Emergency medical services in Sieuxerr

Emergency medical services in Sieuxerr are regulated by the Directorate General of Public Health (DGSP, Direction Générale de la Santé Publique). The DGSP operates the central organization Emergency Medical Assistance Service (SAMU, Service d'Aide Médicale Urgente) which regulates and controls the nationally recognized and accepted practices for emergency medical personnel. From there, each department has its own Departmental Emergency Medical Service, known as DEMS. The DEMS control their respective department's EMS system and are regulated by the larger SAMU organization, however the departments can add additional guidelines and provisions as directed by a council of medical staff.

The departmental system can either directly operate its various air and land-based ambulances, or work in conjunction with hospitals in providing joint ambulance services. This is typically done in larger cities, normally with hospitals providing land-based ambualnces with the local DEMS providing air-ambulance services. There is an execption to Limes, as emergency medical services are perfomed by the Limes Fire Brigade, which operates both air and land-based ambulances. The brigade still however maintains a SDAU code designation.

For non-emergent transport services, many hospitals provide their own but also may contract with private transportation services who strictly perform only non-emergent transport services unless directed to assist in mass-casualty incidets and other situations.

Organization

SAMU is a branch of the Directorate General of Public Health which works specifically in emergency medicine, dictating rules and regulations in standards of care, training and education. Departmental organizations, known as Service Départemental d'Aide d'Urgence or SDAU in Merovingian are issued a two-digit code. As an example SDAU 01 refers of the Limes-based organization. Overseas islands have their own codes as well, but are normally staffed by rotational personnel if permanent personnel cannot be established.

Emergency land-based ambulance services are almost entirety operated directly by SAMU, while some private services exist, these exist as non-emergency transport groups, however they can be activated to respond to critical emergency situations when needed. Fire-fighting services in some departments also operate their own ambulances in conjunction with the local SADU. These are staffed by full-time or volunteer fire fighters and are normally staffed by EMP-E teams, which are roughly equivalent to the EMT found in other nations. They still work under the guidelines set by SAMU. These are found very commonly in rural Sieuxerr, were hospital-based ambulance services may be very far away, and while lower skilled than the normal SAMU ambulance team, EMP-Es are able to maintain life-critical functions during transport to facilities with higher levels of care.

Land-based emergency ambulance services are operated by a vareity of organizations

Land emergency ambulances are normally independent organizations which serve a number of hospitals. They normally reside in stations much like fire departments. Some large public and many for-profit hospitals maintain their own organic non-emergency transportation services that normally reside at the hospital or at an affiliated location.

Air ambulances are operated on a regional basis as well.

Following the fire services, SAMU also has a quasi-military style of organization and ranking.

History

Sieuxerr was one of the first nations to purpose design ambulances for the implicit use of transportation of injured personnel away from a location to definitive care. The early use of these ambulances came about during the late 18th century and were used to transport injured soldiers during battles away from the battlefield to surgical units where they could receive rapid medical care. This system would be implemented in Limes by 1820s by decree of Napoleon Bonaparte after he was impressed by their use on the battlefield, he himself being transported in one after one of the last battles of the 1799 Revolution.

By the 1850s, many major cities in Sieuxerr boasted some kind of ambulance service, however these massively varied in quality and size. At this time, the first motorized ambulances came into service in Sieuxerr, based out of hospitals which could afford such equipment.

Standards

Training and certification

Being completely standardized in the 1990s, there are only three qualification levels in emergency medicine in Sieuxerr, however these are just purpose trained personnel. Registered nurses and physicians can receive additional training in specialization in emergency medicine. An increasing number of air ambulance services run a properly qualified flight nurse and an EMP-A team. Each qualification, as it advances, can perform all the duties the lower qualifications can.

These three qualifications are not exhaustive, and it is very common and encouraged to receive additional education on various subjects such as critical care, pediatric advanced life support, neonatal resuscitation program, and other various programs.

The qualification levels are:

• Emergency Medical Provider - Entry (EMP-E): The most basic qualification, EMP-Es provide basic life sustaining care such as operation of an AED, CPR, and also childbirth. Hemorrhage management is also a skill that EMP-Es can do.
• Emergency Medical Provider - Intermediate (EMP-I): As the name suggests, the EMP-I is the intermediate between an Entry and an Advanced practitioner. Unlike EMP-Es, the Intermediate can established intravenous access and administer non-narcotic medications such as anti-emetics, corticosteroids, sympathomimetics, benzodiazapine and opioid blocking agents, and also more advanced nonsteroidal anti-inflammatory drugs such as Ketorolac Tromethamine. They cannot perform invasive procedures such as a needle thoracostomy, known commonly a chest decompression, but can read and interpret 4-lead ECGs.
• Emergency Medical Provider - Advanced (EMP-A): The final, purposefully-trained emergency medical certification level. EMP-As can perform a wide number of procedures, with many departments allowing for additional training and education to administer for advanced medications and various procedures under the purview of a qualified physician. In certain departments such as SAMU 01 (Limes), EMP-As have been trained in performing tube thoracostomies and have done so successfully.