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Welcome in this part of generalities about ambulances, starlife, emergency numbers, emergency medical services, strategy, training and good samaritan law

Bienvenue dans cette partie de généralités où nous parlerons
d'ambulances, d'étoile de vie, de numéro des secours,
de service de secours médicaux, de stratégies, de formation, ou sur la loi du bon samaritain...

....D'AMBULANCES

An ambulance is a vehicle designated for the transport of sick or injured people.
The first ambulances called by that name were horse ambulances used in the American Civil War. The first practical ambulances were created by Dominique Jean Larrey, a French surgeon (1766-1842), for use in the Napoleonic Wars.

Modern-day ambulances are typically large automobiles on a van or light truck chassis.
However, an ambulance can be any vehicle, including a bus, helicopter, or even a hospital ship.

During the 1960s and 1970s, station wagons were used in some American cities (despite their limited space) and can be seen in motion pictures from that period.
Under the laws of war, an ambulance marked by a red cross is not to be fired on and is to be permitted to carry out its duties in spite of the fighting. An ambulance may not mount weapons, although the Israeli EMS has produced a "tankbulance" that combines a Merkava main battle tank with ambulance features

Service Level
The lines between one level of care and the next are becoming increasingly blurred. Skills that were once reserved for physicians are now routinely done by paramedics, and skills once reserved for paramedics, such as defibrillation, are now routinely done by Basic Emergency medical technicians (EMTs). There is also wide country-to-country, state-to-state (or province-to-province), and even county-to-county variation of what types of care providers at different levels are allowed to provide. That said:
· Basic Life Support or BLS - usually consists of two EMT-Basics. Provides oxygen therapy, splinting, bleeding control, defibrillation with an AED,and light extrication (eg: removing a victim from a car, but not using the jaws of life.)
· Intermediate Life Support of ILS - usually consists of an EMT-Basic and an EMT-Intermediate. EMT-Intermediates provide BLS care with the addition of IV therapy, and often intubation.
· Advanced Life Support or ALS - usually consists of an EMT-Basic or EMT-Intermediate and a EMT-paramedic. EMT-paramedics provide BLS care and ILS care with the addition of manual defibrillation and advanced electrical therapy including transcutaneous pacing (fitting a temporary pacemaker to the patient's chest) and synchronized cardioversion (an advanced form of defibrillation), intubation, medication administration, pleural (chest) decompression, and more.
· Mobile Intensive Care Unit (MICU) - Some services divide ALS, as described above, into units staffed by Intermediates, which they call "ALS units" and units staffed by paramedics, frequently called "MICUs" or "paramedic units." These usually consist of either an EMT and a paramedic or multiple paramedics, and provide the full range of advanced services to include IV therapy, Cardiac monitoring and drugs, pain killers. etc. In some locations, physicians may ride MICUs for special calls or as a matter of course.
· Critical Care Units - consist of a combination of EMTs/Paramedics/Nurses/Physicians depending on the need and service. They may provide special transports for premature babies, cardiac transfers, etc, although in some services, these are standard ALS units.

Need for Flexibility
There is a continuous flux in terms of types of services due to constant efforts to improve efficiency and effectiveness. Indeed, many fire departments are fire-oriented only in name and are becoming all-purpose emergency services organizations.
Ambulances in the United States are usually staffed by at least one EMT driver and one paramedic. Paramedics in the U.S. are professionally trained emergency medical technicians, a healthcare profession distinct from physicians and nurses.
American paramedics called to an emergency will identify and treat anyone needing medical assistance. They stabilize and transport those in need of further medical care to hospitals, calling for additional ambulances as necessary. If the scene is dangerous (because someone is brandishing a gun or a building is on fire) paramedics usually do not enter until police or fire personnel explicitly allow them to do so.
Large American cities like New York and Los Angeles tend to have many distinct ambulance services representing all of the types mentioned above, so pedestrians and drivers must be alert for ambulances of many shapes, sizes, and colors. However, many smaller cities and suburbs are completely dominated by AMR, and AMR vehicles are synonymous with "ambulance" in those areas.
American ambulances usually are fitted with red (and sometimes white, amber and blue) flashing lights and a siren that continuously rises and falls, as opposed to the two or three-tone sirens heard in other countries. When an ambulance turns on its lights and siren, all other drivers are required by law to pull off to the side of the road and yield the right of way.

L’empire Romain fût le premier a disposer d’une organisation permanente de lutte contre l’incendie, divisée en cohortes d’environ 1000 hommes et pour lesquels étaient rattachés 28 médecins (premier exemple de service de santé dans le milieu des secours ).Le terme ambulance provient du latin Ambulans signifiant "qui marche", appliqué au monde des secours, le mot dérive de l'expression militaire "hôpital ambulant" (XVIII-XIXème siècle) et désignait les fameuses infirmerie de campagne du Docteur Larrey.Mais bien avant, on avait utilisé ambulant, tel que celui qui se déplace, au XVII-XVIIIème siècle, c'était les commerçants, les gens du spectacles. La première ambulance à cheval est apparue durant la guerre civile américaine vers 1861, En 1790, en Egypt, "je fis construire cent panier, deux par chameau, disposés en forme de berceau que l'animal portait de chaque côté de sa bosse, suspendus, par les courroies élastiques au moyen d'une prolonge à bascule : ils pouvaient porter un blessé couché dans toute sa longueur" En 1792, M. Larrey (grand théoricien de la logistique de l’avant et Médecin des Armée de l’Empire) imagine le principe d’ambulances volantes à 2 ou à 4 roues constituées d’une équipe de chirurgiens, infirmiers, ainsi que de fourgonde soutien pour le matériel et la réserve, se portant au devant des moribonds pour leurs prodiguer des soins d’urgence et les conditionner en vue d’une évacuation vers l’arrière. En 1871, les oeuvres des ambulances urbaines de l’hôpital St Louis créé la première structure d’assistance médicale d’urgence pour les civils dans laquelle se tiennent prêt à intervenir des médecins et infirmiers avec des voitures hippomobiles.

Ce projet sera abandonné en 1907.

Note that Type I's and Type III's are often called boxes by their crews with Type II's being called vanbulances.
A typical Type II ambulance. Note how, in contrast to the Type III ambulance shown above, the basic shape of this ambulance is that of a standard full-sized van with a raised roof.

