[e-MUST Registry - Evaluation of prehospital medical management of STEMI in Île-de-France]

The e-MUST registry has continuously and comprehensively documented ST-segment elevation myocardial infarctions (STEMIs) managed in the prehospital setting by the 39 Mobile Emergency and Resuscitation Services (SMUR) of the 8 Emergency Medical Assistance System (SAMU) and subsequently managed in the 36 interventional cardiology services in Île-de-France since 2000. This encompasses a population of over 12 million residents. To date, nearly 44,000 patients have been enrolled. The analysis of these findings reflects the real-world management of these patients and the evolution of their care. The results are shared annually with the investigators' teams and have led to around twenty publications. The latest acquired results have demonstrated, in a series of over 630 patients aged over 90, that nonagenarians particularly benefit from prehospital coronary reperfusion decisions, resulting in a nearly 60% reduction in mortality.

[Assessment in the home of the elderly following a first fall with Samu intervention]

The Rising-Dom study is a project to evaluate the impact of home intervention by an experienced geriatric nurse on mortality and institutionalization of older people who fall. It is a multicentre randomised interventional study. The two-year follow-up will compare the evolution of two groups: intervention (assessment by the nurse and proposal of a care plan) vs. usual care (simple information on ageing well and on the prevention of falls at home). First feedback from the field.

[White plan and the organisation of emergency response services in France]

The Eemergency plans for outside hospitals (ORSEC) and inside hospitals (white plan) are often linked and must be well structured in order to respond to the tensions created by exceptional health situations. They must be designed, used and updated like toolboxes. How is the chain of care organised? What is the role of the samu (emergency medical assistance service) in the preparation, activation and coordination of the white plan?

[Role of pre-hospital and hospital emergency services in the management of stroke]

Any out-of-hospital neurological deficit of less than 24 hours should prompt a call for emergency medical help Urgent Medical Aid Service. Early identification of signs of stroke or transient ischaemic attack allows to guide the therapeutic approach towards intravenous thrombolysis or other alternatives. Telemedicine centres complement the network of neurovascular units.

[Analysis of cardiovascular complications occurring during inter-hospital transfers of patients with non-ST elevation myocardial infarction]

AIM OF THE STUDY

Patients with non ST-segment elevated acute coronary syndrome justify specific management in a hospital with an Intensive Cardiac Care Unit. In our area, these transfers are often provided by the Emergency Medical Service. Nevertheless we wonder whether a quasi-systematic medicalization of these patients is rational.

PATIENTS AND METHOD

We tried to authenticate the need for medicalization of these patients through a prospective study including any patient with acute non-ST elevation Coronary Syndrome managed in one of the peripheral hospitals of the area and transferred to the major hospital center in La Roche-sur-Yon. We noted all the complications that occurred during the transfer and, if need be, when these complications required medical intervention.

RESULTS

Out of 226 patients included, 19 had a complicated form of acute non-ST elevation Coronary Syndrome. Out of the remaining 207 patients, 16 (7.7 %) showed a complication during their transfer, 5 of which underwent a medical intervention, none of which was immediately vital. Nevertheless, the statistical analysis did not highlight any significant worsening factors.

CONCLUSION

The low rate of complications occurring during the transfer of initially stable patients encourages us to limit our indications of medicalization in favour of only the unstable patients or having a complication of their non-ST elevation acute coronary syndrome.

[When the patient calls the SAMU because his pacemaker is making "beep-beep". Study on physicians' knowledge on pacemaker sound alarm]

INTRODUCTION

More than 60,000 pacemakers are inserted every year in France. This number has been steadily increasing for a decade. Miscellaneous incidents can lead patients with pacemakers or their relatives to contact emergency services. Following the call to the SAMU-Center 15 of a asymptomatic 90-year-old woman reported that her pacemaker was making "beep-beep", we assessed the knowledge of physicians of the SAMU-Center 15 (call center) dispatching center on the existence of pacemaker sound alarms.

METHODS

Forty-two physicians, emergency physicians and general practitioners, regularly participating in the medical dispatching of the SAMU-Center 15 in Seine-Seine-Denis were interviewed. We asked them how a patient with a pacemaker could be informed of a malfunction of it without being symptomatic.

RESULTS

No physician interviewed mentioned an audible alarm. All of them confirmed their ignorance of its existence. One physician had already been asked for a similar reason and had referred the patient to the emergency department without knowing it was an alarm.

CONCLUSION

Patients and physicians seem insufficiently aware of the existence of the existence of pacemakers' sound alarm. An effort must be made regarding the information on the existence of such an alarm and the way to managed it.

[Palliative care at home, transferring information to emergency medical teams]

Many people wish to die at home. However, the end-of-life period can be marked by the occurrence of numerous symptoms causing situations of crisis. Emergency medical teams are therefore frequently called upon. In order to be able to make the right decisions in a short space of time, they must have quick access to all the relevant information.