SAMU & EMS: The Principle Differences

In the French SAMU (Service d’Aide Médicale Urgente) system – as in the typical U.S. EMS (Emergency Medical Services) system – advance life support units, more formally called Hospital Mobile Intensive Care Units (H-MICUs), provide both lifesaving care and advanced care, administering medications and other therapy to improve the medical condition of various categories of patients. Other medical units possessing basic care capabilities provide lifesaving care.

The decision on which type of unit responds to a specific case depends both on the type of case involved and the availability of different units. Similarly, the hospital destination for the patient is not only a function of geography but also depends to a large extent on the medical condition of the patient.

The main difference between the French system and the American system is that, in the SAMU model, physicians are direct actors in the system; in other words, they staff the H-MICU units and the dispatch centers directly in making the lifesaving decisions needed. In the United States these roles are filled by paramedics and dispatchers; U.S. physicians are still integral to the system, but primarily play a planning and oversight role.

Vive Les Differences!

Despite this difference, the six basic principles on which the SAMU system is founded are in most respects applicable to similar U.S. systems. Following are brief and loosely translated synopses of the SAMU principles and how they differ, in certain particulars, from their counterpart U.S. practices:

• “Emergency Medical Assistance (EMA) is a healthcare activity.” The provision of emergency medical services (EMS) is and should be only one aspect (an extremely important one, of course) of the entire continuity of care – not the transportation to medical care, in other words, but the medical care itself.
• “Interventions in the field must be speedy … [and] efficient, and use suitable resources.” Even major EMS systems do not possess unlimited resources, so decisions must be made, in times of high-call volume, to prioritize the responses available so that the most good can be done for the most patients. An integral aspect of this process is the assignment of the correct type of unit to each type of case involved.
• “The approach to each individual case is simultaneously medical, operational, and human.” To even the most casual observer the first two requirements are obvious – i.e., medical in that patients are provided medical care; operational in that a system must be in place to provide the means needed for transportation, supply, and dispatch. The final requirement, human, is not quite as easy to define; suffice to say, though, that the system must: (a) promote the confidence of patients; (b) respect their choices; and (c) maintain their confidentiality.
• “The responsibilities and detailed arrangements for coordination between the persons involved must be regulated by a set of working rules.” EMS can be considered a true “system” only if it has been created and is being carried out in accordance with clearly defined rules of operation. Adherence to those rules will not only allow all members of the system to anticipate the actions of others within the same system but also will ensure a consistent approach in the treatment of patients.
• “Results depend in large measure upon the skills of those involved.” In an emergency there is simply no substitute for experience and training.
• “Preventive action must complement emergency action.” Many U.S. systems have adopted a common-sense program of monitoring EMS activity as an early warning system for both natural epidemics and bio-terrorism attacks. Because of their contact with anyone who feels ill enough to require an ambulance, the U.S. repository of EMS data is invaluable for this purpose.

These principles provide an exceptionally firm footing for the well organized French SAMU system, and the leaders of any other system in any other country would be well advised to review their own operations in light of those principles.