regional SAMU3. « BMOH + SAMU of Paris »

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A NATIONAL COORDINATED (?) AN EMERGENCY CARE PUBLIC

HEALTH SYSTEM? A REAL INTEGRATED EMS (IEMS)

Ministery of Health + Military Defense Civil Defense Fire Men Rescue (plan Rouge) Private, ONG Foreign Office

REG900ENG 2004 SAMU IEMS Civil Defense 14

For More Informations on Public Health Civil Defense

Emergency Tele-medecine and SAMU regulation

• migmigmig@orange.fr• SLIDESHARE Miguel Martinez

Almoyna

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French MOH and SAMU documents on Public Health Civil Defense

• WWW.sante.gouv.fr• www.samudeparis.org

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WWW.sante.gouv.fr/dossiers/planblanc2004.pdf

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The SAMU network is the key of a actual Public Health Integrated EMS is the nervous system of both day

to day and disaster medicosanitary emergencies