The SMUR of Nice

The Mobile Service of emergency and intensive care (SMUR) is the structure of prehospitalian intensive care which intervenes, apart from the hospital, at the request of the regulating doctor of the SAMU.

Two types of intervention are carried out by the SMUR teams:

• interventions known as “primary”: these interventions aim to deal with, without delay, any vital distress that may occur, no matter where, no matter the age nor the pathology. These interventions have always priority;
• Interventions known as “secondary”: these interventions generally consist in the transportation of already hospitalized patients who require a transfer to a specialized service not existing in the establishment of origin.

The CHU of Nice thus carries out the transfer of patients coming from public or private hospital complexes of Antibes, Cannes, Grasse, Draguignan, Menton, Monaco, Fréjus Saint-Raphaël as well as Corsica.

Each team which intervenes has according to the nature of the intervention:

• an anaesthetist or urgentist doctor;
• a anaesthetist nurse;
• a titular driver of the Ambulance driver Competence Certificate (CCA);
• one assistant, a hospital student or a trainee…

Une équipe SMUR spécialisée pédiatrique est également disponible H24. Sa mission est d'assurer les transports de néonatalogie.

A SMUR team specialized in pediatry is also available H24. Its mission is to ensure transport of neonatalogy (it carried out the transport of more than 144 new-born in 2002).
SMUR Team remains in permanent contact, in particular by radio, with the SAMU and the regulating doctor.
Once arrived on the spot of the intervention, after examination of the victim, the doctor implements the suitable treatment and informs the regulating doctor of the SAMU.
According to the state of the victim, of his desire and of the availabilities of reception of the hospitals, the regulating doctor decides on the patient orientation towards the hospital likely to receive him.The hospital will be informed of its arrival.
The intensive care teams of the SMUR are likely to implement sophisticated technics of anaesthesia-reanimation (general anaesthesia, methods of particular assisted ventilation, transport under intra-aortic balloon of counterpulsation…).

The SMUR staff of Nice is composed of:

• 3 anaesthetists- intensive care doctors (of which the medical director);
• 27 emergency doctors including 10 full times experts;
• 1 intern of medicine;
• 2 hospital students;
• 1 higher framework nurse;
• 5 anaesthetists nurses graduate of state (IADE);
• 2 secretaries;
• 22 titular ambulance drivers graduated from the Ambulance man Competence Certificates (CCA);
• 7 nurse’s assistant(AS);
• 1 radio operator technician;

Radioelectric means of the SMUR of Nice:

• network 150 MHz: 15 relay with numerical indication, automatic search of the better relay:
  number of mobiles: 26
  number of transportables: 33
• network 80 MHz: 15 Civil Safety channels taken care H24 by the SAMU:
  number of mobiles: 15
  number of transportables: 15
• other networks: Marine VHF, help in mountain, aeronautics, the French Red Cross, CHU ambulances of Nice, PSM II, networks 3 RP (Héliophone, Régiocom).

Average mobiles of intervention of the SMUR of Nice:

• 4 medical teams of intervention of day permanence, and, 3 the night, working after 6 p.m.;
• 4 intensive care ambulances called Hospital Mobile Unit (UMH) stationed at the hospital;
• 1 Vehicle of Medical Intensive care (VRM) allowing to convey a medical team in reinforcement of first-aid workers ambulance;
• 1 4x4 vehicle for the specific interventions (perilous environment…);
• 1 connection vehicle;
• 1 helicopter available (of Civil Safety based in Cannes-Mandelieu). The Regional Diagram of Medical Organization (SROS) has planed to equip the SAMU with a twin-turbine hospital helicopter specific to the SAMU 06 with regional vocation during 2004.

Other SMUR of the department

The SAMU 06 established with the CHU of Nice has a departmental vocation. Concerning the medicalization of the emergency calls, it gathers, by convention, the whole of the departmental SMUR.
Like all of the CHU, the SAMU disposes of a SMUR (the SMUR of Nice) which is located in the buildings of the SAMU 06.

