The French emergency system that has been praised everywhere as the model is now being singled out. A crisis that doctors (private or hospital) participating in emergency services have been facing for several years. We have been talking about reforming the emergency system for almost twenty years. SO ! Didn't we want to see too big? Should we take a model from Eastern Europe (read: At 04, medical emergencies, few resources but a well-established system) who sometimes with little means manages to build a system that does not work so badly?
The beginnings of emergency medicine
Let us remember the 60s, the first beginnings of a medicalization of emergency relief in Montpellier, Toulouse & Garches Nearly 10 years later, in 76-78, it was the general implementation of Samu then 15 in a grumpy enthusiasm. We were going to create medical services in all hospitals, connected to the public by a single number covering the whole of France, with hyper-equipped ambulances here, helicopters there. Even if it made some teeth cringe. Because emergency doctors were already working: firefighters first, then liberals. No matter, we were aiming wide and we saw big. Even if in 1977 already, Simone Veil Minister of Health gave up tabling a bill on emergencies. She succeeded in the “remedial oral” in 1979 with a circular on the 15 centers which had not yet reached their adult threshold. Far from bloodshed, successive reports and attempts at reform that often remained short-lived, are the seven beginnings of the current crisis.
1° duplication or how to want to mount at all costs an autonomous system of what already existed. Although the fact was often made a point by the speakers themselves, or their hierarchy, and accentuated by the press, the conflict "whites" (Samu & liberals) - "reds" (Firefighters) did indeed exist.
2° egocentrism. The emergency workers - hospitable or liberal, red or white, have always sought to vampirise their patients. Whereas in other departments, the aim was to better serve the customer; the emergency services have, with very few exceptions, never sought to seduce the patient. Satisfaction studies can be counted on the fingers of both hands. Professor Steg in his 1989 report cited only three in about ten years.
3° training. We have opened up new opportunities for anesthesiologists, while turning off the tap on recruitment, with the help of reforms in medical studies. The result: a drastic shortage of professionals.
4° confidentiality. The unique number 15, easy to memorize, has only been generalized throughout France very slowly; while most European countries already had them. When we see the speed of Telecom in setting up a single number throughout France for specific operations such as the Telethon, we cannot blame this slowness on the technicians. Any advertising on the number remained very limited. Result: today nearly 15 years after the Veil circular (1979), number 15 is not yet well established in the collective memory, troubled by the presence of 17 and 18 in particular.
5°: medical hostility. Physicians generally have a certain reluctance vis-à-vis new technologies which they do not master. The telephone could not be admitted to the rank of a medical tool. “one cannot treat a patient remotely” was the often repeated phrase. So a regulation limited to the bare minimum of an ordinary switchboard.
6°: dogmatism. The very French Jacobin tradition of standardizing and homogenizing everything according to a single model has little equal in Europe. Throughout the initiation period of the Samu and Center 15, it was considered that an emergency medical service was going to set up on its own. Forgetting that there is a well-established SOS doctors, there is a dynamic fire service. This trend is fortunately on the way to extinction and leaves more room for pragmatism.
7°: improvisation. At the same time as we were medicalizing first aid, we neglected reception in hospitals. Clearly we medicalized the front while we “demedicalized” the back. The trend is reversed today, but with the same defect, the lack of homogeneity.
This succession of errors, often contradictory, does not therefore rest entirely on the medical and first aid profession. But just as much as the glaring lack of financial means and the absence of political will often put forward, they mark in a precise way the current building site of the reforms. Equipped with a second precise and well-argued Steg report, the legislator and the Ministries concerned (Interior, Health) no longer have any reason to miss their objective.
Nicolas GROS, Published in Panorama du Médecin, September 1993