État des lieux objectifs des prises en charges psychiatriques pré-hospitalières du SAMU/SMUR 40 en 2016

Abstract : Context: the current will of the ARS is to define, in connection with all health partners, a system for responding to psychiatric emergencies anywhere in the territory, in the sense of organizing a response and a adapted transportation. In 2016, 2993 calls to the SAMU 40 had a psychiatric reason and 214 were the subject of a SMUR intervention. However, there is no modality of care provided, with a vague legislative framework, poor and old scientific recommendations and potential stakeholders (SDIS and private ambulances) who have disengaged. It follows that it is necessary to put in place procedures adapted to these very specific situations. For this it was necessary to make the precise state of play of the pre-hospital psychiatric care of SAMU / SMUR 40 in 2016. Methods: this is a descriptive, observational, retrospective, mono-centric study at SAMU-SMUR Landes in 2016. This includes patients whose care, classified by the ARM under the motive " psychiatric "on the application required the commitment of an effector SMUR-Mont de Marsan. The main objective of this work is to determine the added value of a medical effector on psychiatric interventions. The primary endpoint is the rate of restraint and / or sedation. Results: 92 files were analyzed, including a population whose average age was 42, and 60% of men. A sedation rate of 22% (N = 20) was observed. The compression was measured at 20% (N = 18). Our primary endpoint, contention and / or sedation rate was 29% (95% confidence interval: 20-38) (N = 27). Hospitalizations in a specialized hospital center of 65% (N = 60). A median duration of 75 min, IQR 25-75 [53-104]. Hospitalization after SMUR treatment was a risk factor for compression and / or sedation, an odds ratio of 6.44, 95% CI (1.8-24), p = 0.04 . Discussion: the psychiatric emergency is currently an important part of the activity of the SAMU. Our work shows that interventions rarely require the specificities of a SMUR team. The regulating doctor finds himself isolated at the time of the organization of the transport of the patients. The other effectors, for reasons that are their own, disengage missions. In order to better organize our care response on the territory, three axes of progress are possible: an agreement validated by all the actors, offering a framework of good practice validated medically, administratively and legally. Continuous training for all effectors capable of managing acute psychiatric pathology. The creation of a mobile team of psychiatry.
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Master Thesis
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Alexandre Gachet. État des lieux objectifs des prises en charges psychiatriques pré-hospitalières du SAMU/SMUR 40 en 2016. Médecine humaine et pathologie. 2018. ⟨dumas-02052918⟩

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