Médical régulation

The French system characteristic of the SAMU is that the medicalization starts as of the reception of the call.

When someone dials the 15, he is in immediate relation with the operator/dispatcher center (Center of Reception and Regulation of Calls) (CRRA) still know as Centre 15.
This center is unique in the Alpes-Maritimes department; it centralizes all the emergency calls.
He call is received by the Permanenciers of Assistance of Medical Regulation (PARM) who opens a medical file, locates the request (name, addresses, telephone…), evaluates quickly the nature of the call and its gravity, and, connects with the regulating doctor.

The regulating doctor, after having questioned the caller, makes a medical decision (council, attending practitionar, doctor of guard, private ambulance, firemen, SMUR) adapted to the nature of the call.
Three advantages rise from this management of the calls:

• the most severe patients profit without delay from the most powerful means which are reserved for them;
• the specialized medical teams (SMUR) intervene only on the heaviest cases;
• the most powerful medical resources, necessarily rare and expensive, are used as well as possible.

Moreover, the nearest hospital is not always the one most adapted to the patient’s needs. The regulation and in particular the dialogue between the intervening doctor, the family doctor, the doctor of the supposed hospital structure and the regulating doctor of the SAMU assure the patient, as well as possible, direct medical access to the most appropriate care establishment based on his/her medical needs.

Thus the SAMU 06 is in the center of a vast coordinated device of emergency care integrating all the concerned partners (hospital complexes, liberal doctors, firemen, private ambulances…).
The medical regulation enabling the most adapted medical response is the fundamental element of this device.

This typically French device allows for the optimization of the public health resources and guarantees to all an equal access to emergency care. It’s great flexibility prevents useless hospitalizations and makes possible the most effective use of the heaviest means which are the SMUR.

At the SAMU 06, the medical regulation is organized in the following way:

• 3 or 4 regulating doctors 24/7:
• 2 hospital emergency medical doctors
• and 1 or 2 liberal doctors;
• 5 Permanenciers of Assistance to the Medical Regulation (PARM) from 8am to 8pm
• 3 Permanenciers of Assistance to the Medical Regulation (PARM) from 8pm to 8am.

This team ensures 24/7 thus the response to the emergency medical calls and their follow-up.

Liberal medicine

Inside the SAMU 06, liberal medicine takes part in the assumption of emergencies since the creation of Center 15.

The Association of the Health services and Medical emergency of the Alpes-Maritimes (ASSUM 06), is the liberal partner of the Academic Hospital center (CHU) of Nice for the regulation of the calls of Center 15 (or CRRA) of the Alpes-Maritimes.
The ASSUM 06 is an association based on the 1901 law, created in 1988 on the initiative of the trade unions of liberal doctors and the Doctor’s Council (COM) of the Alpes-Maritimes.
A Convention binding the ASSUM 06 and the CHU of Nice was signed on November 9,1990.

Center 15 officially started on January 21,1995.

The ASSUM 06 gathers the various liberal partners of the department interested in the Urgent Medical aid, that is to say a score of guard doctor associations or private establishments of hospitalization.
27 liberal regulating doctors control in Alpes-Maritimes Center 15. They are installed in liberal medicine and are native to the department. They are renewed by group of 3 every 6 months. The newcomers benefit from a 30 hour formation in the regulation room.

The liberal regulating doctor is present 24h/24 in the regulation room. This presence is doubled during daily “peak” times, during certain public holidays and weekends according to the circumstances.
The liberal doctor manages calls 15, 18 and 112 (via interconnection 15-18, the Alpes-Maritimes convention SAMU/SDIS of 1998), concerned with the permanence of the care, and of the urgent visits in residence and comparable places.
The calls concerned with proven or potential distress are controlled by the hospital regulating doctors as well as the calls concerning public ways and places.

In 1999, out of more than 130 000 businesses treated in the year with Alpes-Maritimes Center 15, the liberal regulating doctor managed approximately 40% of these businesses:

• 47% of the calls gave place to a liberal medical visit;
• 30% to a simple medical council;
• 10% to a transport by private ambulance in first intention;
• finally 3% to the sending of an average public Fireman or SMUR.

In the case of the activation of a liberal medical effector, the regulating doctor will always try to join the attending practitioner. In second intention, it will contact the sector doctor on duty.

In the Alpes-Maritimes, there are 11 turns of duty H24, 4 turns of night time and weekend duty, and 20 turns of duty only on weekends.

Lastly, in the event of unavailability or of excessive delays in intervention, it will contact an association of doctors on duty or emergency medical doctors in proximity (10 associations of this type in the Alpes-Martimes department).

To activate private means of transport, the regulating doctor contacts the private ambulances companies of the sector concerned.
A turn of duty of the of private ambulance companies is in the process of being installed. An ambulance driver coordinator positioned in Center 15 will be in charge of the sending of the ambulances. This had been made necessary by the exposed situation of the regulating doctor according to this turn of duty and the availability of the various private means of transport.

The Alpes-Maritimes Center 15 is a operator and dispatching center (CRRA), new and in full expansion, having an activity among one of the most important of France. It succeeded perfectly in the integration of liberal medicine to the medical regulation for the greatest satisfaction of all the users of the public utility and the partners of the Emergency Medical Service.

Communication and information management means

To fulfill its missions the SAMU 06 has important means of communication and information management:

• a telephone automatic exchange dedicated to the SAMU 06 giving access to the Numeris network with identification of the call number (T20 arrived lines - 10 lines departure, 3 T0 of help);
• a telephone automatic exchange of help not dedicated;
• a connection specialized (transfix 16 ways) with the Firemen of Nice;
• various specialized telephone links (police force, prefecture…);
• a numerical system of recording of the totality of the telephone calls and radio received or emitted by the SAMU 06;
• a computerized management system of the radio operator ways allowing 10 current operators the use of 25 radio ways, the management of the “beep of alarm” of the personnel, the radio interconnection/telephone…;
• a computerized system of assistance to the medical regulation (Centaur 15 - LOCATED France like 32 SAMU in France) allowing the immediate access to data banks, the search for backup facilities by proximity, the management of the directories of the first-aid organizations…;
• a computerized filing of each business treated by the SAMU 06.

The coordination of the first-aid organizations

In the Alpes-Maritimes, in accordance with the regulation, the centers of calls 15, 18 and 112 are inter-connected. A convention on the daily management of emergency medical service was signed by the departmental director of the Fire protection and help organizations, the general director of the academic Hospital center of Nice and the prefect of the Alpes-Maritimes, and it’s application is effective since June 2000.

Thus all the calls will be passed to the SAMU 06 for medical regulation.
A first-aid worker team of Firemen intervenes systematically and immediately on the public highway, in the places frequented by the public and in residence in the event of vital distress.

When an ambulance (private ambulance or Firemen) is dispatched on the spot, an assessment is systematically transmitted by the first-aid team on the spot to the regulating doctor who can then decide on a possible medicalisation and orientation of the victim towards the most adapted establishment.

The use of a common radio operator network allows the teams to remain in permanent liaison with the regulating doctor and largely facilitates the management of the interventions.

This coordination makes it possible to adapt the response to each case and to have in the serious cases an immediate response.
The harmonization of the principles of action of the public emergency medical service and the most complete information of the regulating doctor of the SAMU 06 allows a better management of all the actors of the Urgent Medical Aid. This organization allows a response adapted to each request for assistance and thus spares the hospital from an abusive or unsuited request.