Medical regulation

The medical regulation is the administration charged to manage the sending of the medical means as well as the evacuations within the framework of the urgent Medical assistance. It in general takes the shape of a room of coordination with personnel in charge of the telephone calls with the public and the doctors, of the radio communications with the mobile regulating doctor and first-aid organizations (Smur S, firemen).

The concept of medical regulation was born in France in 1968, with the creation of the first service of urgent medical assistance (Samu) to Toulouse by professor Lareng, in order to coordinate the medical efforts between the préhospitalières teams (Smur) and the services urgently hospital. The samus will be officialized in 1976, but 1979 will have to be awaited so that the samu receives the calls of the public directly.

The basic principle of the medical regulation is the “medical Tri”: it is a question of forwarding the adequate means to the victim, then to bring the victim directly to the qualified medical department. Thus, a serious flaring will go directly to the service of the badly burned persons nearest, a Polytraumatisé will go directly to the Hospital laying out of an operating room available 24:00 /24 7j/7… Previously, the victim was brought to the service of reception of the urgencies, then evacuated nearest towards another hospital if the service could not treat it, which involved a waste of time. The medical regulation makes it possible to comply with the rule of the three R of Dr. Trunkey:

“ the right patient to the right place At the right time ” (the good patient at the good place and the good moment).

General principles of the medical regulation

Appealing the Formula One a demand for urgent medical assistance (damu), the operator must determine the need for urgent medical assistance (bamu). One of the main issues is that the urgency felt by the appealing one (damu) is often without relationship with the real urgency (bamu), either that calling it the urgency underestimates (for example Cerebral vascular accident or a Myocardial infarction having seemingly benign signs), or, more frequent case, that it overestimates it (badly benign having spectacular demonstrations, panics, high social impact).

With the reception of the call, the regulation determines:

if there is a demand for urgent medical assistance (damu); if not (error), it reorientates towards another service;
if so, it enquiert of the localization and opens a medical file;
it determines if there is a need for urgent medical assistance (bamu), by a diagnosis:
1. to collect the request
2. remote handling of appealing to refine the vision of the situation (operational signs of regulation)
according to the urgency, it determines the adapted answer.

“The regulation” can nominate one or more persons here.

The urgency (U) depends:

of the gravity (G) of the state;
of the care (S) necessary;
of the time (T) which one has before an irreversible aggravation
of the social valence (V), i.e. of the impact on the entourage;

If one could quantify each element, one could quantify the urgency by the equation:

U = G × S × V/T

This emergency quantity is what induces the decision on behalf of the regulating doctor (choice of the graduated response). It is noted that the social valence V has a very important impact whereas it is very safe medical. For example a death, which is not an urgency (there is nothing any more to make), has a strong impact, in particular in the case of an infant. This social valence also takes into account the identity of the victim (between an unknown and the princess of Wales), the presence of media, the way in which the person (a SDF for example) is equipped, social impact of the known medical antecedents (skin diseases, AIDS)…

Certain particular cases are problematic. For example, when a child calls (in particular préadolescent), it is difficult to make him evaluate the situation and to trust him to apply certain instructions; whereas the regulation could be satisfied to give a council to an adult in a given situation, it can be judicious to send a rescue squad when a child calls in a similar case. A regulating doctor of Samu of the Cher was condemned the August 10th 2005 to be itself satisfied, in February 2002, of advising with a 10 year old child, appealing for his father, calling the doctor of guard; the regulating doctor started the helps with the second call of the child, but those were able too late to save the father.

Medical regulation in France

In France, the medical regulation is made by the Service of urgent medical assistance (or Samu), and more precisely by its Center 15 , also called center of reception and regulation of the calls (CRRA).

Role of the CRRA

Center 15 is in the middle of the device urgently medical French. It comprises Permanenciers Auxiliaire of Medical Regulation (PARM) and one or more regulating doctors. The PARM receive the calls, collect principal information (place from where the person calls, natural call). The regulating doctor is charged to evaluate the gravity of the state of the victim by putting questions with the person who calls. He determines the continuation of the call: simple councils, or sending of means:

doctor of guard or association of liberal urgentists (standard: S.O.S Doctors)
private Ambulance
Vehicle of help and assistance to the victims (VSAV) of the firemen
VSAV + (Male nurse fireman, engagement is done only by the Codis according to procedures for action or at the request of the crews firemen on the spot)
hospital mobile Unité (UMH) of the Smur.

There is thus a graduated response according to the gravity and of the urgency of the affection.

Center 15 also determines towards which hospital (CH) or private clinic transported must be the victim (according to the state of icelle, the places available and the technical plate). It manages also inter-hospital transport.

Center 15 is in communication as of need with the firemen ( via their CTA).

The regulation aims at bringing to the population a graduated response according to the gravity of the subjected cases; all the means have a cost and the heavy means are necessarily of number finished; it thus consists in on the operational level as well as possible managing the means of intervention available according to the declared businesses.

Statistics

Centers 15 receive approximately 10 million calls per annum (in 2004), with a progression of approximately 10% per annum. The calls to the 15 come (statistical on the calls for thoracic pain):

51 %: public (pilot of a faintness, an accident)

30 %: firemen (having been called on an intervention);

19 %: general doctor.

Concerning the actions taken on the calls:

48 % of the calls are concluded by a simple medical council. This makes it possible to reduce the hospitalization considerably (people which would be presented spontaneously to the urgencies).

15 % of the calls give place at the beginning of a Smur (given strongly variable of one SAMU to the other).

Reference:

French Samu: a new TV-médico-social and medical platform, nearer to the citizen, a diaporama of Samu-de-france.com (file Powerpoint, 23 slides, 614 KB)

Medical regulation in the United States

The the United States, the medical regulation is ensured by the medical Emergency service (EMS). See http://www.lifesupport-france.org

See too

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