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.

La plateforme de télémédecine ORTIF se déploie depuis janvier 2015 en Île-de-France. Elle est implantée dans 95 établissements dans le champ sanitaire et médicosocial et permet de réaliser des télé-expertises et des visioconsultations. La polyvalence des outils fonctionnels doit pouvoir favoriser les usages dans de nombreuses spécialités médicales. Les organisations médicales et le contenu de télédossiers ont été définis par des comités scientifiques des spécialités médicales initialement impliquées. Un télédossier générique a été implanté pour favoriser l’émergence de nouveaux usages. Les usages ont été évalués entre les mois de janvier 2015 et août 2016. Après 18 mois d’utilisation, 14 355 patients ont été pris en charge avec la plateforme ORTIF (4080 les 3 derniers mois) : 8039 pour expertise neurochirurgicale (médiane mensuelle actuelle [MMA] : 485), 608 pour une suspicion d’accident vasculaire cérébral (MMA : 55), 3327 avec l’aide de formulaires polyvalents (MMA : 390), 140 pour enfants polyhandicapés (MMA : 20), 21 pour enfants autistes (MMA : 5). Depuis janvier 2016, on relève 1947 expertises en téléradiologie (MMA : 320), 205 en dermatologie (MMA : 70), 73 pour expertise neurologique de prématurés. Une expérience préliminaire de télémédecine pourrait expliquer les nombreuses utilisations pour les expertises neurochirurgicales et téléradiologiques. La récente évolution de la plateforme va maintenant nous permettre d’identifier les spécialités médicales traitées avec le formulaire générique pour cibler et impulser les nouveaux projets. La polyvalence des outils fonctionnels est une clé de développement des usages en télémédecine.

La plateforme de télémédecine ORTIF se déploie en Ile de France depuis janvier 2015. Elle permet aux professionnels de réaliser des télé-expertises et parfois des visioconsultations. Quel est l’impact sur la prise en charge des accidents vasculaires cérébraux (AVC) ? Le service de neurologie de l’hôpital Sud Francilien est le centre de référence d’un territoire comprenant 600 000 habitants. Il prend en charge plus de 900 patients victimes d’AVC par an, réalise plus de 350 thrombolyses par an complétées éventuellement par une thrombectomie sur l’hôpital de Bicêtre. Il fonctionne en lien avec 9 établissements accueillants des urgences. Six de ces structures sont progressivement équipées d’ORTIF. Nous évaluons le recours à l’expertise neurologique par télémédecine pour les AVC de ce territoire pilote entre janvier et août 2016. Cent quatre-vingt-douze patients suspects d’AVC ont pu bénéficier d’une expertise neurologique avec ORTIF : Melun (53), Étampes (48), Montereau (41), Fontainebleau (17), Longjumeau (14), Nemours (12), Dourdan (6). Une thrombolyse a été effectuée chez 22 d’entre eux dont 11 sur site. Bien qu’encourageants, ces résultats ne reflètent pas suffisamment l’activité potentielle de télémédecine dans ce contexte. L’engagement des directions de service et une expérience préalable de visioconférence sont identifiés comme facteurs favorisant l’utilisation de ces outils. La protocolisation, la réalisation de téléstaffs interservices débutés il y a quelques mois et la mise en œuvre d’un protocole territorial d’imagerie sont les actions mises en œuvre pour impulser les usages. La conduite du changement des professionnels est affaire d’implication de chacun des acteurs et des leaders d’opinion locaux.

