Prefects to Gain Expanded Powers in Emergency Response – A Shift in French Interior Ministry Authority

A forthcoming decentralization bill in France is set to significantly expand the authority of prefects, granting them a central role in organizing emergency aid within their departments. This move, spearheaded by the government, aims to streamline emergency response efforts but has sparked concern among existing emergency service providers, including the Service d’Aide Médicale Urgente (SAMU) and private ambulance operators, who fear a power grab by the Ministry of the Interior.

Current Emergency Response Structure

Currently, emergency assistance in France relies on two primary organizations: firefighters (reachable via 18) and SAMU (reachable via 15). While these entities collaborate daily, a significant portion – approximately 80% of departments – maintain separate call centers and ambulance networks. Firefighters utilize red ambulances, while SAMU employs white ones, alongside private ambulance services and Service Mobile d’Urgence et de Réanimation (SMUR) units, which include a doctor on board.

Calls for Reform and the Role of Prefects

Olivier Richefou, president of the National Conference of Departmental Fire and Rescue Services, has highlighted the inefficiencies of this dual system. He argues that the current structure leads to duplicated efforts and financial strain, stating, “Our country is walking on its head…we continue to have two different places where we capture emergency calls.” He advocates for a unified approach to emergency calls and resource allocation.

The proposed reform, to be included in the spring decentralization bill, would establish a “public emergency relief policy” under the authority of each department’s prefect. The prefect would be responsible for creating a “territorial emergency relief contract” outlining the responsibilities of all involved parties – SAMU, SMUR, firefighters, private ambulance services, and organizations like the Red Cross and Civil Security.

Firefighter Support and Concerns Over Patient Transport

Firefighters generally support the proposed changes. They report that a substantial portion of their interventions (87%) involve non-life-threatening personal assistance, often feeling like auxiliaries to the SAMU and hospital system. A key concern for firefighters is the increasing distance they must travel to transport patients due to the closure of smaller hospitals and maternity wards, extending their mobilization time and impacting volunteer availability. One departmental fire and rescue service manager noted that employers are more willing to allow employees time off for life-saving interventions than for lengthy patient transport.

SAMU Concerns Regarding Decision-Making Authority

Emergency doctors from SAMU and SMUR express apprehension that the reform will transfer final decision-making power regarding emergency resource allocation to the prefect and, by extension, the Ministry of the Interior. They fear this could undermine their central role in the current system. These professionals advocate for a revision of the “Suap-Amu” reference system (Emergency aid to people – emergency medical aid) to clarify the most appropriate responder for each situation – firefighter ambulance, firefighter ambulance with nurse, private ambulance, or SMUR medical ambulance.

Implications and Future Outlook

The decentralization bill’s provisions regarding emergency response represent a significant shift in authority within the French interior ministry. The success of this reform will depend on effectively addressing the concerns of all stakeholders and establishing a clear, coordinated system that prioritizes efficient and effective emergency aid delivery. The role of the prefect will be crucial in balancing the needs of various emergency services and ensuring a cohesive response to crises within each department.