The other departmental SMUR of the Alpes-Maritimes are:

• the SMUR of Antibes located within the hospital of Antibes/Juans-the-Pines (Fontonnes), which has a H24 team;
• the SMUR of Cannes located within the hospital of Cannes (Les Brousailles) which has a H24 team and a second secondary team of transport during the day;
• the SMUR of Grasse located within the hospital of Grasse (Clavary), which also has a H24 team;
• finally, the SROS plans to create an off-set antenna of the SMUR of Nice with Menton (opening envisaged during 2004).
• the SMUR Menton located within the hospital Menton (The Palmosa), is an outpost of SMUR Nice and also has a team H24. Since 1^st November 2005, an agreement between the University Hospital of Nice and hospital Menton provides for the creation of a mixed crew: the doctor is Nice for 70% of medical time, Menton 30% (creation of a position H24), nurse is detached from the emergency department (job creation H24). The car and the allocation of biomedical equipment are provided and maintained by CHU, staffing provided by the pharmaceutical hospital Menton. The average downtime is 90 minutes per primary output: indeed, the geographical area of ​​operation is quite extensive including the Roya valley, until 1:30 any, and evacuations are performed frequently on the CHU Nice 35 kms from Menton.

Zones of responsibility for the SMUR

The Emergency mountain service

In January 1998, the Alpes-Maritimes Prefect, entrusted to the SAMU 06 the responsibility of the regulation and organization of the medicalisation of the operations of mountain emergency.

Thus, in accordance with its lawful mission, the SAMU 06:

• ensures a permanent medical listening of the radioelectric network of Mountain emergency “Mercantour Safety”;
• organizes the medicalisation if the intervention requires it;
• advises the first-aid worker teams on the spot, particularly when a doctor is absent;
• coordinates the medical help on the spot of the operation;
• is systematically the recipient of first-aid and medica the assessments;
• directs the evacuation of the victim and organizes its transport towards the hospital ready to receive him and prepare its reception.
• is systematically the recipient of first-aid and medica the assessments;

By convention with the Company of the Alpes Maritimes Emergency Mountain service, the radioelectric SAMU 06 networks (15 relay) and Help in Mountain (5 relays) can be inter-connected to facilitate the operations of help in mountain.

With the organization of permanent Emergency Mountain service (CRS 06 or the PGHM, in alternation one week out of two, reachable by only one number the: 04 97 22 22 22) SAMU 06 ensures a 24h/24 listening network radio operator Help in Mountain.

The first-aid mountain team of CRS 06 and the High Mountain military police group (PGHM) as well as the chief trackers of the Alpes-Maritimes ski resorts also have a direct access to the radio operator network of the SAMU 06.

The Alpes-Maritimes Company of Emergency Mountain service and the SAMU 06 filed out the 7 refuges kept by the first aid French Alpine Club:

• a “guard” kit including the first aid necessary for the use of the guard or the first-aid workers of passage;
• a “doctor” kit including the intensive care medical use material (drugs, perfusion…) intended to be used by a doctor after a radio operator contact with the regulating doctor of the SAMU 06.

Thus, when a problem occurs, the guards of the refuges can contact the SAMU 06 per radio.

A dialogue pursues between the guard and the regulating doctor, and, according to the gravity of the call, a decision is taken:

• simple medical council;
• use of the “guard” kit;
• use of the “doctor” kit;
• initiation of a terrestrial or héliporter help operation (immediate or delayed in the early morning).

A specific “first aid” training is given to the refuges guards by the SAMU 06 doctors.

Two physicians of the SAMU 06 are included in the Medical Group in perilous environments of Alpes-Maritimes.

The SAMU 06 and catastrophes

The July 22,1987 law allows for the estabishment of emergency plans. The plan, called “RED PLAN”, intended to carry help to many victims is the most frequently implemented emergency plan.

Primarly, it attempts to organize the help chain, in particular, at the medical level.

The SAMU 06 and the departmental SMUR are the fundamental elements of their implementation.

Essencially, once the release of an alarm, the SAMU 06:

• point out the necessary people;
• alarms the care and reception establishments of the department, in particular the CHU of Nice (Plane hospital White);
• send on the spot the necessary means: an anaesthetist-intensive care or senior emergency aid doctor likely to take the direction of the medical help on the prefect or his representative designation;
• SMUR teams;
• emergency Medico-Psychological Cell teams(CUMP) if necessary;
• a vehicle of connection;

On the spot, the SAMU 06 medical teams participate with the other actors concerned in the medicalisation of the help:

• are integrated in the help chain into the level of the collecting;
• organize the categorization of wounded and their identification;
• ensure the operation of the Advanced Medical Station (PMA), a true rural hospital, and the victims’ evacuation from the PMA towards the hospital destination given by the SAMU regulation.

