Monday, August 31, 2009

Instead of France's "Stay'n'Play", Could American Paramedics' "Scoop'n'Run" Have Saved Princess Diana's Life?

Conspiracy theories, all unsubstantiated, abounded [12 years ago]. Had [Princess Diana] been assassinated by the royal family so her estranged husband, Prince Charles, could marry his longtime love Camilla Parker-Bowles? Did the British Secret Intelligence Service bump her off because she was pregnant with Egyptian Fayed's Muslim child?

But the most baffling question,
insists Susan Donaldson James (merci à Duncan), the most baffling question,
was whether doctors could have done more to prevent Diana, 36, from dying.

The horrific accident illustrated the difference between the French and U.S. approaches to emergency care — a relatively small piece of the French medical system, but deemed by some people to be the best in the world and often cited as a model for U.S. health care overhaul.

When rescue workers arrived, Diana was conscious, uttering, "My God" and "Leave me alone" to the swarming paparazzi. Although she had suffered internal injuries, she did not arrive at the Parisian hospital for 110 minutes — too late for the surgery that some speculated could have saved her life.

Diana's last hour — in cardiac arrest and bleeding to death — was spent in a mobile medical unit parked a few hundred yards from Pitié-Salpêtrière Hospital, where an emergency team followed French protocol and administered treatment at the scene of the accident and en route to the hospital.

At the time, many people surmised that had a U.S. ambulance responded, Diana would have been rushed to the nearest emergency room, where a full set of professionals and diagnostic equipment might have revived her.

Colloquially known as "scoop and run," the U.S. system is grounded in studies that show a trauma victim's best chance for survival is reaching the operating room within 10 minutes.

Under the French system, "stay and play," a fully equipped medical ambulance with a doctor stabilizes the patient and then directs him or her to a specialized hospital, even if it is miles away.

Car Crash Victims Served 24/7

"When a patient rolls into the American system, they have a level-one trauma center that runs 24/7, with every specialty and myriad resources for a patient in a car crash," said Dr. Preeti Jois-Bilowich, emergency room doctor at the University of Florida's Shands Hospital.…

Diana Delayed 110 Minutes Before Death

Diana didn't arrive until after 2 a.m. — 1 hour and 45 minutes after the crash — and underwent an emergency thoracotomy. Coroners pronounced her dead from hemorrhaging that resulted from major chest trauma and deceleration that caused a rupture of the left pulmonary vein.

Later, surgeons said that her heart had been displaced from the left to the right side of her chest.

In the 1998 book, "Death of a Princess," Time magazine reporters Thomas Sancton and Scott MacLeod were critical of the French system, arguing that Diana could have been saved in a hospital operating room. SAMU was so upset with the indictment, according to the authors, that they threatened to sue.

The French emergency care reflects the overall health attitudes of that nation — delivering basic primary care and health education to everyone will mean fewer expensive emergency room visits and hospitalizations later on.

Amid the health care debate here, some Americans are taking notice.

The French, at 10.7 percent of the gross domestic product, spend less than Americans do on health care at 16 percent of their GDP, according to 2009 Organization for Economic Cooperation and Development health data. …

French Health Care Tops World

The World Health Organization recently rated the French system as the best in the world. By comparison, the United States rated 37th. The average life expectancy in France is 79.4 years, two years fewer than in the United States.

…In France, everyone is covered, regardless of their ability to pay, with an emphasis on primary care to prevent long-term illness.

"What we do is quite different," Rodwin said. "We take care of people, but not everyone, and we do it once they get very sick. We take diabetics with flare-ups and asthmatics in the emergency room, but we don't do primary care or health education as well for the poor.

"Our population is much sicker compared to France," according to Rodwin, whose research finds that Americans have the highest rates of avoidable hospitalizations — two and a half times higher than the French — for treatable conditions like pneumonia, asthma, diabetes and congestive heart failure.

That's according to a 2008 study from the National Institute of Public Health and the Environment. "The French have a term — solidarity," Rodwin said. "Since World War II, the system is grounded in the philosophy that everyone should have access to health care. That doesn't mean everyone is treated equally. There are those who are more educated or higher socio-economic groups that use more specialty care and probably have access to better quality care, but everyone has access to the minimum."

Mary, a freelance writer who did not want to use her last name, lives in Paris and is a "big booster of the French system." …

U.S. Emergency Rooms 'Tangle of Forms'

"I find the emergency room responses the most dramatic change from the U.S.," Mary said. "I've always had excellent health insurance in the U.S. and I've found every American emergency room visit a tangle as I fill out form after form and sign over my first born before anyone will even look at an injured or sick kid.

"Here, because everyone is insured, there's never any questions in hospitals that people will be treated, and treated quickly, because there's no worry someone's going to be stiffed with the bill."

Jois-Bilowich agreed that the French system is more cost-effective and that most people admitted to U.S. emergency rooms are treated and then released. But, she argues, the U.S. system of trauma care is superior.

No comments: