Les Jeux Olympiques et Paralympiques de Paris 2024 ont été une réussite festive et organisationnelle historique. Une préparation minutieuse a été effectuée sur plusieurs années, impliquant une coordination entre les agences régionales de santé, le SAMU, les établissements de santé, et diverses associations de secours pour planifier la couverture sanitaire préhospitalière. Le système préhospitalier mis en place répondait à un triple défi : (1) assurer les soins courants de la population en dehors des sites olympiques, (2) renforcer les sites olympiques en cas de dépassements des structures sanitaires, et (3) prendre en charge une éventuelle situation sanitaire exceptionnelle. Le SAMU zonal a joué un rôle moteur dans la coordination interservices, tandis que des moyens importants ont été mobilisés pour prévenir les situations sanitaires exceptionnelles telles que les conséquences d’une canicule ou les attentats terroristes. Malgré une légère augmentation de la charge de travail pour les services d’urgence et les équipes de régulation pendant la période des Jeux Olympiques, l’impact global sur les structures sanitaires a été modéré. Ce retour d’expérience a mis en évidence l’importance de standardiser et d’harmoniser les référentiels pour les évènements à venir, tout en renforçant la formation et les exercices pratiques des personnels. La coordination interservices, les dispositifs de secours bien dimensionnés et les outils de communication simples, inspirés de la gestion COVID, sont des éléments clés pour améliorer la réponse sanitaire lors des prochains grands évènements internationaux.

Introduction New-Caledonia, an island located in the South-Pacific, was the first (overseas) French country hit by the coronavirus disease-2019 (COVID-19) pandemic to come out of lockdown. The epidemic was rapidly controlled. Analyzing the impact of an epidemic only makes sense if it is compared with a zone with a similar health care system. Objective To compare epidemic evolution in New-Caledonia and Paris suburb. Methods Health care organization is similar in New-Caledonia and Seine-Saint-Denis, based on an Emergency Medical System call center. We recorded the numbers of patients managed by SAMU (Service d’Aide Médicale Urgente)-Emergency Medical System, transferred to the emergency department and managed in prehospital setting by mobile intensive care unit. We compared these parameters during the reference (February 1-23, 2020) and the COVID-19 (February 24, 2020, to April 19, 2020) periods. Primary end-point: number of days over the 95th percentile of the reference period. Results Number of patients managed was over the 95th percentile during 27 and 47 days in New-Caledonia and Seine-Saint-Denis, respectively. Number of emergency department transfers was more than the 95th percentile during 4 and 31 days, respectively. Number of mobile intensive care unit sent was over the 95th percentile during 3 and 14 days, respectively. Peaks were similar. Conclusion The duration of the critical period rather than its spread affected the health care system.

Les 2 et 3 juin 2021, une panne téléphonique nationale affecte le fonctionnement des numéros d’urgence. L’analyse de l’activité des CRRA15 des huit SAMU d’Ile-de-France a montré (par rapport aux périodes de référence) une baisse du nombre d’appels au SAMU centre 15 et une diminution des dossiers de régulation médicale pendant la panne, suivie d’une augmentation 2heures plus tard. Parallèlement, il n’a pas été observé de variation du nombre de sorties des SMUR, ni du nombre de patients accueillis dans les services d’urgences hospitaliers. Le faible impact observé peut être expliqué par la nature partielle de la panne, mais aussi par la mise en place rapide par l’ARSIF et l’AP-HP d’une information destinée au public et d’une solution de contournement de la panne.

We portray the evolution of the Covid-19 epidemic during the crisis of March-April 2020 in the Paris area, by analyzing the medical emergency calls received by the EMS of the four central departments of this area (Centre 15 of SAMU 75, 92, 93 and 94). Our study reveals strong dissimilarities between these departments. We show that the logarithm of each epidemic observable can be approximated by a piecewise linear function of time. This allows us to distinguish the different phases of the epidemic, and to identify the delay between sanitary measures and their influence on the load of EMS. This also leads to an algorithm, allowing one to detect epidemic resurgences. We rely on a transport PDE epidemiological model, and we use methods from Perron-Frobenius theory and tropical geometry.