The Medical Director of the SAMU 06 or his representative fills the function of Director of the Medical Helps (DSM) if the Prefect of the Alpes-Maritimes deems it necessary.

The transporting of victims is accomplished with the assistance of the departemental SMUR means, the means of the Firemen of the Departmental Service of Fire and Help (SDIS 06), of officially agreed first aid associations and the private companies of medical transport approved by the Prefecture, and, required if necessary as well as the helicopter available means (civil safety, military police…).

In accordance with the December 24,1987circular, the publicly-owned health establishments worked out an internal plan of organization intended to withstand a surge of victims (commonly called White Plan).

The SAMU 06 intervened these last years within the framework of these Red Plan releases on several occasions:

• the catatrosphe of Furiani in Corsica;
• the collapse of the store Ferber Casino in Nice;
• the fire at a retirement home in the highlands of Nice;
• the explosion of a building in le Cannet;
• the train accident in the tunnel of Tende.

The SAMU currently takes part in the exercises intended to test the various aid plans of the Alpes-Maritimes department (airport, tunnel, emergency plan in case of a shipwreck, mountain help plan, risks NRBC at the time of an attack...).

The batch of the second generation Mobile Medical Station (PSM II) is a medical and technical material batch placed at the disposal, by the Senior official of Defense near the Health Ministry, near a certain number of hospitals distributed on the national territory and intended to be implemented in the event of catastrophic events in France or abroad.

It ensures the caring of more than 500 wounded during 48 hours and can also be placed at the disposal in reinforcement of a hospital.
A lighting batch, a heating batch and an autonomous radio operator batch supplement this equipment.

Equipment for exceptional situations:

• 1 complete batch PSM II;
• 1 power generating unit;
• 1 radio operator PSM II network;
• 1 inflatable tent;
• 1 lighting batch;
• 1 heat gun.

Since 2008, the CHU of Nice has been endowed by the HFD of the Ministry of health of a hospital decontamination unit brand "Utilis MDC module 30".
It is designed to decontaminate up to 30 victims at the time, valid/invalid, men and women separately in case of chemical accidents, biological, nuclear, industrial, terrorist attack or war.
Immediately available in a trailer for the decontamination of the University Hospital or within a department or area (reinforcement possible at the request of SAMU Zonal), it protects the health facility of contamination of staff and patients, ensuring a "SAS decontamination" upstream of medical care.

Staff SMUR Nice is regularly formed and trained in assembling the 54m2 module, and specific medical management of victims contaminated with a toxic chemical, biological or radiological.

The Medico-pyschologic emergency cell (CUMP)

The catastrophes cause not only physical injuries but also individual and colective psychological injuries, immediate or differed, acute or chronic wounds.

These victims require ermergency care just as much as the physical casualties.
The fast intervention trained psychiatrists, psychologists and nurses, have to ensure an immediate and post-immediate therapy. This therapy must be extended to the psychological support of the families of the victims as well as to the rescuers.

In the Alpes-Maritimes department, a Médico-Psychological emergency cell, integrated into the SAMU 06, was put in place in 1997. It is coordinated by an hospital psychiatrist of the Nice CHU, Doctor Michel BENOIT ( departmental referent of the médico-psychological emergencies which organize this psychological assumption of the victimes, the families of the victims and rescuers.

This organization is based on a departmental list of volunteers doctors, psychiatrists, psychologists and nurses. When the activation of the CUMP was decided (usually when the launching of a help plan takes place) the mobilized health professionals join the SAMU 06.
Specific equipment (uniforms, means of communication, case of intervention…) is placed at their disposal. The first team constitutes a médico-psychological antenna of help composed of a psychiatrist, a psychologist and a nurse. It is integrated into the elements of the SAMU 06 intervention and conveys on the spot of the disaster.
These provisions are gradually integrated into the various help plans of the Alpes-Maritimes, progressively with their revision.

This cell intervened on several occasions since its installation and takes part in different exercises with the SAMU 06 (red plan, airport plan, avalanche plan, shipwrecked men pan…).