As part of the World Conference on Ultrasound held in Paris,
France, a group of paramedic firemen from Odessa, Texas were invited to participate.  Paramedics in Odessa have been utilizing ultrasound in the field since 2000.  Therefore, they have become a model for other EMS systems wanting to incorporate sonography into their prehospital care.  Odessa has recently joined with the EMS systems in Minneapolis, Minnesota and Manhattan, NY in initiating a multicenter prehospital study.  The aim of this study is demonstrate that paramedics can competently perform prehospital ultrasound examinations and positively impact patient outcomes.

The Emergency system in France is known as Services d’Aide Medicale Urgenteor “SAMU”.  SAMU is a three-tiered system, consisting of dispatch, triage and response.

While in Paris, the paramedics also had an opportunity to examine the French EMS and Emergency care system.  They visited the home base of SAMU 93 and a nearby fire station in the northeast part of Paris.

The dispatch center, known as the registrar is activated by dialing “15” instead of our  “911.”  The first tier of the French EMS system is the phone call, when help is summoned,  placed to the registrar at  “Centre 15.” 

Medicine is socialized in France and as a result, the French have the luxury of many physicians. The second tier of the French EMS system is the physician on duty at the registrar.  The call taker obtains basic information and then passes the call on to one of the physicians on duty at the Centre 15 registrar.  From this point, the physician takes charge of the case.  This doctor will make decisions at multiple key points during progression of the case.  The doctor decides the urgency of the case and the level of response.  The
doctor may decide, for instance, that emergency service is not necessary and not dispatch anyone to the scene. The caller would be instructed to make an appointment with their local clinic.




The third tier of the French emergency system is the graded response to an incident.  In a significant medical situation, the doctor taking the call at the registrar has the fire department respond from their station, an ambulance respond from their location and still another vehicle, staffed with a physician,  nurse anesthesia person and a non-medically trained driver respond.  The concept is to have them rendezvous at the scene and begin to evaluate the medical needs.  Once on scene, the staff reports back to the physician at the registrar.  Both basic and advanced care occurs on the scene. 
The specially equipped SMUR (Service Mobile
d'Urgence et de Réanimation) vehicle is like taking a portable hospital to the scene.  The units are equipped with monitors, defibrillators, ultrasound machines, ventilators and suction devices.  The SMUR vehicles carry the same advanced cardiac life support meds and  IV’ as you would see in the U.S.  In addition, they have portable laboratory capabilities which provide them with on-scene CBC, electrolytes, arterial blood gases and cardiac enzyme capabilities.  The idea behind the French SAMU is to take the doctor and a small hospital the patient and treat them on the scene.  While this on scene evaluation and treatment is occurring, the doctor at the registrar is looking for resources if hospitalization will be necessary.  For example, if the patient is having chest pain, the physician at the registrar is finding a hospital with a CCU bed available.  If the patient has sustained trauma, the doctor at the registrar is finding a hospital with an operating room available.


By triaging and treating in this manner, the French system negates the need for a typical American type of emergency room.  Indeed, the ER at the hospital visited had only a basic type of ER.  The patient’s requiring admission will not be stopping at the ER, only passing thru the area on their way to a ICU, CCU, hospital ward or operating room.The majority of patients will be treated at home and never need to go to the hospital.