Introduction Worldwide, the COVID-19 epidemic has put health systems to the test. The excess mortality is partly due to the influx of patients requiring hospitalization and intensive care. We propose that the chronology of epidemic spread gives a window of time in which hospitals can act to prevent reaching capacity. Methods The out-of-hospital SAMU Emergency Medical System in an entry point into the French health care system. We recorded the number of patients managed, of patients transferred to emergency departments (ED), and of mobile intensive care units (MICUs) dispatched. Each criterion was compared to the mean of the same criterion over the previous 5 years. The alert threshold which indicated a public health crisis was defined as a 20% increase compared to the 5-year mean. Results The reference period, from January 2015 to December 2019, included 3 381 611 calls, and 1 137 856 patients. The study period, from 17 February to 28 March 2020, included 166 888 calls, and 56 708 patients. The daily numbers of patients managed crossed the threshold on February 25, and increased until the end of the study period. The daily number of patients transferred to ED crossed the threshold on March 16, and increased until the end of the period. The daily number of MICUs dispatched crossed the threshold on March 15, and increased until the end of the period. Conclusion The COVID-19 epidemic reached our department in three consecutive waves which overwhelmed the health care system. The first wave preceded by 30 days the massive arrival of critical patients. Health care systems must take advantage of this delay to prepare for the third wave.

Clinical features of COVID-19 have been mostly described in hospitalized patients with and without ICU admission. Yet, up to 80% of patients are managed in an outpatient setting. This population is poorly documented. In France, health authorities recommend outpatient management of patients presenting mild-to-moderate COVID-19 symptoms. The aim of this study was to describe their clinical characteristics. The study took place in an emergency medical dispatching center located in the Greater Paris region. Patients included in this survey met confirmed COVID-19 infection criteria according to the WHO definition. We investigated clinical features and classified symptoms as general, digestive, ear-nose-throat, thoracic symptoms, and eye disease. Patients were included between March 24 and April 6 2020. 1487 patients included: 700 (47%) males and 752 (51%) females, with a median age of 44 (32-57) years. In addition to dry cough and fever reported in more than 90% of cases, the most common symptoms were general symptoms: body aches/myalgia (N = 845; 57%), headache (N = 824; 55%), and asthenia (N = 886; 60%); shortness of breath (N = 479; 32%) and ear-nose-throat symptoms such as anosmia (N = 415; 28%) and ageusia (N = 422; 28%). Chest pain was reported in 320 (21%) cases and hemoptysis in 41 (3%) cases. The main difference between male and female patients was an increased prevalence of ear-nose-throat symptoms as well as diarrhea, chest pains, and headaches in female patients. General symptoms and ear-nose-throat symptoms were predominant in COVID-19 patients presenting mild-to-moderate symptoms. Shortness of breath and chest pain were remarkably frequent.

Introduction. - The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48 hours. A specific medical cover was organized in a particular "post-attacks" context and with harsh constraints due to delimitation of an inner zone under the sole UN authority ("blue zone"). Objective. - To evaluate medical means involved and medical activity. Methods. - Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the "blue zone". End-points: engaged workforce, number of visits, including transfers and medicalized transfers. Results. - In "France zone" (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In "blue zone": 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24 hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43 +/- 1 years. Trauma patients were most numerous (20%). Conclusion. - Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required. (C) 2019. Published by Elsevier Masson SAS

INTRODUCTION The health impact of cold and hot waves is major. Nevertheless, the respective impact of extreme high and low temperatures remains controversial. METHOD The daily number of (1) patients managed by SAMU 93 dispatching centre – primary care requirement indicator, (2) Mobile Intensive Care Unit (MICU) interventions – patient severity indicator and (3) number of deaths have been recorded. Daily minimum and maximum temperatures were recorded from 2010 to 2018. The analysis covered the 10 warmest and coldest days of each year (2 × 70 days), and the 30 warmest and coldest days of the total period (2 × 30 days). RESULTS Over 2,702 days, 1,513,070 patients, 89,478 MICU interventions and 7,350 deaths were analysed. Median temperature: 16.0[10.4-21.6]°C.The coldest days were associated with a significant increase in patients managed (665[609-764] vs 538[474-619]; P < 0.001), MICU interventions (35[32-39] vs 33 [28-38]; P = 0.006) and deaths (3[2-5] vs 2[1-4]; P = 0.0008) considering the 10 days of extreme temperatures in each year and a significant increase in patients managed 615[580-698] vs 542[475-627]; P < 0.001) considering the 30-day extreme of the period.The hottest days were associated with a significant decrease in patients managed (484[443-549] vs 538[474-619]; P < 0.001), MICU interventions (31[25-37] vs 33[28-38]; P = 0.006) and deaths (2[1-3] vs 2[1-4]; P = 0.0008) considering the 10 extreme days of each year and a significant decrease in patients managed (536[479-576] vs 542[475-627]; P < 0.001) considering the 30 extreme days of the period. CONCLUSION Primary care requirement, number of severe patients and mortality increased significantly with extreme low of temperature.

