La ventilation non invasive a montre un benefice lors de la prise en charge en Reanimation de certaines insuffisances respiratoires aigues. Son utilisation par les equipes des SMUR a ete suggeree, mais aucune experience n'a ete reellement rapportee a ce jour. Nous decrivons ici l'observation d'une patiente insuffisante respiratoire chronique presentant une insuffisance respiratoire aigue hypercapnique, traitee par ventilation non invasive permettant d'eviter l'intubation endo-tracheale. L'interet de cette technique ainsi que les limites et les contraintes en SMUR sont discutees.

Introduction: Transfusion of blood products is part of out-of-hospital medical activity. Despite rare use of transfusion and difficult environment, the rules of transfusion must be respected : follow up to detect blood products, security, and patient's information before and after transfusion, follow up of infectious and immunological consequences. However, the current law and usable documents were not conceived for out-of-hospital emergency care. Objective: To improve follow-up of blood product transfusion in out-of-hospital medical care (Smur). Study design: Quality assurance programme. Material and methods: a) Initial evaluation with a retrospective analysis based on the medical chart of patient for whom transfusion has been performed; b) corrective measures were proposed with creation of a specific document concerning transfusion and guidelines for blood product delivery in the out-of-hospital emergency care; c) evaluation of the impact of these correctives measures. Results: Less than one per cent of patients treated by our Smur needed transfusion, mainly during interhospital transfer. Patients were in a life-threatening situation in 50% of cases. Follow-up improved after implementation of the programme from 25 to 83% of transfused patient (p < 0.001). Despite limitation due to the small number of patients, other parameters also improved. Conclusion: The use of specific guidelines and document improves the follow-up of transfusion in out-of-hospital medical care. (C) 2001 editions scientifiques et medicales Elsevier SAS.

INTRODUCTION:Transfusion of blood products is part of out-of-hospital medical activity. Despite rare use of transfusion and difficult environment, the rules of transfusion must be respected: follow up to detect blood products, security, and patient's information before and after transfusion, follow up of infectious and immunological consequences. However, the current law and usable documents were not conceived for out-of-hospital emergency care.OBJECTIVE:To improve follow-up of blood product transfusion in out-of-hospital medical care (Smur).STUDY DESIGN:Quality assurance programme.MATERIAL AND METHODS:a) Initial evaluation with a retrospective analysis based on the medical chart of patient for whom transfusion has been performed; b) corrective measures were proposed with creation of a specific document concerning transfusion and guidelines for blood product delivery in the out-of-hospital emergency care; c) evaluation of the impact of these correctives measures.RESULTS:Less than one per cent of patients treated by our Smur needed transfusion, mainly during interhospital transfer. Patients were in a life-threatening situation in 50% of cases. Follow-up improved after implementation of the programme from 25 to 83% of transfused patient (p < 0.001). Despite limitation due to the small number of patients, other parameters also improved.CONCLUSION:The use of specific guidelines and document improves the follow-up of transfusion in out-of-hospital medical care.

Introduction : La transfusion de produits sanguins labiles (PSL) fait partie des thérapeutiques utilisées par les Smur, mais de façon occasionnelle et dans un contexte souvent difficile. Malgré tout, les règles dˈhémovigilance et de sécurité transfusionnelle doivent être respectées. La législation actuelle en vigueur et les documents à renseigner au cours dˈune transfusion ne sont pourtant pas toujours adaptés au Smur.