Ambulance man

A Ambulancier is an actor of the chain of care which with for role the transport and monitoring of patients or wounded as well as the administration of first aid.

The notion and the role of the ambulance man vary according to the countries, the concept of ambulance man in France is very different from the technician Québécois (TA) ambulance man.

Role and formation

The role, and thus the training of the ambulance men, depend on the organization of the helps in the country. Two cases overall are distinguished:

the countries where the medicalisation frequent, and is decided as of the phone call, it is typically the case of the country having developed a Samu (like the France and the Belgium): the role of the ambulance man is primarily the transport of a stabilized victim (i.e. whose state is not very likely to evolve/move in the hour which follows) or not stabilized, if the victim is not stable, they are assisted of a medical team according to the regulation (transmission of information) with a doctor of the SAMU;
the countries where the medicalisation is rare or non-existent, the Médecin is called in reinforcement by the ambulance, or in some cases is sent in first intention (case of the Anglo-Saxon countries, of Switzerland and Northern Europe): the ambulance men see themselves delegating medical gestures to be able to transport unstable victims ( Paramedic S ).

One thus has two types of ambulance men:

those having a formation of first aid, which can transport the stable victims or assist the doctors or the paramedics : their formation lasts between 100 and 500 hours;
the paramedics which are seen delegating medical gestures on protocol (Intubation trachéale, poses of a Perfusion, administration of Médicament S), and of which hard formation from 900 to 5000 h.

Ambulance men in France

Two categories are distinguished:

Auxiliaries ambulance men

Until 2006, one spoke about driver of ambulance. The term was changed into auxiliary ambulance man by a decree (January 26th, 2006). This decree sets up moreover an obligatory initial training of 70 H as from 2008, until there, the Attestation of formation to first aid (AFPS) is enough.

The titular professional of the station of auxiliary ambulance man ensures the control of the light medical vehicle or is the team-member of the ambulance man, in the ambulance. He can drive an ambulance (vehicle allowing lengthened transport, vehicle known as of “category has” or “C” within the meaning of the decree n°87-965 of the November 30th 1987 relating to the approval of terrestrial medical transport) in team with a person having the Certificate of competence of ambulance man, or drive only a light medical vehicle (VSL, vehicle known as of “category D”), i.e. a car (without special warning signal) allowing the sitted medical transport of an autonomous patient or asking a light assistance.

The auxiliary ambulance man must lay out:

of a driving license conforms to the regulations in force and in a state of validity;
of the prefectoral certificate of aptitude the driving of ambulance after medical examination carried out under the conditions defined in article R. 221-10 of the highway code;
of a doctor's certificate of vaccinations in conformity with the regulations in force fixing the conditions of immunization of the health professionals in France, and between on January 1st, 2008 and on January 1st, 2010, for the auxiliaries ambulance men in the first employment in this function or the professionals who exert this function for one cumulated period higher than three months:
as from 2008, of a certificate of 70 hours formation with evaluation of acquired competences. This training relates to hygiene, the deontology, the gestures of handling, the rules of medical transport and on the emergency gestures for obtaining the certificate to the gestures and emergency care of level 2 or of an equivalent training recognized by the ministry in charge of health. This formation is delivered by the training institutes authorized for the formation with the diploma for the occupation of ambulance man. Beyond on January 1st, 2010, this certificate of formation will have to be provided by all the personnel, holders or substitutes, applicant with functions of auxiliary ambulance man, except for those having already provided such functions before this date.

The ambulance man

To exert, an ambulance man must have a diploma delivered by the regional prefect and who attests necessary competences to exert the trade.

Since September 2nd, 2007, the CCA (certificate of competence ambulance man) and of the DA (diploma for the occupation of ambulance man) became diploma of State of ambulance man, according to the decree 2007-1301, with retroactive effect (the denied holders diplomas are holders of From equivalence).

Complexity of the trade

What an ambulance man?

It is not a Médecin : but it must make an assessment starting from a history, signs, symptoms in order to manage the gestures of first aid and to transmit a complete assessment to the regulating doctor.

It is not a Infirmier : but it applies techniques of care male nurses in the ambulance to ensure of the correct positions and of comfort to the patient during the voyage.

It is not a welfare worker : but it is often approached by people suffering, or many elderly without heating or food, alive in the poor conditions; or by abandoned children. It must include/understand the complexity of the laws of the mentally ills.