Les directives académiques incitent les établissements scolaires (ES) à appeler d’emblée le SAMU pour tout enfant malade ou accidenté. Le nombre de ces appels nous a semblé en augmentation. L’objectif était d’étudier l’évolution des appels émanant des établissements scolaires et de les caractériser. Les appels émanant d’ES sont systématiquement identifiés à la prise d’appel au SAMU 93. Tous les appels pour des patients de moins de vingt ans ont été analysés, du 03/01/2011 au 27/01/2016. Date, âge, sexe du patient, motif de recours, décision médicale, orientation et devenir du patient (en cas d’envoi d’une équipe SMUR) étaient relevés. Au total, 12 379 (1,5 %) dossiers de régulation médicale émanaient d’ES, dont 10 656 pour des patients de moins de 20 ans qui ont été analysés : 5703 (54 %) garçons et 4881 (46 %) filles, d’âge médian 12 (8–15) ans. Le nombre d’appels a significativement augmenté avec le temps : médianes (IQ) de 155 (115–220) versus 208 (172–236) respectivement pour le premier et le dernier trimestre de la période étudiée soit une augmentation de 34 % en cinq ans. Le motif de l’appel était traumatologique pour 5397 (51 %) des appels. Les décisions prises en régulation étaient l’envoi d’un premier secours (n = 3486 ; 34 %), d’une ambulance (n = 3634 ; 36 %) cas et un conseil médical téléphonique (n = 1987 ; 20 %) ; un SMUR a été envoyé 471 (5 %) fois et le transport a été médicalisé 129 (1 %) fois. Finalement, 11 patients ont été admis en réanimation soit une admission pour 969 appels. Les appels émanant d’ES augmentaient. L’envoi d’un SMUR était rare et la médicalisation exceptionnelle. La stratégie de gestion de ces nombreux appels reste à codifier. Academic guidelines encourage schools to call SAMU immediately for any sick or injured child. The number of these calls seemed to be increasing. The aim was to study the evolution of calls coming from schools and to characterize them. Calls to the SAMU 93 coming from schools are systematically identified. All calls for patients under the age of 20 have been analyzed from 03/01/2011 to 27/01/2016. Date, age, sex, reason of the call, medical decision, orientation and outcome of the patient (in case of sending a mobile intensive care unit – MICU – with an emergency physician) were recorded. In total, 12,379 (1.5%) calls come from schools, of which 10,656 were for patients under 20 years old that were analyzed: 5703 (54%) boys and 4881 (46%) girls; median age 12 (8–15) years old. The number of calls significantly increased over time: median (IQ) of 155 (115–220) versus 208 (172–236) respectively for the first and the last quarter of the period studied, i.e. an increase of 34% in five years. The reason for the call was traumatic in 5397 (51%) cases. SAMU emergency physician decisions included first aid responders (N = 3486; 34%), ambulance (N = 3634; 36%) and medical advice (N = 1987; 2%); a MICU was sent in 471 (5%) cases and the transport was performed by MICU in 129 (1%) cases. Finally, 11 patients were admitted to intensive care unit, i.e. one admission for 969 calls. Calls from schools increased. The sending of a MICU was rare and medical management exceptionally required. The management strategy of these numerous calls has to be codified.

