The basis for the legal and organisational formation of the French rescue service is the French rescue service law from 1986, based upon the principles of early medical treatment at accident sites, and which differentiates between emergency treatment and emergency transport. The approval and equipping of rescue service vehicles, workers as well as the approval of emergency ground transport vehicle operators are regulated by numerous rules and enactments.
The French rescue services are characterised by the far-reaching medical control with a central control centre: SAMU (service d’aide médicale urgente). The centres are operated by people from the medical profession, who control and co-ordinate all urgent medical calls for help. The measures taken by SAMU range from a SAMU affiliated doctor being dispatched or the SMUR (service mobile d’urgence et de réanimation) team emergency team being deployed, to the use of ground and air rescue methods, i.e. ambulances or helicopters. In France there is no time limit in which the medical services should arrive - as a rule, the first available and suitable rescue method is deployed. Ground rescue services are divided into four subcategories: rescue vehicles, fire engines, ambulances and mini-ambulances for transporting people without the need for a stretcher. Rescue personnel are also correspondingly divided into four subgroups, each possessing different qualifications. Rescue vehicles and ambulances have to be manned by two people, one of whom must have completed training in rescue and paramedic services.
The majority of the ground based rescue services in France are provided by private rescue service and ambulance organisations. However, hospitals and fire stations normally have their own rescue vehicles.
Every French 'département' (96 in total, plus 4 overseas territories) possesses a SAMU head office, which can be reached by dialling a single emergency number, 15 . The Europewide emergency number, 112, operative since 1997, has been adopted by the fire brigade and SAMU head offices.
The provision of emergency doctors in France is assured by the emergency doctor services, which are connected to the standby and emergency services of established doctors. Teams of emergency doctors "Service Mobiles d’Urgence et de Réanimation" (SMUR) are composed of certain hospitals chosen by the minister of health which carry out primary and secondary medical transport in close co-operation with the respective SAMU office. In addition to their specialist medical training, emergency doctors have to undergo a further two years of training for working in the emergency services.
The 23 rescue helicopters (valid 1992) are found in 21 of the 100 départements, based at hospitals which also serve as the SAMU regional head offices and have at least 6 helicopters available for use all year round. The rescue helicopters are always equipped with the required emergency equipment, and are manned by the team of emergency doctors located at the base, normally a SMUR team.
Personnel / Training
Training to become a rescue paramedic is subject to legal rulings and takes place in officially recognised rescue institutes. (40 in 1992). The training comprises 160 hours of theory and two practical modules with 24 half days spent gaining work experience in hospitals and 26 half days experience in the rescue services. The national final exam comprises a written and oral element.
France also has a budget to work to in the health service. The financing of the rescue services is divided as follows: Medical emergency aid in the case of accidents, serious injuries or life threatening illnesses are free of charge for the patient. The financing of these services is covered by hospital budgets and health insurance companies, as well as national insurance contributions paid by the French taxpayer. All other deployments of rescue teams and emergency vehicles are to be paid for by the health insurance companies. As for most medical services, 70% of the costs are covered by the health insurance company, the remaining 30% being paid for by the patient or additional insurance coverage.
For air rescue services, 48% of the costs are covered by the hospital that owns the helicopter. sponsors contribute to 1% of the financing; the remaining costs are borne by the local supporters and users of the helicopter. Furthermore, the State finances institutions involved in catastrophe aid, which is also available to the rescue services.