Organization of SAMU (Mobile Emergency Service): Example of Brazil

PS: The SAMU is not specialized in Chemical risks. It's specialized in all kinds of emergency.

Objective:To demonstrate the vision of a public service institution focused on chemical emergencies in the region, involving the SAMU.

Introduction

The SAMU was created in the year 2003 with the goal of minimizing the morbi-mortality in Brazil, and improve the quality of consultations with the aid of medical regulation.
The SAMU derives from the merger of two models of APH (Pre-Hospital Care):

  • The American model that prioritizes the speed of service, the golden hour, i.e. remove victims as quickly as possible;
  • The Franco-German model, whose goal is to stabilize the victims and then remove them to the Emergency Service.

The Brazil presents a large population and geographic diversity, aggregating cultures and varied activities. An example is the city of Cubatão - São Paulo, with around 128000 habitants, situated between the sea and the mountain, crossed by 4 highways. The city holds an Industrial Pole with 28 companies from medium to large enterprise size,with various activities, from fertilizers handling, fuel refinery to metallurgy. Cubatão is located next to South America's largest port, the port of Santos.

Discussion

Chemical risks involve hundreds of aggressive to human'schemicals, with great destructive potential that could jeopardize the entire region, requiring a constant monitoring and specialized emergency teams.
Since 2009, the Enhanced Support Unit of the SAMU of Cubatão is the only ambulance that has adequate training and equipment for chemical emergencies. Is the only ambulance of Brazil equipped with DIPHOTERINE® solution.

Below is an intervention example in a paper industry, where a victim was accidentally splashed with Caustic Soda, with injuries in the evolutionary process. The decontamination was immediate and the victim returned to work without sequelae.

Evolving lesion on the face. A few minutes of the accident.
Evolving lesion on the face. A few minutes of the accident.

Lesion in face, neck and thorax
Lesion in face, neck and thorax

Before decontamination with the Diphoterine® solution
Before decontamination with the DIPHOTERINE® solution. Delay Splash x DIPHOTERINE® solution= 30 minutes

Avant la décontamination avec la solution Diphotérine®
Evolution before decontaminating with the DIPHOTERINE® solution

After decontamination with the Diphoterine® solution
After decontamination with the DIPHOTERINE® solution, one day. No lesions.

No lesions.
No lesions. One day.

Photos 1,2,3 and 4, after chemical splashes, around 30 minutes. Before decontamination  with DIPHOTERINE® solution.
Photos 5 and 6, one day after decontamination with DIPHOTERINE® solution. Without burns. Working.

Conclusion

The implementation of such specialized ambulances helps new technical knowledge to emerge, to value the capacity of involved professionals to manage chemical risks, and to improve the quality of care to the population.

Dr Carlos Yoshimura, Plastic surgeon and SAMU physician, Cubatão - São Paulo, Brazil

On line 01/24/2012