Alternatives to the emergency 999 response can be seen in Europe

EDITOR—Snooks et al point out that the current 999 emergency response system has problems: increasing demand from the public and ever shorter response time targets.1 They find a lack of evidence on alternative systems and responses in the English medical literature. By restricting their search, they overlook live examples only a few miles from these shores.

France, since the mid-1960s, has had a system which incorporates many of the alternatives quoted by the authors: the Service d'Aide Medical Urgente (SAMU).2 Calls to the control room are logged by trained telephone operators and then passed on to a “medical dispatcher”: a doctor in emergency medicine, trained by the service. Medical dispatchers may simply provide medical advice to the caller, or they may decide to use one of a range of other responses to a call. These are referral to, or the dispatch of, a primary care doctor; arranging non-urgent transport by a private ambulance; urgent transport by pompiers (emergency technicians working through the fire service); or sending out a mobile intensive care unit with a doctor trained in emergency medicine. Medical dispatchers also coordinate the deployment of additional resources and decide on the most appropriate destination for a patient.

In 2001 the service covering Paris received 300 000 calls (about 820 calls per day). Only 6% of the calls (50 per day) resulted in the dispatch of a mobile intensive care unit. In …