Ambulance service providers come in several types in the USA:
1. Volunteer Ambulance Corps (VAC) or services - function similar to Volunteer Fire Companies. St. John Ambulance is the most common, providing world-wide service in locations ranging from New York City to small rural communites, but many VACs are independant corporations. VACs may be community owned or privately owned, but are typically organised as non-profit organizations. VACs may also be part of Volunteer Fire Companies; in some of these cases, EMTs and drivers are also firefighters. Up until recently, Harbor City Volunteer Ambulance Squad (HCVAS) in Melbourne, Florida was the largest volunteer ambulance squad in the United States.
2. Private Ambulance Service - Normal commercial companies with paid employees, of which the largest is AMR (American Medical Response). While many private companies provide inter-facility patient transfer, many communities' 911 needs are served by private services.
3. Municipal Third Service - Operate as a third service alongside fire and police departments. These are more likely to be found in areas with a high population density, such as a city or metropolitan area.
4. Municipal - Usually fire department owned and operated, though some systems are police department owned and operated.
5. Combined - these are full service emergency service agencies such as airport and college public safety offices. Some smaller towns and cities may also have them. Generally all personnel are crosstrained as EMT's/Firefighter/peace officer.

Ambulances in France & Europe
In France, the most general term is "vehicle adapted to patient transport", the term "ambulance" only applies for some categories of patient transport vehicles.
The word "ambulance" is reserved to transportation on medical prescription, including oral prescription in case of emergency. It does not apply to first responders vehicles (most of times firefighters), although they also transport casualties; their vehicles are called VSAV–véhicule de secours et d'assistance aux victimes (rescue and assistance to casualties vehicle), or VPS–véhicules de premiers secours (first responders vehicles) in case of volunteers from associations. The VSAV and VPS are considered as vectors that bring rescue workers and devices onsite, the evacuation being only the logical following of this intervention but not their main duty.
There are therefore two kinds of ambulance providers: hospitals and private companies.
The reglementation classifies the patient transport vehicles in four types:
· A-type : ambulance for rescue and emergency care (ambulance de secours et de soins d'urgence–Assu) : in these ambulances, the personnel can stand; only these vehicles can be used for emergency (sanitary duty and H-MICU, see below) ;
· B-type : rescue and assistance to casualty vehicles (VSAV), i.e. first responders vehicles, very close to the A-type ;
· C-type : ambulance : the personnel cannot stand, it only allows the transport of a lying patient and of a sitting ambulance technician besides ; due to the lack of room, cares cannot be performed during the transport (these vehicles tend to disappear) ;
· D -type: light vehicle (véhicule sanitaire léger–VSL) : normal car without any specific equipment, for patient who can sit.
The A, B and C-types are called "specially equipped" vehicles, and must follow the NF EN 1789 standard (December 1999).
First responders vehicles
A VSAV has three professional1 CFR onboard, a VPS has five volunteer CFR.
The first responders of the VSAV and VPS are called secouristes and have 60 hours of initial education (plus additional continuous education) and perform non-medical, non-invasive acts. They use splints (including cervical collars, long spine boards and vacuum mattresses), oxygen first aid, and make the casualty lifting.
Hospital ambulances
There are two kind of hospital ambulances:
· internal ambulances, which drive the patients from a building to the other; these are sometimes simple vehicles without any medical equipment when the transport do not require any care (these are always very short transportations).
· the UMH–unité mobile hospitalière (H-MICU–hospital medical intensive care unit) from the SMURr–service mobile d'urgence et de réanimation (mobile emergency resuscitation service) : an ambulance with an MD, a nurse and an ambulance technician that do pre-hospital intervention and interhospital transportation under intensive care.
The H-MICU is often a light rapid-intervention vehicle, i.e. a car carrying the personnel and the material to the casualty; the transport itself is made with a VSAV or a private ambulance equipped with the medical unit.
Special warning devices and traffic law
The H-MICU (A-type) and VSAV (B-type) have a blue rotating light and a two-tones siren (high-low-high-low-high-low...). When these special warning devices are on and when the emergency of the mission justifies it and as long as they do not endanger the life of other people, the traffic law allow them to get rid of certain limitations such as speed limits, direction of driving, priorities and traffic light. In most states, this allows ambulances to travel no more than 5 miles per hour above the posted speed limit. Also, when approaching a red light, the ambulance must first stop, determine the intersection is clear, and then may proceed regardless of what color the light is.
The ambulance of private companies (A- and C-type) have a blue flashing light and a three-tones siren (high-low-high...high-low-high...). When these special warning devices are on and when the emergency of the mission justifies it and as long as they do not endanger the life of other people, traffic laws allow them to get rid of certain limitations such as speed limits while respecting lane priorities and traffic lights.

I have a few ambulances pictures that i don't know origins, so if you want to look at them, may be you'll be able to help me .... HERE

Dessiné et géré par le National Highway Traffic Safety Administration (USA - ministère des transports -1966) est en charge des normes de sécurité automobile et de la surveillance du respect par les constructeurs de ces directives, et dont l'une des missions originelle était d'établir les normes des EMS.

La création de ce sigle a suivi une plainte de la Croix-rouge concernant l'utilisation abusive et désordonnée de son emblème. Cette plainte concernait entre autre l'utilisation d'une croix-rouge dans un triangle orange

The Star of Life is a blue, six-pointed star with the Rod of Asclepius in the center, originally designed and governed by the NHTSA. Internationally, it designates emergency care units and personnel.
A similar orange star is used for search and rescue personnel.
The Star was created in 1973 by Leo R. Schwartz, Chief of the EMS branch at the NHTSA to avoid juridic problems related to the use of derivatives of the Red Cross (like orange cross, green cross, etc.). The Star of Life was registered as a certification mark on February 1, 1977.
The six branches of the star are symbols of the six main tasks executed by rescuers all through the emergency chain:
1. The first rescuers on the scene observe the scene, understand the problem, identify the dangers to themselves and the patient(s), and take appropriate measures to ensure the safety on the scene (circulation, electricity, chemicals, radiations, etc.).
2. The first rescuers call for professional help.
3. The first rescuers provide first aid and immediate care to the extent of their capabilities.
4. The EMS personnel arrive and provide immediate care to the extent of their capabilities.
5. The EMS personnel proceed to transfer the patient to a hospital for specialised care. They provide medical care during the transportation.
6. Appropriate specialized care is provided at the hospital

The National Highway Traffic Safety Administration (NHTSA, often pronounced "nit-suh") is a U.S. Government agency, part of the Department of Transportation, responsible for setting safety standards and verifying compliance by automobile manufacturers. It also issues guidelines for consumers, and publishes the results of safety tests of various automobiles, to allow buyers to evaluate the anticipated behavior of an automobile in a crash.