Introduccion: el impacto en la salud de las olas de frio y calor es muy importante. Sin embargo, el impacto respectivo de las temperaturas extremas, altas o bajas, sigue siendo polemico. Metodo: el numero diario de (1) expedientes de regulacion medica (ERM) gestionados por la SAMU 93 [Servicio de Atencion Medica de Urgencia], un indicador de la demanda de atencion primaria; (2) de intervenciones de los equipos del SMUR [ambulancias asistenciales], un indicador de la gravedad del paciente; y (3) de pacientes fallecidos. Se registraron las temperaturas minimas y maximas diarias desde 2010 hasta 2018. El analisis se centro en los 10 dias mas calidos y mas frios de cada ano (2 × 70 dias), y los 30 dias mas calidos y mas frios del periodo (2 × 30 dias). Resultados: durante 2.702 dias, se analizaron 1.513.070 ERM, 89.478 intervenciones del SMUR y 7.350 fallecimientos. Temperatura media: 16,0 [10,4-21,6] °C. Los dias mas frios estaban relacionados con un aumento significativo de los ERM (665 [609-764] contra 538 [474-619]; p < 0,001), de las intervenciones del SMUR (35 [32-39] contra 33 [28-38]; p = 0,006) y de los fallecimientos (3 [2-5] contra 2 [1-4]; p = 0,0008) si se tenian en cuenta los 10 dias de temperaturas mas extremas cada ano y con un aumento significativo de los ERM (615 [580-698] contra 542 [475-627]; p < 0,001) si se tenian en cuenta los 30 dias mas extremos del periodo. Los dias mas calurosos estaban relacionados con una disminucion significativa de los ERM (484 [443-549] contra 538 [474-619]; p < 0,001), de las intervenciones del SMUR (31 [25-37] contra 33 [28-38]; p = 0,006) y de fallecimientos (2 [1-3] contra 2 [1-4]; p = 0,0008) si se tenian en cuenta los 10 dias mas extremos de cada ano y con una disminucion significativa de los ERM (536 [479-576] contra 542 [475-627]; p < 0,001) si se tenian en cuenta los 30 dias mas extremos del periodo. Conclusion: la demanda de atencion primaria, el numero de pacientes graves y la mortalidad aumentaron significativamente con las temperaturas extremadamente bajas.

Introduction : Le taux d’occupation des lignes téléphoniques d’un Samu-Centre 15 conditionne la fluidité de la gestion des appels et donc sa capacité de répondre à l’urgence. La disponibilité des assistants de régulation médicale (ARM) et des médecins régulateurs est déterminante. Nous nous sommes interrogés sur l’impact du nombre d’ARM sur la prise en charge des appels d’un Samu-Centre 15. Méthodes : Le taux d’appels raccrochés (par l’appelant) après 15 secondes a été retenu comme critère de jugement principal. Il a été analysé en fonction de l’effectif « réel » d’ARM. L’effectif théorique d’ARM a été pris comme référence. Deux analyses ont été réalisées, la première portant sur 672 périodes d’un quart d’heure de la semaine 51 de l’année 2016 (en période d’épidémie de grippe) et la seconde sur 3 624 périodes d’une heure sur les cinq premiers mois de l’année 2017. Résultats : Sur la première période, le nombre médian d’appels raccrochés après 15 secondes était de 1 (0–3) par quart d’heure. Il variait de 0 (0–1) à 3 (1–5) selon l’effectif d’ARM auquel il était parfaitement inversement corrélé (p < 0,001). Sur la seconde période, le nombre médian d’appels raccrochés était de 4 (1–8) par heure. Il variait de 2 (1–6) à 10 (6–16) selon l’effectif d’ARM auquel il était parfaitement inversement corrélé (p < 0,001). Conclusion : Le taux d’appels raccrochés après 15 secondes était parfaitement corrélé à l’effectif (plus précisément au sous-effectif) d’ARM. Sur une année, le nombre estimé d’appels perdus ainsi était proche de 50 000 ! Prendre en considération l’effectif des ARM est une nécessité absolue.

Introduction > The atmospheric pollution is a growing public health problem. The highly urbanized regions such as Paris area seem particularly exposed. However, the overall health impact is poorly documented. Objective > To investigate the influence of air quality degradation on the demand for primary care. Method > Site: medical dispatching center SAMU 93-Center 15. Related population: 1.6 million inhabitants. Data: daily number of medical regulation records (DRM) and daily air quality index (AQI) using the Airparif (R) database from January 2014 to February 2017. The AQI is classified into five levels. Level 4 corresponds to the threshold of information and recommendations to reduce certain sources of polluting emissions and level 5 to the alert threshold setting up measures of restriction or suspension of the activities contributing to the pollution including vehicles circulation. Results > The analysis covered 1134 consecutive days and a total of 639,576 DRM. Average daily DRM number: 564 (507-643). IQA >= 4 for 56 (5%) days and >= 5 for 4 (0.4%) days. The number of DRM was very closely correlated with the IQA (R-2 = 0.91); the daily median varied from 502 (494-621) for an IQA of level 1 to 650 (540-704) for an IQA >= 4. Conclusion > Degradation of air quality was significantly correlated with demand for primary care. The environmental alert is also a health alert. The impact was major (DRM + 30%) considering all pathologies, all the pollutants on a departmental scale.

