Paramedics in France

Until very recently, the French pre-hospital care strategy was based on either first responders (firemen) or prehospital medical teams (MD + nurse + ambulance driver) called Smur (service mobile d'urgence et de réanimation, emergency resuscitation mobile unit). With this organisation, any situation requiring a paramedic is handled by a physician who specialises in pre-hospital emergencies.

Due to a lack of physicians, interhospital transportation requiring intensive care was often performed by an ambulance driver and a nurse working on protocol, although it was not entirely legal (the nurses are allowed to apply a medical protocol, but the definition of a Smur necessarily includes an MD). In any case, the protocols had to be written specifically for a given patient, so such protocols could not be used for pre-hospital emergencies (the patient was not seen by the MD who wrote the protocol).

The legislation evolved in 1997, and nurses belonging to a fire department (or ISP–infirmier sapeur-pompier) can now apply emergency protocols in pre-hospital situations, in the same way as paramedics. They can also receive oral prescriptions by phone or radio and thus provide specialised care.

Therefore, there is no specific paramedic profession in France, but the existing nursing profession have evolved to meet the needs of pre-hospital care.

Organization

Emergency telephone number

* 112 (general)

* 18 (firefighters)

* 15 (medical emergencies) Dispatcher and medical regulation

Samu Rescue

firefighters (sapeurs-pompiers) First responder level

* firefighters (all absolute emergencies, all interventions in the dangerous environments and on the street)

* private ambulance companies (relative emergencies in buildings) Paramedic level

firefighter nurses (infirmiers sapeurs-pompiers, ISP), since 1997, still rare in 2006 (aim: 1 ISP for 150 professional firefighters or 1,000 volunteer firefighters)

see Paramedics in France Prehospital medical level

* general practitioners have a duty (few days a month), and can be called to visit the patient at home even by night and on week-end (they are called directly by the patient, or by the samu), in case of relative emergencies that do not require transportations
this situation was contested by the physicians who made a strike in 2002 some refuse to take their duty, so the situation is evolving in some places to "medical houses", i.e. the physician takes his duty in a definite place and does not go to the patient's home any longer

* Smur

* firefighter physicians (médecins sapeurs-pompiers, MSP, usually general practitionners who have a voluntary activity in the fire department) in some countryside areas Emergency room

* Service specialized in emergency care (SAU): all emergencies, specialized services (incl. surgery, cardiology and neurology)

* Proximity units (Upatou): most common emergency (medical cares, small surgery)

see Emergency rooms in France

See also

• Paramedics
• Ambulance
• Emergency Medical Services