History
In 1965 and 1966, public pressure grew to increase safety of cars, culminating with the publishing of Ralph Nader's book Unsafe at Any Speed, and National Academy of Sciences' "Accidental Death and Disability - The Neglected Disease of Modern Society". In 1966, congress held a series of highly publicized hearings regarding highway safety, and passed legislation to make installation of seat belts mandatory, and created several predacessor agencies which would eventually become the NHTSA, including the National Traffic Safety Agency, the National Highway Safety Agency, and the National Highway Safety Bureau.
The NHTSA was officially established in 1970 by the Highway Safety Act of 1970. In 1972, the Motor Vehicle Information and Cost Savings Act expanded NHTSA's scope to include consumer information programs.

La star life est une étoile bleue dotée de 6 branches dont les significations nous rappelle...

Aux états unis, c'est en 1959 qu'apparaît le premier numéro d'appel alors que le 911 n'est apparu en Alabama qu'en 1968, et est généralisé dans les années 70.

En France, c'est en 1929, qu'apparaît la connexion automatique avec le 18, le 15 n'apparaît qu'en 1978.

Le 112 a été proposé par le Conférence Européenne des administrations des Postes et Télécommunications en 1972 mais n'a été utilisé qu'en 1991 après accord du conseil des communautés européennes.

Ce numéro n'est opérationnel dans toute l'Europe que depuis 2000 en raison de divers problèmes techniques (en France par exemple, il y avait incompatibilité avec l'annuaire, le 11)

Le 112 est gratuit, disponible de tous les pays Européen, et interconnectés entre les différents services ( police - fire - ambulance), certains pays ont gardés leurs anciens numéros et le 112, d'autres n'ont gardé que le 112.

Garder le numéro secours médical, ou police ou pompiers propre à un pays en plus du 112 permet aux étrangers d'appeler sans problèmes les secours mais aussi aux locaux de gagner du temps en évitant d'en perdre en passant par une centrale pallier supplémentaire et donc perdre de temps....pense t'il, qu'en est il ?

The first emergency number system to be deployed was in London, United Kingdom on June 30, 1937. When 999 was dialed, a buzzer sounded and a red light flashed in the exchange to attract an operator's attention. It was gradually extended to cover the entire country, but it was not until the late 1960s that the facility was available from every telephone.

In the days of loop disconnect dialing, attention was devoted to making the numbers difficult to dial accidentally by making them involve long sequences of pulses, such as with the UK 999 emergency number. This contrasts to modern times, where repeated sequences of numbers are easily dialed on mobile phones, particularly as mobile phones will dial an emergency number while the keypad is locked or even without a SIM card. Some people in the UK have reported accidentally dialing 112 by loop-disconnect while working on extension telephone wiring, and point to this as a disadvantage of that number.

The first North American emergency number was the 999 system deployed in Winnipeg, Manitoba, Canada in 1959 at the urging of Stephen Juba, mayor of Winnipeg at the time. The first US911 emergency phone system was set up in Alabama in 1968, but it was not in use everywhere until the 1970s. To standardize the number across most of the NANP, Canada switched to using 911 as its emergency number in 1972. (Some Caribbean islands use 999.)

In France, in 1928, telephone operators had to connect the calls for emergency reasons even when the phone service was closed. In 1929, an automatic connection system is set up, initially for less than 10,000 people in Paris, allowing them to dial 18 to reach the fire brigade. The service was not widespread until the 1970s.

The CEPT recommended the use of 112 in 1972. The European Union subsequently adopted the 112 number as a standard on 29 July1991. It is now a valid emergency number throughout EU countries and in many other CEPT countries. It sometimes works in parallel with other emergency numbers in countries such as Britain and Ireland.

The GSM mobile phone standard includes 112 as an emergency number, no matter what other local emergency number are applicable. This is valuable for foreign travelers, who may not know a local one.

Using 112 instead of another emergency number on a GSM phone may be advantageous, since 112 is recognized by all GSM phones as an emergency number. A phone dialing a different emergency services number may refuse to roam onto another network, leading to trouble if there is no access to the home network. Dialing 112 forces the phone to make the call on any network possible. However, some GSM networks (e.g. in Belgium, Spain, UK, Liechtenstein) are reported to connect emergency calls only from phones with a valid account on their network, e.g. customers and roamers only. Some GSM networks will not accept emergency calls from phones without a SIM card, or a SIM card without credit.

In the United States, the FCC requires networks to route every mobile-phone 911 call to an emergency service call center, including phones that have never had service, or whose service has lapsed. As a result, there are programs that provide donated used mobile phones to victims of domestic violence and others especially likely to need emergency services.

Mobile phones generate additional problems for emergency operators, as many phones will allow emergency numbers to be dialed even while the keypad is locked. Since mobile phones are typically carried in pockets and small bags, the keys can easily be depressed accidentally, leading to unintended calls. A system has been developed in the UK which connects calls where the caller is silent to an automated system, leaving operators more free to handle genuine emergency calls.

999 is Ireland's and the United Kingdom's emergency telephone number along with the EU standard 112. Either number can be used but 999 is more popular and better-known than 112. It is also the emergency telephone number in some Commonwealth countries. It is also used in the Ghana, The United Arab Emirates, Hong Kong, Macau, Malaysia and Singapore.

It is an all-service number, meaning that it should be called in any situations where state-run emergency services are needed. The three main and best-known services are fire brigade, police and ambulance. Other available services include coastguards, mountain rescue and cave rescue (where locally relevant). Some situations such as a major car accident or a terrorist attack (including nuclear, biological, or chemical attacks) will require multiple and/or specialist services but the first point of call for reporting such incidents from the general public is still the 999 system. In some situations there will be specific instructions on nearby signs to notify some other authority of an emergency before calling 999. For example there are notices on bridges carrying railways over roads telling people that, if they see a road vehicle striking the bridge, they should call the railway authority (on a given number) first and then call 999 to inform the police.