Introduction: The rate of occupancy of SAMU-Center 15 telephone lines determines the fluidity of the call management and therefore the capacity to respond to the emergency. The availability of medical dispatching assistants (ARMs) and emergency physician is crucial. We questioned the impact of the number of ARMs on the handling of calls in a Samu-Center 15. Methods: The rate of on-hook calls (by the caller) after 15 seconds was used as the primary end-point. It was analyzed according to ARM's "real" workforce. The theoretical number of ARM was taken as a reference. Two analyzes were carried out, the first covering 672 periods of 1/4 hour of week 51 of the year 2016 (during an influenza epidemic) and the second covering 3,624 periods of one hour out of the five first months of 2017. Results: In the first period, the median number of on-hook calls after 15 seconds was 1 (0-3) per 1/4 hour. It varied from 0 (0-1) to 3 (1-5) depending on the number of ARMs to which it was perfectly inversely related (P < 0.001). In the second period, the median number of on-hook calls was 4 (1-8) per hour. It varied from 2 (1-6) to 10 (6-16), depending on the number of ARMs to which it was perfectly inversely related (P < 0.001). Conclusion: The rate of calls hung up after 15 seconds was perfectly correlated with the number of ARMs. Over one year, the estimated number of lost calls was close to 50,000! Consideration of ARMs membership is an absolute necessity.

The use of non-heart-beating donors (NHBD) could help shorten the list of patients who are waiting for a kidney transplant. The aim of this study was to evaluate efficiency of prehospital management of non-heart-beating donors in Seine-Saint-Denis area. We performed a retrospective cohort study of non-heart-beating donor managed by prehospital medical team of Samu 93 from February 2007 to January 2008. There were 28 non-heart-beating donors included consecutively. Twenty-five NHBD (89%) were canuled by Gillot probe within 150 min from patient collapse. Fourteen NHBD were harvested and 17 kidneys were transplanted. Six-month survival rate for NHBD grafts was 94%. In the same time, eight brain dead donors were managed by Samu 93 and were harvested leading to transplant 16 kidneys. Finally, 50% of overall kidney transplant activity in Seine-Saint-Denis was provided by NHBD grafts.