La télémédecine améliore l’accessibilité aux soins urgents pour les patients victimes d’AVC. L’analyse de déploiements d’autres réseaux identifie 4 clés pour les réussir : la formation, l’analyse des prises en charge, l’ergonomie et les adaptations. La plateforme de télémédecine ORTIF se déploie depuis janvier 2015 en Île de France. Elle impliquera à terme 100 établissements pour des expertises en neurochirurgie, pour les AVC et la neurologie. Elle permet de partager sur le Web des données médicales, de l’imagerie et de réaliser des visio-consultations. Elle accueille aussi des réseaux en médico-social et ambulatoire pour 30 structures. Le GCS D-SISIF en charge du cadrage du projet, du déploiement et accompagnement, a conçu un processus d’industrialisation. Des comités scientifiques et techniques ont défini les organisations, le télédossier, les aspects médico-économiques et des tableaux bord de suivi. Une hotline et un site de formation e-learning ont été créés. Un point d’étape a été réalisé en juillet 2015. Quarante-trois établissements ont été déployés. Cinq cent quinze acteurs ont bénéficié d’une formation. La note de satisfaction était de 3,4/4. Ont transité via la plateforme 1271 avis d’expertise : 1043 avis neurochirugicaux, 66 avis neurovasculaires et 162 avis de neuroradiologie. La progression de la création de télédossier était de 177 % entre les mois d’avril et mai au profit surtout de l’expertise neurochirurgicale qui bénéficiait d’une expérience de télémédecine préalable. Le faible nombre de centres experts neurovasculaires déployés initialement explique les usages moins nombreux mais montrent l’importance d’un accompagnement des acteurs dans ces nouvelles modalités d’expertise. La proportion de recours à la hotline (nombre d’incidents/nombre établissements fonctionnels) était de 2,4 en fin de premier mois du déploiement et de 0,78 dans le dernier mois objectivant la qualité fonctionnelle. La télémédecine est un outil support aux organisations médicales pour permettre une amélioration de l’accessibilité aux soins et donc de leur qualité. L’accompagnement des acteurs est un enjeu fort de la réussite du déploiement de tels projets.

Introduction: We sought to identify symptoms predictive of hospitalisation of patients having the acute allergic reactions managed by an Emergency Medical Dispatch Centre in France. Methods: A prospective study was conducted from 20th August 2006 to 5th November 2006 on incoming calls to the Emergency Medical Dispatch Centre for the Hauts de Seine province, France. Statistical analyses were used to identify hospitalisation predictors. The validity of predictors identified was tested. We calculated equivalents of sensitivity (probability of presence of the sign when the reaction is severe), specificity (probability of absence of sign when the reaction is not severe), positive predictive value (probability of severe reaction when the sign is present) and negative predictive value (probability of non-severe reaction when the sign is not present). Results: A total of 210 calls were included. The following clinical hospitalisation predictors identified had very good specificity and good positive predictive value: facial oedema, sense of choking, respiratory distress, cough, difficulty speaking, dysphagia, abdominal pain, dizziness, collapse, and chest pain. However, none of the selected predictors had a safe negative predictive value (and sensitivity). Conclusion: This study has identified positive clinical predictors of hospitalisation for acute allergic reactions patients managed by a Medical Emergency Dispatch Centre. The next step will be a multicentre study in order to develop a severity score or a decision-making algorithm.

Over the last twenty years or so, emergency departments have undergone significant changes. They have faced a continual increase in activity of around 2 to 5% per year. Numerous factors are to be taken into account with regard to elderly people, notably their fragility. This is why a full assessment is essential when the patient arrives. Whenever possible, a return home must be favoured.

Dans notre pratique de medecine d’urgence, l’organisation de la permanence des soins est une preoccupation majeure. Elle conditionne la possibilite de prendre en charge et d’orienter correctement les patients notamment aux horaires de gardes. La loi Hopital, Patients, Sante, Territoires (HPST) a mis au rang des missions de service public l’organisation de la permanence des soins des etablissements de sante (PDSES). Elle se definit comme la prise en charge et la surveillance des patients non hospitalises au sein de l’etablissement aux horaires de permanence des soins. Les objectifs affiches de cette organisation sont « la mise en place d’une offre de soins graduee de qualite, accessible a tous, satisfaisant a l’ensemble des besoins de sante, tout en veillant a gommer les disparites au sein du territoire national ». Elle est financee par des credits du Fonds d’intervention regionale de la loi de financement de la securite sociale, exclusivement pour la partie temps medical (garde). Les donnees de demographie medicale mettent en perspectives ces enjeux. En 2009, les praticiens en activite etaient 214 000 ; mais depuis la decroissance est constante et se prolongera jusqu’en 2019 avec une perte de 10 % des effectifs. Selon les modeles proposes, la diminution pourrait aboutir a des pertes de densite medicale superieure a 25 % dans certaines regions : la Corse, le Languedoc-Roussillon, l’Ile-de-France, la Provence-Alpes-Cote d’Azur ou le Rhone-Alpes... Plusieurs specialites participant a la PDSES seront particulierement concernees : l’anesthesie, la reanimation et la chirurgie viscerale. Ces evolutions risquent de bouleverser les habitudes de fonctionnement, de fragiliser l’organisation actuelle dans les etablissements, notamment dans la constitution et la perennite des listes de gardes.

BACKGROUND:Acute allergic reactions often occur in out-of-hospital settings, and some of these reactions may cause death in the short term. However, initial diagnosis, management and processing of acute allergic reactions by Medical Emergency Dispatch Centres are not documented. The aim of the present study was to describe acute allergic reactions and their management by a Medical Emergency Dispatch Centre.METHODS:A prospective study was conducted from 20 August 2006 to 5 November 2006 on incoming calls for acute allergic reactions to the Medical Emergency Dispatch Centre for the Hauts de Seine (Paris West suburb, France). The agreement between initial diagnosis (made by dispatching physician) and final diagnosis (made by the physician who later examined the patient), and between initial and final severity, were evaluated using Cohen's weighted κ coefficient.RESULTS:210 calls were included. The diagnoses made by the dispatching physician were: in 58.1% of cases urticaria, in 23.8% angioedema, in 13.3% laryngeal oedema, and in 1.9% anaphylactic shock. The agreement between initial and final diagnoses was evaluated by a κ coefficient at 0.44 (95% CI 0.26 to 0.61) and the agreement between initial and final severity was evaluated using a κ coefficient at 0.37 (95% CI 0.24 to 0.50).CONCLUSIONS:Only moderate agreement is highlighted between the initial severity assessed by the dispatching physician and the final severity assessed by the physician later examining the patient. This demonstrates the need to develop a tool for assessing severity of acute allergic reactions for dispatching physicians in Medical Emergency Dispatch Centres.

New guidelines for the management of cardiac arrest in children and infants were published in 2005 by the International Liaison Committee On Resuscitation and the European Resuscitation Council. These guidelines preceded publication of French recommendations in September 2006, including changing practices in Paediatric Life Support (PLS).1International Liaison Committee On Resuscitation Part 6: paediatric basic and advanced life support.Resuscitation. 2005; 67: 271-291Abstract Full Text Full Text PDF Scopus (85) Google Scholar, 2Biarent D. Bingham R. Richmond S. et al.European Resuscitation Council guidelines for resuscitation 2005 Section 6: paediatric life support.Resuscitation. 2005; 67: S97-S133Abstract Full Text Full Text PDF Scopus (210) Google Scholar, 3SFAR SFMU CFRC Recommandations formalisées d’expert: prise en charge de l’arrêt cardiaque.Ann Fr Anesth Reanim. 2007; 26: 1008-1019Crossref Google Scholar, 4Goddet N.S. Dolveck F. Descatha A. et al.Prise en charge de l’arrêt cardiaque de l’enfant et du nourrisson au sein d’un SAMU – SMUR: evaluation préliminaire des pratiques dans le cadre de l’évaluation des pratiques professionnelles.JEUR. 2008; (abstract): 134-135Google ScholarIn the emergency medical system of our district, we have 7–10 general pre-hospital emergency medical teams (GPEMT) localised in four units and only one specialized for newborns and children (paediatric unit). In this situation, GPEMT with limited knowledge of the PLS are sometimes faced with children in cardiac arrest.The aim of this study was to evaluate knowledge of PLS before and after simulation training among our GPEMT (largest unit of the district). The study was conducted in three stages from February 2007 to November 2009. Newborns were excluded. A questionnaire about PLS was completed by physicians, nurses and paramedics of the GPEMT before and after training. All professionals included in this study were volunteers. The following details were obtained during completion of the questionnaires: guidelines reading, definition of the end of childhood, cardiac arrest cause, sequence of action for PLS, compression–ventilation ratio, use of automated external defibrillators, use of manual defibrillators, use of epinephrine, and duration of resuscitation. Simulation training was then organised for all the members of the GPEMT. Six half-day training classes were organised with theoretical and practical approaches simulating real life situations of PLS. Statistical analyses comprised descriptions of variables and proportion comparison by χ2 test.Sixty-one questionnaires were analyzed in 2007 and 43 in 2009. Table 1 reports results for PLS. Guidelines were read by 10% of the professionals in 2007 and almost 20% in 2009. Hypoxemia was identified as the cause of cardiac arrest cause in 75% (n = 45) in 2007 and 98% (n = 41) in 2009. Only 21% (n = 12) rescuers in 2007 