In the UK, the number is operated by BT and Cable and Wireless for the Home Office.

The 999 service was introduced on 30 June1937 in the London area. 999 was chosen because of the need for the code to be able to be dialled from payphones - the old A/B button payphones. The telephone dial (GPO Dial No 11) used with these coinboxes allowed the digit '0' to be dialled without inserting any money. It was very easy to adapt the dial also a digit '9' without inserting money. All other digits from 2 to 8 were in use somewhere in the UK as the initial digits for subscribers telephone numbers and hence could not easily be used. Also had any other digits been used, other digits between that one and the already free '0' would also have been able to be dialled for free. Also no other 'subscribers' telephone numbers existed using combinations of the digits '9' & '0' - other than one in Woolwich - therefore there would be no other unauthorised 'free' calls. Thus the easy conversion of coinbox dial was the deciding factor and the fact that 999 was not used anywhere - other than for accessing the odd 'position 9' of a Engineering Test Desk in the telephone exchange - codes 991 upwards accesed the individual Test Desk postions.

The 'pan European' 112 code was introduced in the UK by BT in December 1992, with little publicity. It connects to existing 999 circuits.

On 6 October1998, BT introduced a new system whereby all the information about the location of the calling telephone was transmitted electronically to the relevant service rather than reading it out audibly (with the possibility of errors)

000 (sometimes known as triple-O) is the primary national emergency number in Australia. It is operated by Telstra Corporation Limited as a condition of its telecommunications licence, and is intended only for use in life-threatening emergencies. Other emergency numbers in Australia are 112 for GSMmobile phones—which is redirected to a 000 operator—and 106 for textphones.

Prior to 1961, Australia had no national number for emergency services; the police, fire and ambulance services possessed many phone numbers, one for each local unit. In 1961, Telecom introduced the 000 number in major population centres and near the end of the 1980s extended its coverage to nationwide. The number 000 was chosen for several reasons, one of which was that zero was closest to the finger stall on rotary dial phones, so it was easy to dial in darkness.

As the Australian Communications and Media Authority does not regard State Emergency Service (SES) calls as life-threatening, the 000 number does not allow them to be contacted. Asking for the SES prompts a recorded announcement explaining how to proceed.

On December 3, 2003, floods and storms in Melbourne caused a large influx of 000 calls, preventing some calls from being answered immediately: this caused some users interviewed by authorities to believe that they had dialled the wrong number. A subsequent investigation recommended that a recorded announcement be set up to assure callers that their calls were being connected[1].

The push for the development of a nationwide emergency telephone number came in 1957 when the National Association of Fire Chiefs recommended a single number to be used for reporting fires. In 1967 the President's Commission on Law Enforcement and Administration of Justice recommended the creation of a single number that can be used nationwide for reporting emergencies. The burden then fell on the Federal Communication Commission, which then met with AT&T in November 1967 in order to come up with a solution.

In 1968, a solution was agreed upon. AT&T had chosen the number 911, which met the requirements that it be brief, easy to remember, dialed easily, and that it worked well with the phone systems in place at the time. How the number 911 itself was chosen is not well known and is subject to much speculation. However, many feel that the number 911 was chosen to be similar to the numbers 2-1-1 (long distance), 4-1-1 (information, later called "directory assistance"), and 6-1-1 (repair service), which had already been in use by AT&T since 1966.

Furthermore, the North American Numbering Plan in use at the time established rules for which numbers can be used for area codes and exchanges. At the time, the middle digit of an area code had to be either a 0 or 1, and the first two digits of an exchange could not be a 1. At the telephone switching station, the second dialed digit was used to determine if the number was long distance or local. If the number had a 0 or 1 as the second digit, it was long distance, and it was a local call if it was any other number. Thus, since the number 911 was detected by the switching equipment as a special number, it could be routed appropriately. Also, since 911 was a unique number, never having been used as an area code or service code (although at one point GTE used test numbers such as 11911), it fit into the phone system easily.

Just 35 days after AT&T's announcement of 9-1-1 as their choice of the three-digit emergency number, on February 16, 1968, the first-ever 9-1-1 call was placed by Alabama Speaker of the House Rankin Fite from Haleyville, Alabama City Hall to U.S. Rep. Tom Bevill (Dem.) at the city's police station. Bevill reportedly answered the phone with "Hello." Attending with Fite was Haleyville mayor James Whitt. At the police station with Bevill was Gallagher and Alabama Public Service Commission director Eugene "Bull" Connor (formerly the Birmingham police chief involved in federal desegregation). Fitzgerald was at the ATC central office serving Haleyville, and actually observed the call pass through the switching gear, as the mechanical equipment clunked out "9-1-1." The phone used to answer the first 911 call, a bright red model, is now in a museum in Haleyville, while a duplicate phone is still in use at the police station. Some accounts of the event claim that, "Later, the two (Bevill and Fite) said they exchanged greetings, hung up and 'had coffee and doughnuts.'"

In 1973, the White House urged nationwide adoption of 911. In1999, President Bill Clinton signed the bill that designated 911 as the nationwide emergency number. Even though 9-1-1 was introduced in 1968, the network did not completely cover the United States and Canada until the late 1990s.

9-1-1 and enhanced 9-1-1 are typically funded pursuant to state laws that impose monthly fees on local and wireless telephone customers. Depending on the state, counties and cities may also levy a fee, which may be in addition to, or in lieu of, the state fee. The fees are collected by local exchange and wireless carriers through monthly surcharges on customer telephone bills. The collected fees are remitted to 911 administrative bodies, which may be a statewide 911 board, the state public utility commission, a state revenue department, or local 911 agencies. These agencies disburse the funds to the Public Safety Answering Points for 911 purposes as specified in the various statutes. Telephone companies, including wireless carriers, may be entitled to apply for and receive reimbursements for costs of compliance with federal and state laws requiring that their networks be compatible with 9-1-1 and enhanced 9-1-1.