La loi dite « Léonetti » prévoit le recours aux soins palliatifs (SP). Très peu de données françaises sont disponibles sur cette pratique nouvelle en néonatologie.Décrire et évaluer la pratique des SP au nouveau-né (motifs d'entrée, modalités) et son évolution dans le temps.Étude observationnelle ambispective avec inclusion de toutes situations de SP en néonatologie. Analyses, quantitative et qualitative, des données recueillies systématiquement. Comparaison entre deux périodes P1 (2006–2007) et P2 (2008–2010).Inclusion de 93 nouveau-nés en SP pour complications de la prématurité (36/93–39 %), encéphalopathie anoxo-ischémique (19/93–20,5 %), syndromes polymalformatifs (8/93–8,5 %), cardiopathies sévères (8/93–8,5 %), causes diverses (22/93–23,5 %). Le nombre d'entrée en SP/nombre de naissance et le nombre de décès après SP/nombre de décès en néonatologie sont restés stables. En cas de diagnostic prénatal (n = 31), une augmentation des « projets de naissance en SP » (13/22 en P2 vs 1/9 en P1 ; p = 0,02) a été observée. Un arrêt des thérapeutiques actives et une limitation des gestes de soins/surveillance ont été plus fréquents en P2 vs P1, respectivement 37/59 vs 12/34 (p = 0,02) et 39/59 vs 14/34 (p = 0,03). La titration des antalgiques de palier III était élevée et stable sur les 2 périodes, mais l'évaluation systématique de la douleur semblait plus fréquente en P2 (81,6 % vs 64,5 %, p = 0,085).Un nombre non négligeable de nouveau-nés atteints d'affections diverses est concerné par les SP. Malgré son introduction récente en néonatologie, la pratique des SP évolue notablement, majoritairement dans le cadre de la loi.The "Patients' rights and end-of-life care" act known as "Leonetti's Law" promulgated in 2005 has promoted the use of palliative care to avoid unreasonable obstinacy when life-sustaining treatment appears disproportionate. Very little is known about this new practice for newborns in French neonatal units.To describe and evaluate the practice of palliative care in the newborn (mode of entry, characteristics, and modalities) and its evolution over time.Ambispective observational study conducted in a level III neonatal center. We included all newborns presenting conditions for which palliative care was introduced. Quantitative and qualitative analyses of routinely collected data, recorded from medical and nursing charts. We compared the recorded data between periods P1 (2006–2007) and P2 (2008–2010) using the Chi2 test to assess changes over time.A total of 93 newborns benefited from palliative care during the study period. The main medical conditions motivating palliative care initiation in the newborns were severe complications of prematurity (36/93, 39%), anoxic-ischemic encephalopathy (19/93, 20.5%), severe malformations (8/93, 8.5%), severe congenital heart disease (8/93, 8.5%), and other various etiologies (22/93, 23.5%). Both the number of newborns in palliative care/total number of births and the number of deaths after palliative care/total number of neonatal deaths remained stable. In case of prenatal diagnosis (n = 31), there was an increase in the number of "palliative care from birth projects" (13/22 in P2 vs. 1/9 in P1, P = 0.02). Collective meetings during the decision process were significantly more frequently reported in the infants' charts in P2 (48/59 in P2 vs. 18/34 in P1, P < 0.01). Withdrawing and withholding life-sustaining treatment and limiting procedures of care and/or procedures of surveillance/monitoring were more frequent in P2 as compared to P1, respectively 12/34 vs. 37/59 (P = 0.02) and 14/34 vs. 39/59 (P = 0.03). A titration of level III analgesics treatment was high in both periods and remained stable. However, a trend toward an increase of systematic pain evaluation over time was observed (81.6% in P2 vs. 64.5% in P1; P = 0.085).A significant number of newborns affected by various pathologies undergo neonatal palliative care. Despite their recent introduction in neonatal medicine, palliative care practices have changed significantly. These practices are mostly in compliance with the "patients' rights and end-of-life care" act promulgated in France in 2005.

Objective: To evaluate the usefulness Of Ultrasonographic examinations as a diagnostic tool for emergency physicians in out-of-hospital settings.Methods: Prospective study performed in a French teaching hospital. Eight emergency physicians given ultrasound training for out-of-hospital diagnosis of pleural.. peritoneal, or pericardial effusion; deep venous thrombosis; and arterial flow interruption. After clinical examination, a probability of diagnosis ("clinical score) was assigned on visual analog scale from 0 (absent lesion) to 10 (present lesion). Clinical score between 3 and 7 was considered as clinically doubtful. After ultrasound examination, a second probability ("ultrasound score') was similarly determined. Potential usefulness of ultrasound examination was evaluated by calculating the absolute difference between clinical and ultrasound scores. Patients were followed tip to determine filial diagnosis: present or absent lesion. "Ultrasound usefulness score" (USS) was determined attributing a positive (when ultrasonography increased diagnostic accuracy) or a negative (when ultrasonography decreased diagnostic accuracy) value to the absolute difference between clinical and ultrasound scores.Results: One hundred sixty-nine patients were included and 302 ultrasound examinations performed. Median duration of examination was 6 minutes (5-10 minutes). The suspected lesion was found in 45 cases (17%). Mean USS was +2 (0-4). Ultrasonographic examination improved diagnostic accuracy (ie, positive USS) in 181 (67%) cases, decreased it (ie, negative USS) in 22 (8%) cases, and was not contributive (ie, USS was 0) in 67 (25%) cases. When initial diagnosis was uncertain (n = 115) diagnostic performance reached +4 (3-5) and ultrasonographic examination improved diagnostic accuracy in 103 (90%) cases.Conclusion: Out-of-hospital ultrasonography increased diagnostic accuracy in out-of-hospital settings. (c) 2006 Elsevier Inc. All rights reserved.