performed 1 min of CPR before they went for help, compared with 84% (n = 36) in 2009 (p < 10−4). Duration of CPR was <20 min in 3% (n = 2) in 2007 compared with 65% (n = 28) in 2009 (p < 10−4).Table 1Results for paediatric basic and advanced life support.Expected response2007 n = 612009 n = 43χ2 testPaediatric basic life supportEnd of childhoodPuberty7% (4)51% (22)p < 10−4Compression ventilation ratio ChildOne rescuer: 30/225% (15)72% (31)p < 10−4Two or more: 15/234% (21)51% (22)ns InfantOne rescuer: 30/216% (10)61% (26)p < 10−4Two or more: 15/223% (14)47% (20)p < 0.05Automated external defibrillator Lower age of use1 year33% (12)84% (36)p < 10−4 Paediatric padsAttenuated energy75% (44)81% (35)nsPaediatric advanced life supportManual defibrillator Second shock energy4 J/kg15% (9)65% (28)p < 10−4EpinephrineFurther dose every 3–5 min51% (31)44% (19) Open table in a new tab This study highlighted the importance of training for the general teams rarely faced with children and infants, especially in cardiac arrest. Their performance improved between 2007 and 2009. All physicians, nurses and paramedics reported the importance of the simulation and the interest in discussing and training for uncommon pathology. Simulations seem to have benefited the training and knowledge of the GPEMT.5Nelson K.L. Mills Jr., W. Umbel S. et al.Lighting sudden cardiac death, simulation and automated external defibrillator.Resuscitation. 2007; 74: 567-574Abstract Full Text Full Text PDF Scopus (11) Google Scholar There may have been a selection bias because only 69.3% of the members of the unit answered in 2007 compared with just 49.0% in 2009. However, the persistently low proportion of expected answers leads us to think that any bias is likely to be small.Regular training programs of general EMS should include uncommon life-threatening events like cardiac arrest in children and infants, even if in most cases paediatric units could support them in these situations. Further studies on cost-effectiveness of this training are needed.Conflicts of interestNone. New guidelines for the management of cardiac arrest in children and infants were published in 2005 by the International Liaison Committee On Resuscitation and the European Resuscitation Council. These guidelines preceded publication of French recommendations in September 2006, including changing practices in Paediatric Life Support (PLS).1International Liaison Committee On Resuscitation Part 6: paediatric basic and advanced life support.Resuscitation. 2005; 67: 271-291Abstract Full Text Full Text PDF Scopus (85) Google Scholar, 2Biarent D. Bingham R. Richmond S. et al.European Resuscitation Council guidelines for resuscitation 2005 Section 6: paediatric life support.Resuscitation. 2005; 67: S97-S133Abstract Full Text Full Text PDF Scopus (210) Google Scholar, 3SFAR SFMU CFRC Recommandations formalisées d’expert: prise en charge de l’arrêt cardiaque.Ann Fr Anesth Reanim. 2007; 26: 1008-1019Crossref Google Scholar, 4Goddet N.S. Dolveck F. Descatha A. et al.Prise en charge de l’arrêt cardiaque de l’enfant et du nourrisson au sein d’un SAMU – SMUR: evaluation préliminaire des pratiques dans le cadre de l’évaluation des pratiques professionnelles.JEUR. 2008; (abstract): 134-135Google Scholar In the emergency medical system of our district, we have 7–10 general pre-hospital emergency medical teams (GPEMT) localised in four units and only one specialized for newborns and children (paediatric unit). In this situation, GPEMT with limited knowledge of the PLS are sometimes faced with children in cardiac arrest. The aim of this study was to evaluate knowledge of PLS before and after simulation training among our GPEMT (largest unit of the district). The study was conducted in three stages from February 2007 to November 2009. Newborns were excluded. A questionnaire about PLS was completed by physicians, nurses and paramedics of the GPEMT before and after training. All professionals included in this study were volunteers. The following details were obtained during completion of the questionnaires: guidelines reading, definition of the end of childhood, cardiac arrest cause, sequence of action for PLS, compression–ventilation ratio, use of automated external defibrillators, use of manual defibrillators, use of epinephrine, and duration of resuscitation. Simulation training was then organised for all the members of the GPEMT. Six half-day training classes were organised with theoretical and practical approaches simulating real life situations of PLS. Statistical