The amount of the fees vary widely by state and locality. Fees may range from around $.25 per month to $3.00 per month per line. The average wireless 9-1-1 fee is around $.72. Since the monthly fees do not vary by the customer's usage of the network, the fees are considered, in tax terms, as highly "regressive", i.e., the fees disproportionately burden low-volume users of the public switched network (PSN) as compared with high-volume users. Some states cap the number of lines subject to the fee for large multi-line businesses, thereby shifting more of the fee burden to low-volume single-line residential customers or wireless customers.

Congress in 2004 authorized $250,000,000 in annual funding for the 9-1-1 program, but actual appropriations to state and local 9-1-1 agencies are yet to occur.

In over 93% of locations in the United States and Canada, dialing "911" from any telephone will link the caller to an emergencydispatch center—called a PSAP, or Public Safety Answering Point, by the telecom industry—which can send emergency responders to the caller's location in an emergency. In some areas enhanced 911 is available, which automatically gives dispatch the caller's location, if available.

Dialing 9-1-1 from a mobile phone (Celluar/PCS) in the United States originally reached the state police or highway patrol, instead of the local public safety answering point (PSAP). The caller had to describe his/her exact location so that the agency could transfer the call to the correct local emergency services. This happens because the exact location of the cellular phone isn't normally transmitted with the voice call.

In 2000 the FCC issued an Order requiring wireless carriers to determine and transmit the location of callers who dial 9-1-1. They set up a phased program: Phase I transmitted the location of the receiving antenna for 9-1-1 calls, while Phase II transmitted the location of the calling telephone. The Order set up certain accuracy requirements and other technical details, and milestones for completing the implementation of wireless location services. Subsequent to the FCC's Order, many wireless carriers requested waivers of the milestones, and the FCC granted many of them. As of mid-2005, the process of Phase II implementation is generally underway, but limited by the complexity of coordination equired between wireless carriers, PSAPs, local telephone companies and other affected government agencies, and the limited funding available to local agencies for the conversion of PSAP equipment to display the location data (usually on computerized maps).

These FCC rules require new mobile phones to provide their latitude and longitude to emergency operators in the event of a 911 call. Carriers may choose whether to implement this via GPSchips in each phone, or via triangulation between cell towers. In addition, the rules require carriers to connect 911 calls from any mobile phone, regardless of whether that phone is currently active. Due to limitations in technology (of the mobile phone, cell phone towers, and PSAP equipment), a mobile callers' geographical information may not always be available to the local PSAP. Although there are other ways, in addition to those previously stated, in which to obtain the geographical location of the caller, the caller should try to be aware of the location of the incident for which they are calling.

In the U.S., FCC rules require every telephone that can physically access the network to be able to dial 911, regardless of any reason that normal service may have been disconnected (including non-payment). On wired (land line) phones, this usually is accomplished by a "soft" dial tone, which sounds normal, but will only allow emergency calls. Often, an unused and unpublished phone number will be issued to the line so that it will work properly.

If 911 is dialed from a commercial VoIP service, depending on how the provider handles such calls, the call may not go anywhere at all, or it may go to a non-emergency number at the public safety answering point associated with the billing or service address of the caller. Because a VoIP adapter can be plugged into any broadband internet connection, the caller could actually be hundreds or even thousands of miles away from home, yet if the call goes to an answering point at all, it would be the one associated with the aller's address and not the actual location. It may never be possible to accurately pinpoint the exact location of a VoIP user (even if a GPS receiver is installed in the VoIP adapter, it will likely be indoors, and may not be able to get a signal), so users should be aware of this limitation and make other arrangements for summoning assistance in an emergency.

In March 2005, commercial Internet telephony provider Vonage was sued by the Texas attorney general, who alleged that their website and other sales and service documentation did not make clear enough that Vonage's provision of 911 service was not done in the traditional manner.

In May 2005 the FCC issued an Order requiring VoIP providers to offer 9-1-1 service to all their subscribers within 120 days of the Order being published. The Order as set off anxiety among many VoIP providers, who feel it will be too expensive and require them to adopt solutions that won't support future VoIP products.

There are some problems with the assignment of the number 9-1- 1. In particular, it can cause some dialing-pattern problems in hotels and businesses. Some hotels, for example, have been known to require dialling "91+" to make an outside call. This leads to calls that look like 91+1+301+555+2368. Since that's a valid number, which starts with 911, and is not a call to an emergency service, a timeout becomes necessary on actual calls to 911. Such prefixes are strongly discouraged by telephone companies. This is also part of the reason why no area codes start with a "1": the slightly less troublesome "outside line" prefix of "9+" would then cause the same problem: "9+114+555+2368", for example. Another possible problem is that the international phone code for India is "91", and sometimes calls meant for India end up at the local emergency dispatch office. And in Germany, the domestic area code "0911" is reserved for the town of Nürnberg (Nuremberg) - in European countries with an open telephone numbering plan, like Germany, all area codes begin with a "0" prefix.

The number's close association with emergencies has led to "911" being used as shorthand for "emergency" in text messages sent to pagers and mobile phones—however, this is often used to tag situations which do not have the life-safety implications that an actual call to 911 implies.

Additionally, 9-1-1 is used so pervasively in U.S. and Canadian media and safetyeducation that other countries have sometimes had difficulty in educating children not to dial 9-1-1 for help at all. Even many American tourists do not know that 9-1-1 is not generally an emergency number outside the U.S. and Canada, and sometimes face problems when they are abroad.

The Netherlands, however, has redirected 9-1-1 to the local emergency line, 1-1-2.

The most common emergency number outside the U.S. and Canada is 1-1-2. The next most common is 9-9-9. Germany, for example, also uses 1-1-0 for police and
1-1-2 for fire & ambulance.

In 1991, the European Union established
1-1-2 as the universal emergency number for all its member states. In most E.U. countries, 1-1-2 is already effective and can be called toll-free from any telephone or any cellphone. The GSM mobile phone standard designates 1-1-2 as an emergency number, so it will work on such systems even in the U.S. In the UK, the number is 9-9-9 with 1-1-2 working in parallel.

In New Zealand, because rotary telephone dials were scribed in the reverse order of ones in the UK (0-9, instead of 9-0), 1-1-1 was selected as the emergency number.

9-1-1 Emergency Telephone Number Day was proclaimed, by President Reagan in 1987, to occur on the 11th day of September, the ninth month, of that year. The proclamation was made to promote the North American universal emergency telephone number 9-1-1.

