Page 47 - Rebrame - 2022 - Ed. 1

Revue E

training formats for emergency medicine in the United of the different countries in an attempt to remedy the use
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States. In Europe, the EUSEM advocates a 4-5 year of patients in the emergency room (Figure 6).
training in Emergency Medicine with a curriculum
(EBEEM). SCOOP AND RUN VS STAY AND PLAY

OVERCROWDING: A FATALITY FOR THE Two major models of emergency care delivery exist today in
EMERGENCIES OF THE 21ST CENTURY? Europe: the Anglo-American model and the Franco-German
model. A majority (63%) of European countries have a pre-
Overcrowding is frequently described in terms of the “input- hospital EM system (EMS) managed by trained emergency
throughput-output” model by Asplin et al . physicians (Figure 7). Various northern European countries
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use the paramedical system and the pre-hospital EMS is
A systematic review by Morley et al. to primary care 23,24,25 partly managed by doctors (33%) or technicians. Most
which has led to an increase in low acuity presentations, 23,25 countries developing new emergency care systems follow
increased use of emergency departments by the elderly the Anglo-American model. In the UK, the turnaround
and those with complex conditions, 26,27,28 and an overall time is reduced from 8 minutes to 20 minutes with Basic
increase in demand for emergency services. Several types Life Support (BLS) sustaining ambulances or Advance Life
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of UAS models can be described according to the resources Support (ALS) ambulances with 7000 paramedics trained

Figure 6: Select combinations of emergency department categories.

(2 years) in the skills of emergency or NHS ambulance In the absence of reliable studies comparing the 2 systems
service (Figure 8 and 9). In the immediate care plan, «scoop and run» (renamed «load and go») and «stay and
some doctors trained in pre-hospital emergency medicine play» («stay and stabilize»), the analysis of pre-hospital
can intervene on site, in helicopter-borne interventions systems in the world seems above all to be organized at
(HEMS) in the UK or Australia. However, the pre-hospital the level of the management of appropriate medical or
medicalization system may delay the patient’s arrival time traumatic emergencies.
at the emergency department.
Thus, as much the coronary emergency seems favorable to
The experience of Princess Diana’s accident in 1997 had early medicalization to direct the patient as soon as possible
triggered a heavy controversy on the medicalization of to the catheterization room, as much penetrating trauma
pre-hospital relief and the French SAMU model. (stabbing or shooting) require rapid transport to the Trauma
Center as US, Israeli ,UK emergency services working with
However, there are few studies comparing the Franco- surgical teams and trauma surgeons.
German vs Anglo-American models of emergency care.
We must nevertheless consider that a combination of
There are no morbidity/mortality studies to assess the the 2 systems with a trained medical team making quick
paramedical system.

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