analyses comprised descriptions of variables and proportion comparison by χ2 test. Sixty-one questionnaires were analyzed in 2007 and 43 in 2009. Table 1 reports results for PLS. Guidelines were read by 10% of the professionals in 2007 and almost 20% in 2009. Hypoxemia was identified as the cause of cardiac arrest cause in 75% (n = 45) in 2007 and 98% (n = 41) in 2009. Only 21% (n = 12) rescuers in 2007 performed 1 min of CPR before they went for help, compared with 84% (n = 36) in 2009 (p < 10−4). Duration of CPR was <20 min in 3% (n = 2) in 2007 compared with 65% (n = 28) in 2009 (p < 10−4). This study highlighted the importance of training for the general teams rarely faced with children and infants, especially in cardiac arrest. Their performance improved between 2007 and 2009. All physicians, nurses and paramedics reported the importance of the simulation and the interest in discussing and training for uncommon pathology. Simulations seem to have benefited the training and knowledge of the GPEMT.5Nelson K.L. Mills Jr., W. Umbel S. et al.Lighting sudden cardiac death, simulation and automated external defibrillator.Resuscitation. 2007; 74: 567-574Abstract Full Text Full Text PDF Scopus (11) Google Scholar There may have been a selection bias because only 69.3% of the members of the unit answered in 2007 compared with just 49.0% in 2009. However, the persistently low proportion of expected answers leads us to think that any bias is likely to be small. Regular training programs of general EMS should include uncommon life-threatening events like cardiac arrest in children and infants, even if in most cases paediatric units could support them in these situations. Further studies on cost-effectiveness of this training are needed. Conflicts of interestNone. None.

Mesurer, chez des fumeurs non motivés au sevrage, le changement motivationnel après une spirométrie systématique au cabinet de médecine générale.Étude interventionnelle prospective monocentrique de type « avant-après ». Ont été inclus quel qu'était leur motif de consultation, 74 patients majeurs et fumeurs non motivés au sevrage tabagique. Les résultats spirométriques, comportant le rapport VEMS/CVF et l'âge pulmonaire, étaient commentés et remis. Neuf mois plus tard, ils étaient réévalués téléphoniquement.Cinquante-six pour cent étaient des femmes, d'en moyenne 46,5 ans, ayant fumé 26,3 paquets-années. Quatre-vingt-deux pour cent avaient un rapport VEMS/CVF normal mais 38 % un âge pulmonaire pathologique. Neuf mois après, 61,1 % ont augmenté leur motivation au sevrage. La consommation était de 10,9 cigarettes/jour, contre 13,3 cigarettes/jour à l'inclusion (p = 0,0254). Augmenter sa motivation n'était pas statistiquement liée à l'âge, au sexe, aux sevrages antérieurs, au tabagisme quotidien, à la dépendance nicotinique ni à la normalité du rapport VEMS/CVF (p > 0,75) mais significativement lié à la normalité ou non de l'âge pulmonaire (p < 0,03).Cette étude suggère que la pratique d'une spirométrie, dans un cabinet de médecine générale, est susceptible, par la détermination de l'âge pulmonaire, de faire progresser la motivation au sevrage tabagique des fumeurs non motivés.Our aim was to investigate whether spirometry, performed in general practitioners' offices would change non-motivated smokers' attitudes toward smoking cessation.We performed an interventional, prospective, before-after single-center study, approved by a research ethics committee. We included 74 smokers older than 18 years old, who reported no intention to quit smoking, whatever they were visiting general practitioners for. We performed spirometry and gave them their results, FEV1/FVC and lung age together with a comment on it. Nine months later, we called them for another assessment.Fifty-six percent were women with an average-age of 46.5, who smoked 26.3 pack-years. Eighty-two percent of them had normal FEV1/FVC but lung age was pathological among 38% of them. Nine months later, 61.1% reported an increased motivation to quit smoking. They smoked 10.9 cigarettes per day versus 13,3 at baseline (P = 0.0254). Increase in motivation was not statistically related to age, gender, previous smoking cessations, daily smoking, nicotine dependence or an abnormal FEV1/VC ratio (P > 0.75) but was significantly related to the presence of an abnormal lung age status (P < 0.03).This study suggests that spirometry in general practice, combined with the determination of the lung age, may increase motivation towards smoking cessation in smokers who lack motivation.