Until 2001, September 11 was celebrated by many United States communities as "9-1-1 emergency number day" or simply "911 day". The promotional effort was often led by firefighters and the police. After the September 11, 2001 attacks, the reminders of 9-1-1 were merged with or dropped in favor of remembrance of the attacks.

When the 9-1-1 system was originally introduced, it was advertised as the "nine-eleven" service. This was changed when some panicked individuals tried to find the "eleven" key on their telephones (this may seem bizarre and amusing, but it is important to remember that in emergencies people can easily become extremely confused and irrational). Therefore, all references to the telephone number 9-1-1 are now always made as nine-one-one — never as "nine-eleven."

Some newspapers and other media require that references to the phone number be ormatted as 9-1-1; nine-eleven is still used occasionally but less so since the term came to refer to the September 11 attacks in the United States, as Americans write dates month/day (unlike Europeans, who write dates day/month).

Many countries' public telephone networks have a single emergency telephone number, sometimes known as the universal emergency telephone number or occasionally the emergency services number, that allows a caller to contact local emergency services for assistance. The emergency telephone number may differ from country to country. It is typically a three-digit number so that it can be easily remembered and dialed quickly. Some countries have a different emergency
number for each of the different emergency services; these often differ only by the last digit.

For routine and non-urgent enquiries emergency services generally provide traditional telephone numbers for contact. These are normally listed in the local telephone directory. In the United Kingdom, for example, the number 0845 46 47 can also be dialled for NHS Direct, a non-emergency medical service. Routine and non-urgent calls as well as hoax or prank calls to emergency services numbers waste the time of both dispatchers and emergency responders and can endanger lives. False reports of emergencies are often prosecuted as crimes.

In the North American Numbering Plan, 3-1-1 is the new urgent telephone number, that can be used to contact the police and other services to report minor incidents and historic crime that does not endanger life, to avoid overloading 9-1-1. Some cities also use 3-1-1 for contacting other municipalgovernment services, or to report situations like power outages.

The telephone number 1-1-2 is the international emergency telephone number for GSMmobile phone networks. It does not necessarily work on other mobile phone technologies. In all EU (European Union) countries it is also the emergency telephone number for both mobile and fixed-line telephones. [1]

In countries where 1-1-2 is not the standard emergency telephone number, GSM telephone users who make calls to 1-1-2 generally have their calls redirected to the local emergency telephone number, if it exists. GSM telephone users in this situation should contact their service provider for emergency information applicable to their service. Most GSM mobile phones can dial 1-1-2 calls even when the phone keyboard is locked.

The emergency telephone number is a special case in the country's telephone number plan. In the past, calls to the emergency telephone number were often routed over special dedicated circuits. Though with the advent of electronic exchanges these calls are now often mixed with ordinary telephone traffic, they still may be able to access circuits that other traffic cannot. Often the system is set up so that once a call is made to an emergency telephone number, it must be answered. Should the caller abandon the call, the line may still be held until the emergency service answers and releases the call.

An emergency telephone number call may be answered by either a telephone operator or an emergency service dispatcher. The nature of the emergency (police, fire, medical) is then determined. If the call has been answered by a telephone operator, they then connect the call to the appropriate emergency service, who then dispatches the appropriate help. In the case of multiple services being needed on a call, the most urgent need must be determined, with other services being called in as needed.
Emergency dispatchers are trained to control the call in order to provide help in an appropriate manner. The emergency dispatcher may find it necessary to give urgent advice in life-threatening situations. Some dispatchers have special training in telling people how to perform first aid or CPR.

In many parts of the world, an emergency service can identify the telephone number that a call has been placed from. This is normally done using the system that the telephone company uses to bill calls, making the number visible even for users who have unlisted numbers or who block caller ID. For an individual fixed landline telephone, the caller's number can often be associated with the caller's address and therefore their location. However, with mobile phones and business telephones, the address may be a mailing address rather than the caller's location. The latest "enhanced" systems, such as Enhanced 911, are able to provide the physical location of mobile telephones. This is often specifically mandated in a country's legislation.

Australia: 000 On a mobile phone, dial 112 or 000, remembering to tell the operator what state you are in. If you have a textphone/TTY, you can use the National Relay Service on 106. SES units in Victoria, New South Wales and South Australia can be contacted on 132 500. In Western Australia, the number is 1300 130 039. In the ACT, the number is 6207 8455. In Queensland, Tasmania and Northern Territory, you will have to call the individual units.

The Emergency Medical Service system (known by the acronym "EMS" in the USA and Canada) is responsible for providing pre-hospital (or out-of-hospital) care by paramedics, emergency medical technicians (EMT's), and Medical first responders (MFRs in US terminology). The goal of EMS is to provide early treatment to those in need of urgent medical care, and ultimately rapid transportation to an Emergency department. Stabilizing a patient early (within the golden hour significantly increases their chances of survivial, particularly in the event of a heart attack, diabetic emergency, or severe physical trauma).

EMS providers work under the license and indirect supervision of a medical director or board-certified physician who oversees the policies and protocols of a particular EMS system or organization. Due to the nature of the environment in which EMS personnel must work, equipment and procedures are necessarily limited; however, prehospital personnel are able to provide a high level of care.

EMS professionals are trained to follow a formal and carefully designed decision tree, more commonly referred to as a protocol or standard of care, which has been created and approved by physicians. The emphasis in emergency services is on following correct procedure quickly and accurately rather than on making in-depth diagnoses that require much professional training and experience. The use of a decision tree allows EMS workers to be trained in a much shorter time than physicians, with EMT-Basic classes, for example, as short as 1-5 months. Paramedic training is the highest level of EMT, and allows advanced airway skills including airway tube placement, emergency creation of an airway
( crichothyrotomy), cardiac monitoring, intravenous cannulation and Advanced Cardiac Life Support.

National EMS standards for the US are determined by the U.S. Department of Transportation and modified by each state's Department of EMS (usually under its Department of Health), and further altered by Regional Medical Advisory Committees (usually in rural areas) or by other committees or even individual EMS providers. In addition, the National Registry of Emergency Medical Technicians, an independent body, was created in 1970 at the recommendation of President Lyndon B. Johnson in an effort to provide a nationwide consensus on protocols and a nationally accepted certification. National Registry certification is widely accepted in some parts of the U.S., while other areas still maintain their own, separate protocols and training curricula.

