Experience is key for SMUR nurses

To work in the SMUR (Structure Mobile d'Urgence et de Réanimation), nurses must have a wide range of experience because they may be called upon to handle any situation, from childbirth to critical care, in any location. Gaël de Beaudrap, a nurse at the Service d'Aide Médicale Urgente (SAMU) in Marseille, has worked in cardiology intensive care, a multidisciplinary intensive care unit, and a burn center before joining the SAMU, where he has been for 26 years.

SMUR teams and their equipment checks

In Marseille, seven medical teams of the SMUR are available 24 hours a day. Four of these teams are affiliated with the Assistance Publique-Hôpitaux de Marseille (AP-HM) and three are firefighters. When they arrive at the SMUR, the teams first check which vehicle they are assigned to. Unlike in hospitals, where patient handovers are performed, at the SMUR, the handover is on the equipment.

Preparation for every mission

Before starting their missions, the teams perform detailed checks on all equipment, from syringes to the truck's bolts. This is crucial because, unlike in hospitals where missing supplies can be replaced quickly, in the field—whether at a patient's home, under a car, or in a helicopter—missing equipment can be critical. This thorough preparation takes time, but the teams must always be ready for an emergency call.

Diverse responsibilities and logistics

SMUR teams handle a wide range of tasks, from routine duties like preparing orders and managing logistics to preparing for exceptional health situations. They also check the helicopter, validating its readiness with the pilot and flight assistant. The helicopter is used to save time, whether in primary emergencies to save a life or in secondary transfers to move patients to specialized care.

Primary and secondary interventions

SMUR nurses respond to two main types of interventions. Primary interventions involve retrieving patients in critical situations like road accidents or heart attacks, where they aim to stabilize the patient and transport them to the hospital. Secondary interventions involve transferring patients from smaller hospitals to larger ones with more advanced facilities. The helicopter is used in both cases to save time and improve patient outcomes.

Time pressure and teamwork

Every departure, especially by helicopter, is timed with a stopwatch in mind. During flights, the team may assist the pilot and flight assistant, especially during landings on challenging terrain. The goal is to respond quickly and save time, which is crucial for all types of patients and conditions. However, weather constraints can limit the time spent on site, adding to the pressure.

Structure and roles within SAMU

The SAMU includes three units: the call regulation center, the mobile emergency and resuscitation services (SMUR), and the emergency care teaching center. The SMUR includes trucks, helicopters, and cars, and the team includes at least one doctor and a nurse. Ambulance drivers also accompany the team, helping with equipment and procedures. During secondary transfers, a medical student or intern may be present to learn about the work.

Challenges and evolution in the field

Despite improvements in equipment and skills, the team spirit among SMUR nurses has diminished over time. The equipment is better, but the sense of camaraderie is not as strong as before. Nurses must also work with firefighters, law enforcement, and other emergency services, which requires adaptability and collaboration. The emotional toll of the job is significant, and support systems are now in place to help with the psychological impact of the work.