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Behind France's "Cold-Blood Emergency Call"

2018-05-15 11:03:45 Author: Source: European Times comments:0  Click:

The French Emergency Medical Assistance Service (SAMU) has recently been controversial. (Source: AFP)
With limited personnel and resources, how to optimize the emergency call flow as much as possible while avoiding the loss of energy? How can a few minutes of inquiries more accurately identify people who really need help and use institutional design to compensate for and limit the negative effects of the operator?
On December 29 last year, Naomi, a 22-year-old woman from Strasbourg, was negatively treated by a staff member when she called the SAMU phone and died of her illness because she could not get timely treatment. Ironically, SAMU had Naomi contact the emergency doctor organization SOS médecins himself and, after a round of laps, SOS médecins finally returned to SAMU to intervene.
The recording of the call on the day of the incident was opened up by the media and triggered a lot of controversy. Before the formal investigation results came out, French Minister of Health Agnès Buzyn first categorized the incident, denounced the “cold-blooded” staff and criticized the incident as a “serious dereliction of duty”.
Family of the deceased: Can't let the operator be a "scapegoat"
Due to the confusion about why Naomi had not been treated for a long time, her family had applied for an emergency call recording: "The content of the recording shocked us. We didn't think that was the case at the time [...] we wanted to know that one person was How can we say something to a dying patient? Let more people know about it."
On Wednesday, the Strasbourg Procuratorate initiated a preliminary investigation of the matter. Since the call log between the operator and the deceased was announced by the media, the staff of Strasbourg University Hospital and several other urban hospitals received calls with threatening statements. However, the deputy family lawyer said publicly: "Naomi's family does not want the operator to take full responsibility." They look forward to dating the wrong party in all aspects of the incident.
The operator is overworked?
At present, the operator involved has been suspended. According to reports, she was a nursing staff who had "crashed" after "being aware of the seriousness of things." The president of Strasbourg University Hospital stated: “Our colleague is in a very bad condition. Now a psychologist is helping her. In fact, we have an obligation to help her. In the past, she has been serving the hospital and SAMU.” .
The other colleagues of the operator also said: "She is a very good person and often helps sick colleagues to work on the shift." In addition, it was reported that the operator was overworked for 12 consecutive days, but this statement was refuted by the head of the hospital.
Strasbourg Hospital Manager: "Extra rare"
"In my long career, I have never encountered this situation," said Christophe Gautier, head of the University Hospital Strasbourg. Gotiere claimed that although the tragedy occurred on December 29 last year, he had been ignorant of the media until it was exposed in late April. After confirming that the recording was true, he initiated an administrative investigation on May 2. At present, he has met with the deceased's family and will meet again on May 23, "to convey to them all the contents of the investigation."
Gautier cautiously did not make any conclusions about the investigation, but he did not forget to point out that the operator's statement was "seriously inconsistent with the procedure": "In the case of abdominal pain, it should be transferred to the emergency medical doctor (médecin régulateur) Needless to say, the attitude of the operator is totally different. At the end of the day, Gautier stressed that the transfer of the phone to the doctor should be the operator's "subconscious behavior."
Gotije also made it clear that the operator might be over-tired: “She is inaccurate.” “She worked for the second day in a row. She had already taken two weeks off. She started work at 7:30 in the morning on December 29, Nao. Rice is calling at around 11:30. ".
French netizens prosecuted first aid experience: “It would be nice to eat a few aspirins”
In addition, Francois Braun, chairman of SAMU's emergency center, also pointed out that any call will be transferred to the emergency medical doctor. After the doctor consults, the decision is made. This incident is absolutely inconsistent with the procedure. "We will not let the caller replay. If necessary, we will transfer the call to another service."
However, if you do not transfer the call to an emergency medical doctor and the doctor asks you to make a decision afterwards, it is absolutely inconsistent with the procedure. Many French netizens have experienced "no procedure". For example, the “France West” interviewed several French people who had an unpleasant experience with SAMU:
Alexander: "The wife is almost dead"
A Frenchman named Alexander recalled: "In January 2010, my wife failed to grasp her arm and was thrown forward because of the sudden braking of the bus. I ran into the handrail violently. After returning home, she felt very uncomfortable.I hurried to call SAMU and the other person said to me: "After a fall is normal," I suggest my wife go to bed after eating aspirin, and say, 'Tomorrow is fine.' I certainly do not trust, so I quickly called the doctor SOS.A doctor soon arrived at home for my wife to check and immediately called for an ambulance. Due to severe internal bleeding, my wife was taken to the hospital when the blood pressure It has fallen to 7. If we followed SAMU's instructions, she would have died long ago."
Alexander added that he respected those emergency doctors who rescued the wounded in various situations day after day. Sharing his personal experience just hoped that the society would pay more attention to the current issues so that the tragedy could not be repeated.
Thierry: "The operator said wait a few hours."
“In 2016, I suddenly lost consciousness for a few seconds when I was working, and my conversation was incoherent. My colleagues called SAMU and the operator asked me to wait for a few hours, to see how healthy they were, and let me play again in the evening. Telephones. Colleagues drove me directly to the hospital. When I arrived, I had a slight stroke with a blood pressure of 24. Fortunately, due to the efficient operation of the emergency doctor, no sequelae were left.”
