Madrid November 2008 Dr Nicolas Letellier AFHSH (French Medical Helicopter Association)

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1 Madrid November 2008 Dr Nicolas Letellier AFHSH (French Medical Helicopter Association)

2 EMS in France is based on medical teams called SMUR Each SMUR is under the control of a medical call center called SAMU 2

3 A medical team always made up of a physician, a nurse and a driver (or pilot). This team is based in an hospital, in or near by the Emergency Department. The SMUR can be called out either for primary or secondary missions. Usually SMUR of small hospitals are concerned by primary missions, while SMUR of referral hospitals are used for both primary and secondary transports. 3

The SMUR can be called out either for primary or secondary missions.

4 Each «SMUR» team is under the command of its SAMU. It has several means of transportation. It can use light vehicle, ambulance or helicopter if it has one. Most often these Helico-SMUR are not specialized teams. These teams are working in the E.R. waiting for a call from their SAMU. 4

It can use light vehicle, ambulance or helicopter if it has one.

5 Picking up victims from the scene to hospital 5

6 From hospital to hospital 6

7 Activity per team and per year 500 to 1500 primary missions 500 to 1500 secondary missions. 7

8 SAMU are medical call centers answering to phone number 15 (sometimes 112 ) As well as SMUR teams they are located in hospital. They are managed by emergency physicians and telephone operators. Each has under its responsibility 3 or 4 SMUR 8

9 SAMU s call centers are connected to other call centers as Fire Department s calls centers (answering to phone number 18 or 112 ) Firemen receiving phone calls for health reasons put through callers to SAMU operators. Fire Department deal with accidents happening onto public places but care and destination of patients are under the responsibility of the SAMU center. 9

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11 One SAMU for each French district (from to inhabitants) There is one or more physicians (2 or 3) to answer phone calls assisted by telephone operators (usually 2 for each doctor) On average a SAMU has to deal with over to emergency calls per year (according to its population) 11

telephone operators (usually 2 for each doctor) On average a SAMU has to deal

12 In France 433 SMUR 107 SAMU 12

13 Helicopters were historically implemented without any precise policy. Each medical director of a SAMU had to fight with the ministry of health to have his helicopter from the early sixties until now. At the beginning they were used mainly for car crashes, later on for hospital to hospital transfers. Nowadays they perform 38% primary versus 62% secondary missions 13

helicopter from the early sixties until now.

14 Two problems: Lack of doctors Too many small hospitals One solution: The helicopter 14

15 Ministry of health begins to understand the interest of helicopters. Small centers can be closed as soon as patients can be safely «exported». 15

16 Build helipads Fly modern powerful machines Cat A class one Make helicopter more reliable to be used even in bad meteorological conditions 16

17 In summer 10% of the flight are cancelled for weather reasons in winter 55% are. 17

18 So we started a program for developing night flight and low altitude IFR hospital to hospital navigation based on satellite procedures (GNSS, Point in space). One experimental airway between Dreux and Nogent Le Rotrou is actually tested. Training pilots to these techniques is obvious. 18

19 Powerful helicopters Helipads 19

20 Red from the fire department (35 helicopters) Blue from the police department (40 helicopters) White from hospital (40 helicopters) 20

21 Class 1 12 EC EC 355 N squirrel Power 2 EC 365 dolphin 1 MD 902 Class 2 10 EC 355 F1 or F2 squirrel 1 Bell long ranger twin 21

22 The HEMS map SAMU Fire Department Police 22

23 Helipads (750) 23

24 Main roads 24

25 +/ flight hours +/ missions 62% of secondary missions 38% of primary missions 71% of flight hours for secondary missions 29% of flight hours for primary missions 25

26 French people currently have 16.5 minutes medical helicopter flight per inhabitants. 26

27 Average flight time for primary mission: 34 minutes (mission length: 89 minutes) Average flight time for secondary mission: 53 minutes (mission length: 110 minutes) 13% of night missions 60% need of ambulance relay 27

28 28% Cardiology 18% Traumatology 15% Transfer to ICU 12% Neurology 28

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32 All French EMS and HEMS systems are paid by public money that is ministry of health through what we call la sécurité sociale. Private funding is not an actor of our Emergency System. 32

33 French EMS is a major element of the health system because of the decreasing number of General Physicians The system is suffering of its own success 15 millions affairs primary missions secondary missions 33

34 Helicopter is a powerful tool for reorganization of health care Helicopter use is a central part of new French EMS system We could now say : It saves money By saving medical time By permitting concentration on reference hospitals it equalizes chances of all citizens in case of accidents or unexpected diseases 34

35 Thank you 35

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