French regional trauma network: the Rhone-Alpes example

Abstract

Editor–We read with great interest the special issue of the British Journal of Anaesthesia dedicated to severe trauma care in the UK.1McCullough AL Haycock JC Forward DP Moran CG Major trauma networks in England.Br J Anaesth. 2014; 113: 202-206Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar The trauma system implemented in the British territory is remarkable and this issue highlighted the need for worldwide implementation of national trauma networks. In France, regional networks for trauma care have been developed in the Rhone-Alpes region for a decade. RESUVAL (trauma network of the Rhone Valley) and TRENAU (trauma system of the Northern French Alps Emergency Network) federate 40 hospitals within a regional area (Drome, Rhone, Ain, Isere, Savoie and Haute Savoie, France) and combine the American trauma system’s organization and the French expertise in pre-hospital medical care. In France, the Service d’Aide Medicale Urgente (SAMU) and the Service Medical d’Urgence et de Reanimation (SMUR) were created to face the poliomyelitis epidemic in the 1950s and to provide pre-hospital medical care for trauma all over the country. In practice, trauma care accounts for only 15% of all pre-hospital emergencies, and a majority of the activity is represented by myocardial infarction, stroke and cardiac arrest. Triage algorithms based on medical assessment and management at the scene have been proposed for patients with severe blunt trauma. The triage procedure integrates the initial assessment of the trauma severity by pre-hospital physicians, the need for medical facilities and the proximity of trauma centres. After medical assessment, trauma patients are categorized into three levels of severity according to criteria of injury severity and the response of pre-hospital resuscitation. This triage procedure aims to admit trauma patients to the most suitable trauma centre according to their available facilities to avoid secondary potentially harmful transfer. Marked differences should be noted between the French and the British trauma networks. Evaluation by the pre-hospital medical team is one of the hallmarks of the French trauma system. The effects of pre-hospital medical management were recently assessed in the French Intensive Care Recorded in Severe Trauma (FIRST) study. In a cohort of 2700 patients with severe blunt trauma, pre-hospital management with SMUR was associated with a significantly reduced mortality on day 30 after the injury. Interestingly, adjustments for the time delay from accident to hospital admission marginally affected these results. Another advantage of pre-hospital medical evaluation could be the rapid assessment of trauma severity by ultrasonography to improve pre-hospital triage. Another specific feature is the anaesthesiologist–intensivist leadership in the trauma team at hospital admission. The French regional network for trauma care developed in the Rhone-Alpes region is a specific adaptation of the American trauma system to the organization of pre-hospital medical care in France. Because the effect of the trauma system on mortality after severe trauma is well documented, trauma networks should be implemented in all French territory. The British organization, with its national networking, shows us the path. None declared.