Dominic: "The operator said I drink too much"
“One day in 2011, my right leg lost consciousness and my arm had the same situation. I tried to explain the situation to the operator, but my lips were too paralyzed to move, and the other person thought that I was drinking more. I replied: 'Ms. I think this is a sign of a cerebrovascular accident'. I never expected that the other person would say that if I were a doctor, then she would not need her help. Moreover, no one else would give it because of this. SAMU calls."
Isabel: "Mom is dead when the emergency doctor arrives."
Isabel recalled the painful day of his life: "On April 30, 2006, Mom felt very tired when she woke up in the morning. Her heart was uncomfortable and she also vomited. She called 15, and she wanted to get the doctor's contact information. As a result, the other person thought that Symptoms don't seem to matter and she refused to give her a number.In the afternoon, when I was downstairs, I suddenly heard loud noises upstairs.My mother was unconscious and I immediately called an ambulance and gave my mother heart and lungs. Recovery. But when firefighters and emergency doctors arrived, Mom died. She told others at the age of 64."
Like Alexander, Isabella affirmed the work of French emergency doctors: "They are excellent. There is nothing to say. But the emergency supervision process is problematic. Since the death of my mother, I have contacted the director of the hospital several times. At the beginning. He said that her mother only complained of leg pain on the phone, so the SAMU operator did not think it necessary to intervene, but this excuse did not convince me that my mother did not like to complain. So I 'harassed' the director for two months. In order to understand the truth, he finally admitted that his mother mentioned on the phone that she had symptoms of nausea, headache and heart pain, and the operator responded by suggesting that her mother stop taking blood pressure pills and wait until May 2 to see her family doctor. ". So far, the hospital concerned has not apologized to Isabella, and she has “not recovered from her mother’s death”.
In response to the Naomi incident, France’s “Le Monde” specifically described what the emergency telephone 15 is all about.
What is SAMU?
The 103 emergency medical assistance services (SAMU) in the entire law are responsible for handling emergency calls for calls 15 and 112.
1. What is the flow of emergency call answering?
The SAMU's phone is answered by the Medical Management Assistant (ARM). This person will collect basic information such as the patient's name, location, contact information, and reason for first aid. According to the SAMU Center's reference and evaluation guides, ARM has three options when it receives an incoming call:
In the worst case scenario, ARM starts emergency services before transferring to emergency medical doctors.
Transfer to emergency medical doctors;
In less urgent circumstances, he will temporarily shelve the case.
In these three cases, supervising doctors will intervene to handle incoming calls. Depending on the circumstances, the doctor decides whether to talk to the patient to further understand the condition. And the decision to coordinate, make interventions, and follow up on case actions is at the doctor's disposal.
2.ARM is a doctor?
No, he does not need to have a medical background (undergraduate diploma).
ARM is working under the supervision of supervising doctors and its task is to "understand the needs of patients, determine the urgency of illness, and, if necessary, mobilize emergency resources before informing the doctor." The same document stipulates that ARM's behavior must always be performed under the supervision of a doctor, and any decision must be "confirmed by a doctor."
3. How many telephone calls does SAMU handle?
In the past 30 years, the number of calls handled by call centers has grown exponentially. In 1988, there were less than 4 million each year, and in 1997 it rose to 10.7 million. According to a survey conducted by the French Ministry of Health (this is the most comprehensive but also outdated) survey, the number of calls in 2016 reached 24.6 million.
When Le Monde contacted the Ministry of Health, the latter provided only partial data for 2016: 38% were irrelevant (phone calls were dropped, malicious calls were made, wrong numbers were dialed). In 13% of calls, the SAMU operator only gave advice, and 48% of emergency calls involved specific medical assistance measures.
4. The provinces differ greatly in medical resources
According to a SAMU status report issued in 2010, there were 955 full-time doctors and 2003 ARMs in the entire law in 2008, and the average time to process one case was 13.2 minutes. However, the situation in each province is very different: In some provinces, the average time for doctors to handle one case is 57.3 minutes; in other provinces where medical resources are not sufficient, doctors respond in less than 2 minutes (1.9 minutes). In 2016, each operator handled an average of eight emergency calls per hour, but again, this figure is very different in different provinces.
It is this situation that has caused the French Association of Emergency Medical Doctors (AMUF) and the French SAMU Association (SUDF) to request “immediate” meetings with the Minister of Health to discuss how medical funding and resources can better meet modern medical regulations and service standards.
With limited personnel and resources, how to optimize the emergency call flow as much as possible while avoiding the loss of energy? How can a few minutes of inquiries more accurately identify people who really need help and use institutional design to compensate for and limit the negative effects of the operator? This can not help but think that the French Minister of Health Buzan first identified the incident as a "serious dereliction of duty" for individual "cold-blooded" workers. Is it a bit of a hurry?
[Disclaimer] This article only represents the author's own opinion and has nothing to do with the CTI Forum. The CTI Forum maintains its neutrality in the presentation of statements and opinions, and does not provide any express or implied warranty for the accuracy, reliability or completeness of the contents contained therein. Readers are for reference only, and please bear full responsibility for yourself.

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