The origins of EMS date back to the days of Napoleon, when the French army utilized horse drawn "ambulances" to transport the injured soldier from the battlefield. One of the first civilian EMS services can be traced back to 1869, when Dr. Edward L. Dalton at Bellevue Hospital, then known as the Free Hospital of New York, in New York City started a basic transportation service for the sick and injured. The component of care on scene began in 1928, when Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, which was the first land-based rescue squad in the nation. Over the years EMS continued to evolve into much more than a "ride to the hospital."

In particular in the US state of California and in Seattle, Washington state (see Medic One), projects began to include paramedics in the EMS responses in the late 1960s. Groups in Pittsburgh, Pennsylvania and Portland, Oregon were also early pioneers in prehospital emergency medical training (see paramedic). Despite opposition from firefighters and doctors, the program eventually gained acceptance as its effectiveness became obvious. Furthermore, such programs became widely popularized around North America in the 1970s with the television series, Emergency! which in part followed the adventures of two Los Angeles County Fire Department paramedics as they responded to various types of medical emergency. James O. Page served as the series technical advisor and went on to become integral in the development and EMS in the U.S. The popularity of this series encouraged other communities to establish their own equivalent services.

Many EMS units are typically the same as a First Aid, Rescue, EMS, Emergency or Safety Squad. However, a Rescue Squad may also rarely be part of a Fire Department, race car team, or military unit. In the traditional sense, dating back to the early 1900's, a Rescue Squad is a volunteer organization that provides Emergency Medical Services as part of the rescue operation which includes but is not limited to confined space, cave, motor vehicle extrication, search and rescue, high angle, water rescue, mountain/ski rescue and so on. As many Fire Departments only recently during the 1990's have taken over rescue, many squads that used to function as "true" Rescue Squads have recently only been relegated to basic EMS Ambulance services. However, a large majority of Rescue Squads still maintain and perform their original and historical function of Emergency Medical Services as part of a rescue operation such as Motor Vehicle Extrication, Search, or any of the other aforementioned rescue operations. Typically, a Rescue Squad has equipment such as ambulances, light and heavy rescue vehicles, boats, and other rescue equipment, and staffs their rescue department with EMT's who understand patient care in a rescue situation. A prime example would be an organization such as the Pittsburgh EMS http://www.city.pittsburgh.pa.us/ems/

SAMU

SAMU (Service d'Aide Médicale d'Urgence, "Emergency Medical Assistance Service") is the French hospital based emergency medical service. It was founded in 1968 by coordinating the existing SMUR teams (prehospital care units).
The name SAMU is also used by several French-speaking countries as well as Spanish-speaking countries such as Argentina; it then stands for Sistemas de Atencion Médica de Urgencias y Emergencias (sometimes SAME).

SAMU missions are defined in a law of 1986. SAMU are defined as hospital services providing permanent phone support, choosing and dispatching the proper response for the call in the swiftest delays. These responses can range from
• Medical advices (28% of the calls)
• Sending ambulances, from the fire department for street accident or disease or absolute emergencies at home (24% of the calls), or from private companies for relative emergency transportation from home (8% of the calls)
• Sending a generalist physician at home (22% of the calls)
• Sending a ressuscitation ambulance (H-MICU: hospital mobile intensive ressuscitation unit, called UMH-Unité Mobile Hospitalière), fast intervention vehicle or medical helicopter for the most serious cases
• Management of crisis with large numbers of casualties (plan rouge, plan blanc), they maintain the mobile sanitary kits (postes sanitaires mobiles, PSM).
The French philosophy for medical emergencies allows the reanimation units to be dispatched only in life-threatening cases.
SAMU are also in charge for the training of emergency physicians.

SAMU organisation
All French Départements hold one SAMU (that is roughly one for 500 000 people), which makes a total of a hundred units, and 350 SMUR in the whole France.
Additionally, two SAMU have special tasks :
• The SAMU de Paris is in charge for emergencies in fast trains (TGV) and flying Air France aircraft.
• The SAMU de Toulouse is in charge for ships at sea.
The main component of the SAMU is the dispatch, called Centre 15 (15 is the emergency number for medical emergency) or CRRA (centre de réception et de régulation des appels: calls reception and dispatch center). The CRRA received about 10 million calls in 2004, with a regular increase of 10% per year:
• 57% from individuals (witnesses or victims of an accident or disease);
• 27% from the firefighters (NB: in France, firefighters are in charge of emergency ambulances, as certified first responders)
• 5% from the hospitals (usually life threatening emergencies in a department)
• 5% from a general practitioner (usually visiting a patient at home)
• 5% rest (police, ambulance - in France, private ambulance society mainly act as transport for programmed acts, a kind of paramedical taxi).

Prehospital Care Strategy
The French doctrine relies on the hopes of survival for a critically injured patient decreasing exponentially with time, which explains why so many patients die during transportation. To maximise the chances of recovery, it is believed important to cut down on tansportation time, and bring a fully equipied and qualified team to the patient, rather than sending an ambulance to pick up the patient and double the travel back to hospital. To this effect, Mobile Emergency Units (SMUR) are equipped with both a fully qualified emergency physician and medical equipment.
This doctrine also simplifies greatly the Emergency department of hospitals (eliminating the need for a "smaller hospital within the hospital"), and ensure that the stabilised patient will receive care from a specialist rather than an emergency generalist.
In extreme cases, heart operations have been performed on the street (resulting in surviving patients). Overall, the French SAMU is arguably one of the very best in the world, innovating in lots of areas (the French SAMU are the only emergency teams to have tested portable succion cardiopumps on scene) and inspiring equivalent services in other countries.
The French emergency system is very different from emergency systems from the USA and the United Kingdom, for instance : one notable difference is that intervention units (ambulance or SMUR) may decide to stay on the scene for a long time (much more than the typical 10 minutes that ambulances spend on a scene before picking up a patient in most other countries).
This is often described as stay and play, opposed to the scoop and run strategy performed in the United States and in the United Kingdom. This is not totally true as in most cases, the patient is at the hospital within the golden hour, the best description would be play and run.
This feature is often misunderstood among the American public or British public. For instance, when Diana, Princess of Wales died in Paris, some British tabloids took outrage that the patient had stayed on the scene for two hours, leaving the impression that the delay might have caused the death. Actually, the SAMU doctrine allowed the patient to receive extensive care during these two hours, including cardiac ressucitation in the ambulance [1].