INTRODUCTION:After the publication of new recommendations for cardiopulmonary resuscitation (2005 guidelines and 2006 French recommendations), we conducted a study amongst EMS teams concerning their approach with children and infants, nationwide. The objective was to measure the level of knowledge of guidelines and practice. METHODS:The online questionnaire was offered to emergency physicians belonging to the French emergency database, between November 1st and December 15th 2007. Incomplete questionnaires were excluded from the study. We recorded: profile of personnel, knowledge of guidelines, basic CPR and advanced CPR parameters. RESULTS:Four hundred and thirty-nine questionnaires were analyzed. Personnel was aged under 40 in 50.2 %, with 2-5 years experience in prehospital emergency care (57.6 %); 51,3 % declared having had training in pediatric CPR. A minority of subjects declared knowing the 2005 Guidelines (35 %), more the French 2006 recommendations (62.5 %). Basic CPR: transition age child/adult known in 30.3 %. Compression/ventilation ratio: 30/2 for one rescuer in 50.2 % (child), 46.5 % (infant); 15/2 for two or more rescuers in 57.6 % (child), 48 % (infant). AED age for use (1 year old) known in 59.8 %. Advanced CPR: epinephrine dose known in 89.3 % (intravenous) and 34.3 % (tracheal). External shock known in 57.2 %. CONCLUSION:This study emphasizes the lack of knowledge, especially with regard to first aid. Formations will be developed.

Training exercises are now frequently used in health disaster and emergency medicine to train first responders,1 including the use of tabletops’ exercises.2–4 However, these kinds of drill are barely described in occupational and industrial safety and health. They represent an interesting alternative to real life disaster plans, considering the enormous human and technical resources that are required, and the disruptance of company’s daily business. We aimed at developing a special training for professionals of health and safety (occupational physicians, hygienists…) in case of health disaster in industrial settings, using a tabletop exercise. We organized a one day-session about disaster fundamentals for 28 occupational physicians included in a Master degree in emergency medicine training. A tabletop exercise was made based on a scenario of a fire in a plant with risk of chemical explosion - 22 victims and one dead (person). Three groups of 9/10 participants had 1h15 to discuss and « play » rescue operations from the initial accident to the discharge of the last victims from the triage centre. They were supervised by a physician and a nurse who are specialized in disaster training. We used a large tabletop representing the industrial plant and the figurines/vehicles (patients, industrial and emergency responders, firemen and police officers, journalist…). Satisfaction and cost were evaluated such as repeatability. The participants were largely satisfied by the training and believe, such as the teachers, that the exercise well illustrates the roles of occupational physicians, the triage centre, and intricate logistics during a health disaster. The direct cost was $1,285 (975 euros), namely $646 for the figurines and $639 for the supervisors for the first year ($46 per participant). At the opposite of a real life exercise, we didn’t notice any impact on daily activities of the company/plant. One year later, the tabletop was performed again with other 28 participants with similar satisfaction and reduced cost (only $639 for the supervisors, $23 per participants). Tabletop exercises simulating industrial disasters appear to be a cost-effective way to train professionals of health and safety. Similar experiences are reported in other contexts: airport disasters,2 biological threats in a public health preparedness,5;6 training of medical technicians for emergency.3 Tabletop exercises could also be used to train different categories of participants in similar drill. Considering the purpose of training participants to organise the prevention and the management of industrial disasters in their own company, it was seen as easier and as cheaper than real life disaster plans. To conclude, although real life exercise remains essential (especially in order to challenge emergency responders) effectiveness should be studied in depth. We think these kinds of exercises should be developed in the industrial settings.

