[Restructuring of emergency services: a safety imperative]

More than 7,000,000 cases have been treated each year in the emergency care units of the french Hospitals. The majority of them have been properly treated. However complaints of unsatisfactory treatment were noted and in some cases very serious complications were reported. The main cause of the weakness of some care units rests in the qualitative and quantitative "under medicalisation". First care is often administered by students without control by the staff. Frequently also, the senior members of these units have an insufficient medical curriculum. A National Commission to reform the emergency care units (Commission Nationale de Restructuration des Urgences on CNRU) has been set up by the Government in order to define ways to reorganize these units. The Commission has established 3 conditions which are required for an emergency care unit: high medical skill which implies that the patients have to be treated by a senior physician; permanent reception: which requires a sufficient number of physicians to allow the presence of seniors 24h/24; responsibility: the function of every member of the team has to be clearly defined. The Commission has suggested the reception of emergency patients to be organised in two structures of different level: 1) the Department of Emergency (Service d'Accueil des Urgences or SAU) in which all the medical and technical requirements allow the reception and treatment of all types of emergency cases; 2) the reception and orientation units (Antennes d'Accueil et d'Orientation or ANACOR) which is a light structure assigned for the patients whose troubles are not surgical and who do not require major treatments. Such an organisation in a double structure requires a clear information of the population, an improvement of the medical regulation of the emergency cases and an the adaptation of the medical studies. Finally the aim of the reform is to improve the quality of care, to increase the safety of patients and to limit the inequality of patients facing an emergency situation.