Le premier service de médecine d'urgence a vu le jour en 1869 à l'hôpital de New York City, ou un service assurait le transport basic des malades et blessés.
En 1928, 1er "Rescue squad" à Roanoke (Virginie - USA) se crée, puis les EMS se sont développés depuis les années 60 malgré l'opposition des médecins et pompiers jusqu'aux années 70.... où miracle du petit écran, une série des années 70 intitulé "Emergency" (dont l'histoire se déroulait avec l'équipe de Paramedics du Los Angeles Fire Department) propulse ces EMS naissant au devant de la scène.
En France, c'est en 1955 qu'apparaissent les 1ère équipe mobile de réanimation dont les premières missions consistait dans la prise en charge des accidentés de la route et les transferts inter hospitaliers pour les malades atteints de paralysie respiratoire.
Dès 1965; les SMUR se multiplie avec la parution du décret ministériel sur la création des SMUR.
Les SAMU naissent en 1968 pour coordonner les SMUR et s'associent dès 1974 avec le secteur de médecine libérale.
En France, c'est en 1955 qu'apparaissent les 1ère équipe mobile de réanimation dont les premières missions consistait dans la prise en charge des accidentés de la route et les transferts inter hospitaliers pour les malades atteints de paralysie respiratoire.
Dès 1965; les SMUR se multiplie avec la parution du décret ministériel sur la création des SMUR.
Les SAMU naissent en 1968 pour coordonner les SMUR et s'associent dès 1974 avec le secteur de médecine libérale.

Si vous ne connaissez pas cette série (je ne la connaissais pas), allez rencontrer les fans

Utilisation de la "GOLDEN HOUR", les chirugiens donnent 1H aux équipes d'intervention pour amener du lieu de l'accident à la "TRAUMA ROOM" tous patient traumatisé; unique moyens de sauver le patient.

The strategy developed for prehospital care in North America is called Scoop and Run. It is based on the Golden Hour theory, i.e., that a victim's best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This is appers to be true in cases of internal bleeding, especially penetrating truama such as gunshot or stab wounds. Thus, the minimal prehospital care is performed (ABCs, i.e. ensure airway, breathing and circulation; external bleeding control; spine immobilization; endotracheal intubation) and the victim is transported as fast as possible to a trauma center. This philosophy is aptly summarized by the following quotation from "The Rules of EMS": "Trauma is treated with diesel first." The aim in "Scoop and Run" treatment is generally to transport the patient within ten minutes of arrival; hence the birth of the phrase, "the platinum ten minutes" (in addition to the "golden hour"), now commonly used in EMT training programs. It should be noted the "Scoop and Run" is a method developed to deal with trauma, rather than strictly medical situations (e.g. cardiac or respiratory emergencies).

The stay and play strategy was designed in France with the SMUR (Service Mobile d'Urgence de Réanimation, emergency mobile resuscitation unit) and SAMU (Service d'Aide Médicale d'Urgence), as it was noted that an unacceptable number of patients were dying during transport. The French thus developed a strategy based on maximum care before transportation. Prehospital medical care is provided by a medical doctor MD, a nurse and an ambulance technician, with almost all the equipment and drugs that can be found in an emergency department. The priority here is the stabilization of the patient prior to transport, including intravenous drip to raise the blood pressure (one of the causes of death during transportation is the drop in pressure, which decreases perfusion of the brain and heart; see shock). The German EMS is very similar to the French system.

In case of a severe myocardial infarction (or heart attack), all care is performed onsite (including the possibility of thrombolysis), and the victim is transported only if the heart starts again or the patient is declared dead. Defibrilation is performed by a firefighter rescue team with an automated external defibrillator if they arrive before the medical team. Note that this example is one of the only "real" stay and play approaches performed in France; in most cases, the treatment by the physician is fast and the patient is transported to the hospital within the golden hour.

Les médecins Français ont étudié le nombre de décès lors de transport, et ont orienté leur démarche vers une stabilisation du patient avant le transport surtout en cas d'ACR pour lequel la route vers l'hôpital ne sera envisagé qu'avec un patient vivant ou mort, alors que certains pays vont ventiler et masser jusqu'à l'hôpital.

C'est un mixte des 2, prise en charge des traumatisés graves (seul traitement réel : le bloc), mais utilisation du temps ne pouvant pas être réduit (désincarcération) pour la stabilisation et la médicalisation de la victime.

objectif : pression artérielle normale (9 de systolique) puis évacuation rapide avec moyen rapide.

Both the scoop and run and the stay and play strategies have their advantages and drawbacks. The synthesis of these two opposite strategies has led recently to a new concept: the play and run. The time that cannot be reduced (e.g. while extracting a victim trapped in a car) is used to perform medical care. The treatment aim is no longer to recover a "normal" blood pressure, but a minimal blood pressure, using not only intravenous drip but also vasocompressing drugs and antishock pants (to compress the legs and push the blood into the rest of the body). The aim is to reduce the risk of death due to transportation trauma while respecting the golden hour. The problem with play and run lies in the difficulty of getting a good IV stick in a moving vehicle and controlling the volume of IV fluids given to the patient. Too little fluid will cause inadequate circulation and heart failure, while too much fluid will cause excessive loss of oxygen-bearing blood.

Two levels of care are provided by EMS systems: Basic Life Support and Advanced Life Support (BLS and ALS).

BLS providers are CFRs (Certified First Responders) and EMTs, or EMT-Bs (Emergency Medical Technicians-Basic), and provide all care outlined in the EMS standard of care, except for invasive procedures and (to a certain extent) giving medications. EMTs also rarely receive training in EKG interpretation, one of the most basic ALS skills.
ALS providers are principally paramedics and EMT-Intermediates (EMT-I), who are certified to perform invasive procedures and to give a wide variety of drugs. The biggest difference between EMT-I's and Paramedics is that while EMT-I's handle advanced airway management like Paramedics, they do not have as in-depth cardiac training and usually administer fewer medications. There are also Rescue EMTS who are certified and/or have the training in water rescue or in motor vehicle extrication using the jaws of life in medically directed rescue.