Le développement du secourisme sur le lieu de travail est devenu important au vu de différents éléments : la fréquence des accidents cardiovasculaires graves, la pression croissante médicolégale et l’accès facilité aux défibrillateurs. L’objectif de notre étude est de réaliser une revue systématique de la littérature pour évaluer les connaissances actuelles sur le secourisme en milieu du travail.Nous avons réalisé une revue systématique basée sur cinq bases de données (Pub-Med, Web of Science, Science Direct, Institut national de recherche et de sécurité [INRS] et Centre européen de référence pour l’éducation aux premiers secours [CEREPS]) avec les mots clés « First aid », (« Workplace », ou « Occupational disease ») entre 2000 et 2014, inclus. N’ont été incluses que les études se déroulant sur le lieu de travail et pour lesquelles une prise en charge avec intervention des premiers secours était décrite (deux étapes, deux relecteurs indépendants).Sur 168 articles répondant aux mots clés, 18 ont été inclus après les deux étapes de sélection. Les études provenaient majoritairement d’Europe et d’Amérique du Nord : 5 se réfèrent à la réglementation du secourisme sur le lieu de travail, 8 à la prise en charge, 3 à la formation et 2 traitent à la fois la réglementation et la prise en charge. D’un point de vue réglementaire, il ressort de l’ensemble de ces études que la législation et l’organisation des urgences en milieu du travail sont très hétérogènes entre les pays et que des disparités existent au sein même de ceux-ci. Les salariés chargés de la mise en œuvre des premiers secours doivent pouvoir bénéficier d’une formation théorique et pratique adéquate ainsi que de locaux adaptés avec accès à l’équipement et au matériel nécessaires. Du point de vue de la formation, l’intérêt d’un rafraîchissement fréquent des connaissances est démontré pour obtenir de meilleurs résultats en termes de connaissances théoriques et de compétences pratiques.Le secourisme semble prendre une place importante dans le milieu du travail, sans pour autant que les pays se soient dotés de recommandations spécifiques et homogènes sur le sujet. Créer un système efficace de premiers secours en entreprise signifie non seulement agir de manière déterminante sur les accidents du travail, mais également contribuer à agir sur la prévention des risques professionnels.Implementing effective first aid systems at workplaces worldwide is a major challenge, and must take into account the increasing frequency of cardiovascular disorders, increasing access to defibrillators, and legal consequences of injury occurring in this particular setting. The aim of the study was to perform a systematic review to evaluate the current knowledge of first aid techniques at the workplace.Five databases (Pub-Med, Web of Science, Science Direct, Institut National de Recherche et de Sécurité [INRS] and European Reference Centre for First Aid Education [ERCFAE] were searched from 2000 to 2014, using the keywords “First aid”, [“Workplace”, or “Occupational disease”]). The full-text articles included had to take place at the workplace and to describe a first aid intervention. A two-stage process with two independent readers was used to select relevant papers.The keyword search returned 168 results; 18 were relevant studies included in this systematic review. Studies were mainly from Europe and North America: 5 referred to the regulation of first aid at the workplace, 8 to organization, 3 to training and 2 both to regulation and organization. Legislation and organization regarding workplace emergencies were very different between countries, and disparities existed even within the same country. Employees involved in first aid interventions require adequate theoretical and practical training as well as access to necessary equipment; improvements in training and organization are needed in many countries. One-time training is not adequate for maintenance of skills; periodic “refresher courses” are shown to improve knowledge as well as theoretical and practical skills.Our literature review found a lack of consistent recommendations for first aid training and organization in workplaces worldwide. Developing effective workplace first aid systems can limit the morbidity from workplace health events, and in some cases has led to improved injury and illness prevention programs.