In France an ambulance is more than just a vehicle to pick up and transfer patients. Richard Hannaford reports.
One Saturday afternoon in 1966 Dr Marcel Lascar, discovered a blocked drain in his apartment in Paris. "My bathroom had flooded and an employee from SOS Dépannage (emergency repairs) came right away to fix the problem." A week later a friend died of a heart attack because he couldn't contact a doctor on a Saturday afternoon. For Dr Lascar the answer was obvious - SOS Médecins.
Since then the service has grown. It now has 71 associations across France covering most of the urban and suburban areas. In fact SOS Médecins is a federation of privately-run organisations. Each area has a 24-hour seven-day-a-week call centre staffed by trained operators. They assess the gravity of each call and can either give advice or send a doctor to the patient's home address. Patients pay a fee for a call out which they then get reimbursed from their social security insurance.
Doctors can either travel with an ambulance or ahead of it, and are specialists in critical care. They can stabilise and resuscitate and carry drugs and equipment for most emergency situations. Last year they handled four million calls and carried out two million visits. More recently the service has developed a rapid service for heart attack victims - SOS Cardio.
By creating SOS Médecins, Dr Lascar was following a long standing tradition in French history. It's a little known fact (outside of France that is) that the first recognisable ambulance was designed by a Frenchman during the Napoleonic Wars. Dominique Larrey, a surgeon, is still renown for his work on emergency care of war wounds. But, horrified by the way the dying were left on the battlefield, he also organised a horse drawn carriage to pick up the wounded and bring them to emergency battlefield hospitals.
But what Dr Lascar did in 1966 was change the philosophy of how to organise emergency care. Previously everything was focused on getting patients back to the hospital as quickly as possible. However, he turned that on its head and instead said get specialist treatment to the patient. And that has guided French emergency care thinking ever since.
SOS Médecins is one of a number of different ways the French population is covered for medical emergencies. In terms of resources there are a number of different types of ambulances that are used by a variety of agencies be they private companies, local government agencies, or hospitals.
In a normal emergency, say for example a car crash, most calls are put through to what are called first responder vehicles known as either VSAV's (véhicule de secours et d'assistance aux victime) or VPS's (véhicules de premiers secours). These are often joint collaborations with either the fire service or with volunteers from other health associations.
They are staffed by secouristes who have undergone an intensive training and can do advanced first aid. Those with more advanced training are called ambulanciers.
They often work with a team from the local hospital called a SMUR - service mobile d'urgence et de réanimation - or mobile resuscitation service.
Typically these have a doctor a nurse and an ambulance technician on board, although the doctor can travel separately in a car for faster mobility. (In some cases a nurse is given training in firefighting skills or vice versa and these are then called ISPs - infirmier sapeur pompiers.
The vehicle will carry not only a defibrillator but also a heart monitor that can help confirm whether someone's heart is in crisis and thus allow the team to deliver the vital clot busting drugs that can save lives.
For Dr Vincent Maher, cardiac specialist and medical director of the Irish Heart Foundation, this is something we need to look at more closely in Ireland. There have been pilot projects in the North West with a Cardiac Ambulance Service, and the Donnegal Rapid Treatment scheme - which enabled local GPs to administer these thrombolytic agents.
"Ideally if we get a heart attack we want to know that we can get treated within a couple of hours with clot busting drugs - time is the critical factor," he says.