When you dial 15, they are the first to answer you, at the other end of the line in the Samu operation centres. The medical regulation assistants (ARM) receive and process emergency calls, which they then direct according to the seriousness and availability of the various teams and doctors. In the midst of the emergency services crisis, this profession, which lacks visibility, has also been on an indefinite strike since July 3.
71 services out of 100 are currently affected by this movement. The visit, on August 14, of the new Minister of Health, Aurélien Rousseau, who discussed the various claims of the ARM with the teams of the Samu de la Haute-Garonne, did not make it possible to dispel all the fears. “The Minister has recognized that some of our requests were legitimate but we do not know which ones. For the moment, everything remains unclear”, laments Yann Rouet, co-president of the French Association of Medical Regulation Assistants (Afarm), at the initiative of the strike, contacted by L’Express.
Much more than a simple telephone switchboard operator, the ARM, which has only been recognized since the Rist law of May 2023 as a health professional, must have real in-depth medical expertise. “Many ARMs are former paramedics or volunteer firefighters. But, as we do not touch patients, we were told for a long time that we could not claim this status”, explains Yann Rouet.
Rescuers by phone
However, the ARMs have a preponderant role in directing patients while waiting for help to arrive. Some situations cannot wait for a team to be on site: “This is also where we come into play: for vital emergencies, explains the co-president of Afarm. We will give instructions for a cardiac massage , advice in the event of serious burns or explain how to apply a pressure dressing to prevent the person from bleeding out. [NDLR : des compressions abdominales] if a person is choking and every minute counts. Without immediate intervention, death is guaranteed.” First aid gestures to be instructed by telephone and to untrained people to save lives, this is also ARM’s job.
Among the demands of the strikers: an increase in wages, hiring, as well as a revision of the statutory salary grid of hospital practitioners. A hardship bonus, which already exists in hospital emergency departments, is also demanded in order to recognize the pressure and the difficult conditions linked to the practice of the ARM profession. The workload is indeed considerable: sometimes up to twelve hours a day, at an intense pace, where calls follow one another without downtime. You have to deal with callers in distress and sometimes virulent: “Some people react to stress this way. We are trained to deal with these situations, but, behind, our teams are insulted, even threatened with death, while ‘they are there to help,’ laments Yann Rouet.
A strong psychological impact
Some of his colleagues suffer from anxiety, sleep disorders or depression related to their practice. But, in France, there are very few resources to remedy psychological distress in call centres. “It’s still quite taboo to talk about it among colleagues. I think it’s a bit of a question of modesty and the fact that people are getting used to dealing with these things in the medical environment.”
Although ARMs do not operate in the field, they frequently deal with life-threatening emergencies, people injured and in distress. “We’re on the phone, so we don’t have a visual. And the imagination, in the end, can be deleterious. We don’t necessarily know either how it happens for patients once they’re no longer on the phone. end of the line. We hang up and, immediately, the phone rings again. We have to pick up and move on. No time to settle down or digest, “he says.
Yann Rouet has fifteen years of career as ARM behind him. Before that, he was a paramedic for ten years. But certain calls continue to mark him: “It was last year, at the start of the school year, a child hanged himself. He was the age of my daughter. It was impossible not to project himself. impacted a lot. Overall, whether you’re a parent or not, calls that involve children, I think you can never get used to.”
Recent developments
The profession has undergone changes in recent years. The number of calls continues to multiply. Cell phones increase accessibility to 15 but also contribute to saturating the lines. “We often have three or four calls for the same accident. To make an inventory, it’s hell. Four ARMs who pick up for the same thing, these are three ARMs unavailable for other emergencies.” Since Covid-19, Yann Rouet has also noted an increase in figures and is worried about winter 2024 if a new wave of covid or flu should arrive. Last June, to avoid congestion in the emergency services, François Braun, then Minister of Health, encouraged the French to call 15 before, possibly, moving.
Medical regulation assistants are also particularly affected by medical desertification, which affects 87% of the territory. An overhaul of 15 into a care access service (SAS) is in progress. In this context, the ARMs must also refer patients without an attending physician to appropriate services. “It mobilizes our teams. It is sometimes about isolated people who require an hour of ambulance. Obviously, that makes us fall behind the rest, on real emergencies”, regrets Yann Rouet.
With 31 pilot sites, the SAS must be generalized in all the services of the Samu in France by the end of the year. If funding is released for its development, the lack of staff remains the main obstacle to its implementation. “The ignorance of the profession, both among the general public and in the health sector, is felt in recruitment. In training, this year, we are offering 400 places for only 200 registered. To ensure emergencies and the additional care access service is far too little,” he concludes.
The Afarm, in a survey carried out with the Samu-Urgences de France union, estimates that between 1,000 and 1,500 additional ARM positions should be created. François Braun had promised between 2,000 and 3,000 during the launch of the communication campaign on the profession. Promises of employment still outstanding.