It is not a Sage-femme : but it at the time of making childbirth in residence or in the ambulance or nonsuitable environments for the mother or the baby.

It is not a police officer : but it must include/understand the laws of the Highway code and apply them.

It is not a Sapeur-pompier : but it must include/understand and apply the techniques of rescue in the accidents, the effects of the toxic loadings.

It is not a mechanic : but it must have basic knowledge in mechanics to repair the breakdowns and to maintain the vehicles.

It is not a Sociologue, a Psychologue : but it must help people in situations of distress, the emotional attitudes and know acceptable control according to the particular cultures. It is brought to deliver its opinion on cases when the regulating doctor asks him.

It is not a director : but it directs a situation, projects in the short run, uses own resources to complete an established objective, and handles the environment to lead the objective.

It is not a Physiologiste : but it must be able to identify the effects of accelerations on the affected casualty or bodies, caused by the various changes of management and of deceleration of the vehicle.

It is not a racing driver : but it must lead quickly and comfortably when that requires it.

Here are which shows well all the complexity of the trade of ambulance man.

Role of the private ambulances

The private ambulances are private companies approved for medical transport, and which employ drivers of ambulance and the personnel médico-technique (CCA). They ensure the transport of the patients of their residence towards the structures of care and of the structures of care their residences (transport known as primary education) on medical regulation (transport is refunded by the Health insurance); that includes/understands inter alia programmed surgical operations, the recurring care (dialysis, chemotherapy, radiotherapy…). They also take care of transport between the structures of care (transport known as secondary).

The private ambulance men take part in the public helps; the companies in turn place crews at the disposal of the Samu which can send them to residence for evacuations (primary education transport) towards the urgencies of the hospitals; they do not carry out missions on the public highway except in supports of the public helps under certain conditions. In the event of deficiency of ambulance men, intervention in residence without concept urgently vital, the Samu can send to the place a vehicle of help and assistance to victims (VSAV) of the firemen. Any intervention in medium not protected is spring of the firemen. The private ambulances are “vehicles of general interest profiting from facilities of passage” (Article R311-1 of the highway code, conveys category has or C according to the decree of the NOR June 10th, 1998: EQUS9800722A).

There are two types of ambulances:

the ambulances of category has or ESA (Ambulance of Care and emergency Help); it is with this type of ambulance, known as of great volume, that the ambulance men must ensure the services of urgencies (departmental guards) and accompany the teams by the S.A.M.U
the ambulances of category C, known as of small volume, which are used for all other transport as lengthened patients

They are provided with special warning signals which can be actuated when the mission is urgent:

blue fires with glare ( flashes ) (Article R313-27 of CR and decree of the NOR October 30th, 1987: EQUS9800722A);
sound signalling hooter (siren) to two let us tons in three times (pine-pon-pine… pine-pon-pine) for the not-urgent missions (Article R313-34 of CR and decree of October 30th, 1987).

The R432-2 articles and 3 of the highway code gives them exemptions when the special warning signals are activated, when the urgency of the mission justifies it and with the proviso of not putting the safety of the other user in danger , on the following points:

use of the sound signalling hooters (horn and siren) and luminous (calls of headlight and flash-lights); the use of the warning signals is normally restricted with the avoidance of the accident;
going beyond speed limits;
on expressway and highway: parking, circulation on the hard shoulder, step back and half-turn;

but they must comply with all the rules of priority, in particular red lights, panels stop and yield the passage, priority on the right, priority with the pedestrians.

Organization of the guard ambulancière and regulation of urgent medical transport

The guard ambulancière is organized in each department by the Departmental association of medical transport urgently (ATSU or ADTSU), an association gathering the private companies of ambulance. The financial balance of the company during a guard is ensured by the payment (reduced of 60%) of the transport accomplished by the Social security, like by the payment of a fixed price of guard of 346€ to compensate for the reduction of dried up to 40% of the normal. During these departmental guards, the company places its ambulance at the whole disposal of center 15, the ambulance of guard cannot in no case to be used for a transport which is not ordered by the SAMU. The employee is as for him is remunerated 12 hours which return in its weekly amplitude time and which are raised of 10% in compensatory leave. The employee donot can in no case to work 11 hours before and 11 hours after its guard (Confers master agreement of May 4th, 2000 Collective agreement of transport, additional of medical transport).

According to the departments and the agreements between the CRRA and the local ATSU, the companies of ambulances can place at the disposal a person in Center 15 (CRRA) in order to manage the transport demands medical within the framework of the guard. This makes it possible to release the PARM (permanancier of center 15) of this task.

The ambulance man within a SMUR

In the emergency Mobile services and of Reanimation (SMUR), the crew of a hospital mobile Unité (UMH) includes/understands a titular ambulance man of the CCA and heavy-goods vehicle license (except with APHP) and of the Formation of adaptation to use (FAE) of ambulance man of SMUR of the hospital public office (stopped of April 26th, 1999 OJ Number 113 of May 18th, 1999 page 7295).

This formation of adaptation to employment is validated by a certificate of follow-up of formation delivered by the Center of teaching of the emergency care (CESU)

Legislative texts

Public health code, L.51-1 articles in L.51-5
of the November 30th 1987 relating to the approval of terrestrial medical transport (NOR: ASEP8701205D) modified by the decree n°94-1208 of the December 29th 1994, n°96-176 of the March 4th 1996, n°97-1186 of the December 24th 1997, n°2001-532 of the June 20th 2001 and n°2003-674 of the July 23rd 2003
Stopped of March 21st, 1989 relating to teaching, the tests and the delivery of the certificate of competence of ambulance man modified by the decree of June 4th, 2002
Decree n° 91-45 of the January 14th 1991 bearing particular statuses of the working personnel, the drivers of car, the drivers ambulance men and the personnel of maintenance and healthiness of the hospital public office * Decree of January 10th, 1996 relating to the exercise of the activity of ambulance man of the nationals of the Member States of the European Union and other States left with the agreement on European Economic space (NOR: TASP9620191A)
Stopped of July 23rd, 2003 fixing the periods of the departmental guard ensuring the permanence of medical transport (NOR: SANH0322762A)
Circular DHOS/O1 n° 2003-204 of April 23rd, 2003 relating to the organization of the guard ambulancière
Stopped of January 26th, 2006 relating to the conditions of formation of the auxiliary ambulance man and to the diploma for the occupation of ambulance man (NOR: SANP0620487A)
national Collective agreement of road transport and the auxiliary activities of transport, N°3085.

See the legislation page of Unah

Ambulance man in Switzerland

The situation depends on the cantons. The first laws on the equipment of the ambulances and the training of the ambulance men date from the end of the Années 1980 (cantons of Basle, of the Tessin, Geneva).

In the canton of Geneva, the law was voted in 1987. The formation included/understood 900 H of course and training courses for ambulance men already in activity, alternation over three years, and made it possible to found a common base for the whole of the partners of the medical back-up system.

In 1998, the canton adopts new regulations suggested by the Swiss Croix-Rouge (CRS), which had received for mandate to think of the evolution of the profession; these regulations in particular propose to revalorize the occupation of ambulance man on the same level as the other paramedical professions. The ambulance men thus acquire an autonomy in the gestures of rescue, and thus a delegation of the medical gestures, according to the model of the BASIC life support (BLS) and of the advanced cardiac life support (ACLS) states-unien.

It results a formation from it from approximately 4 600 H over three years, of which between a third and a half of training course practical. The first year is devoted to the bases (Anatomie, Physiologie, psychosocial approach…), with specific professional competences (professional role, led, Radiotelefony…) and with the assumption of responsibility of the stable patients; it comprises four training courses: in Orthopedy, in services of ambulance private or public, and two in the field of the elderly or Handicap ée. The second year is devoted to the complex situations, the third year with the exceptional situations; these two years comprise training courses in hospital medium (urgencies, Anesthésiologie, Pédiatrie, Obstétrique and Mental health), in a central of call (central 144), again in services of private or public Ambulance and in a emergency Mobile service and of reanimation (SMUR). Then, in third year, the pupil will have to achieve a work of diploma and a training course with option.

External bonds

Gate of the Swiss ambulance men (Ambulanciers.ch)
Swiss Site of the services of rescue (Swissrecue)
Genevese cantonal Federation of ambulance men (FCGA)
Protocols ambulance men
the trade of ambulance man, page of the site of the Ministry for French health
File terrestrial medical transport of Secourisme.net

Site relating to the employees ambulance men

Site dedicated to the trade of the ambulance man-smur
Site dedicated to the employees ambulance man-private

Sites relating to the owners ambulance men

Turbulances, site of the magazine of French ambulance men
national Room of the services of ambulance (CNSA)

Internal bonds

urgent Medical assistance
Ambulance
Vehicle of help and assistance to the victims

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