PISU (Emergency Care Nursing Protocols) include specific clinical and therapeutic procedures allowing firefighter nurses to intervene effectively in emergency situations. These protocols ensure rapid care of victims before the arrival of medical teams, playing an important role in patient stabilization during fires, accidents, or serious emergencies.

The deployment of the PISU (Priority Intervention Support Platoon) is based on a rigorous organization, requiring in-depth initial training and regular maintenance of skills under the supervision of the Departmental Fire and Rescue Service (SDIS).

By combining rescue gestures, precise protocols and crisis management, this approach reflects the evolution of firefighters' missions towards rapid and coordinated health interventions. The PISU thus underline the importance of close collaboration between all emergency rescue actors.

What are the PISUs?

Definition and objectives

Emergency Nursing Care Protocols (PISU) are written and medically validated documents. They allow fire-fighter nurses to perform specific care procedures in emergency situations, before the arrival of a doctor. These protocols are designed to ensure rapid, safe and adapted care of victims in critical clinical situations such as acute asthma, burns, convulsions or status epilepticus. The integration of pharmacies for internal use ensures the immediate availability of necessary medications.

The main objective of the Prehospital Immediate Stabilization Posts (PISU) is to provide an immediate therapeutic response. This allows to relieve pain, stabilize the patient's condition, and prepare their transfer to an appropriate care center. All this is achieved while ensuring the quality and safety of the care provided.

The importance of ICUs in emergency care

As part of the fire department's interventions, the PISU (Paramedic Firefighter Units) play an important role. They bridge the critical time gap between the arrival of first responders and full medical intervention. Thanks to their training and protocols, paramedic firefighters can initiate appropriate care while working closely with the emergency medical services and the SAMU (Emergency Medical Aid Service) regulation.

This coordinated organization significantly improves the chances of survival and recovery for patients during life-threatening emergencies. In parallel, the PISU (First Intervention Sanitary Points) allow for better structuring of health interventions within the SDIS (Departmental Fire and Rescue Services). By relying on validated protocols, they strengthen the legal security of caregivers and the confidence of teams in the field.

Fundamental principles of PISUs

Legality and ethics in emergency nursing

Emergency Nursing Care Protocols (PISU) are governed by a strict legal framework, guaranteeing the legal security of fire-fighter nurses in the performance of their duties. This regulation is mainly based on the Public Health Code and specific decrees which precisely define the delegated skills and the limits of intervention.

These protocols are developed and validated by the chief physician of the Departmental Fire and Rescue Service (SDIS), thus ensuring essential medical compliance. Ethically, PISUs require professionals to demonstrate benevolence, discipline, and respect towards the patient. The main objective is to provide an immediate benefit to the victim while preserving their physical integrity and dignity.

Clinical decision-making in emergency situations

In emergency situations, clinical decision-making relies on a rapid but rigorous analysis of information gathered from the victim and the context of the intervention. The firefighter nurse must adopt a structured clinical reasoning, based on the decision-making questions provided in the PISU to choose the most appropriate protocol, taking into account the benefit/risk ratio for the victim.

This approach includes performing a differential nursing diagnosis as well as evaluating the exclusion or inclusion criteria specific to each protocol. The ability to anticipate, remain calm, and collaborate effectively with the commander of rescue operations (COS) and the regulating physician of the SAMU (Emergency Medical Service) is also essential to ensure optimal and safe care.

Main nursing protocols in emergency situations

Airway management and respiratory support

Airway management is an absolute priority in emergency situations. Emergency Care Nursing Protocols (PISU) include specific procedures to maintain or restore airway patency. Firefighter nurses are trained to perform essential actions such as clearing the airways, inserting cannulas, and implementing appropriate ventilatory support.

In cases of acute asthma or respiratory distress, protocols call for the rapid administration of targeted treatments to improve the patient's ventilation and oxygenation, thereby reducing the risk of deterioration of their clinical condition.

Cardiopulmonary resuscitation (CPR) and defibrillation

PISUs integrate cardiopulmonary resuscitation (CPR) procedures, including the early use of an automated external defibrillator (AED). These protocols allow firefighter paramedics to intervene effectively in the event of cardiac arrest, combining chest compressions, ventilation, and defibrillation, in accordance with international recommendations.

They also specify the procedures for managing cardiac arrests of traumatic or medical origin. These procedures reinforce training in the establishment of vascular access routes, such as intraosseous infusion, for rapid and effective management.

Trauma and Hemorrhage Management

The management of trauma, which is frequent during fire brigade interventions, is based on targeted protocols. These protocols allow for a rapid assessment of injuries, effective control of hemorrhages, and stabilization of fractures or serious injuries.

A key example is the Damage Control protocol, which guides initial management before transfer to a specialist center. Tools such as tourniquets, targeted compressions and hemostatic dressings are used in a controlled manner to optimize the chances of survival while limiting complications associated with significant blood loss. The use of an emergency cart centralizes this essential equipment.

Identification and management of acute medical emergencies

PISUs also include protocols for acute medical emergencies, such as seizures, severe hypoglycemia, or severe allergic reactions. These procedures prescribe a precise clinical evaluation and the rapid implementation of appropriate treatments, even in the absence of a physician.

For example, the management of patients with acute asthma attacks or those suffering from life-threatening distress is based on updated recommendations. These ensure management that complies with professional and safety standards, while ensuring maximum protection for the patient.

Required training and skills for PISU (Post-Intervention Surveillance Unit)

Training specific to nurses

Training in Emergency Nursing Care Protocols (PISU) is an essential step for any nurse wishing to become a firefighter nurse. Delivered in several modules spread over several days, it offers an adapted pedagogical progression, allowing participants to reconcile learning and professional commitments.

This program includes essential modules such as:

• Rapid recognition of emergency situations.
• The application of specific SDIS protocols.
• Mastery of essential technical skills such as resuscitation and trauma management.

To stay in line with developments in the field, training is regularly updated according to national and local recommendations. Realistic simulations are integrated to ensure a practical and effective increase in skills.

Skills and validation of learning

Skills validation is an essential step. Nurses must pass theoretical and practical assessments, including MCQs and intervention simulations. This validation is mandatory before being authorized to practice PISU in the field.

The skills assessed include:

• Technical mastery of procedures and protocols.
• The ability to make rapid and appropriate clinical decisions.
• Teamwork with the group leader and other firefighters.
• Managing the stress inherent in emergency interventions.

To maintain a high level of quality and safety in care, continuous improvement is required. This involves regular continuing education sessions, ensuring that nurses remain up-to-date in their skills and practice.

Innovations and future of PISU

Technological Advancements and Their Integration

The PISU now benefit from an increasing integration of technological innovations, profoundly transforming the practice of emergency nursing care. The digitalization of electronic health records (EHRs) facilitates immediate access to essential medical information, allowing firefighter nurses to document and adapt their interventions more effectively in the field.

Furthermore, artificial intelligence (AI) supports clinical decision-making by providing early alerts and personalized recommendations, helping to optimize the quality and speed of care provided. Telehealth and telemonitoring open up new perspectives, providing the possibility of remote monitoring and enhanced coordination between field teams and medical centers. This is particularly valuable in managing complex health crises.

Future challenges and avenues for improvement

Despite these advances, several challenges must still be addressed for PISUs to continue to progress. The national standardization of protocols, while respecting the local specificities of the SDIS, remains a major challenge to ensure consistency of practices.

Maintaining a high level of initial and continuing training is also essential in the face of the increasing complexity of care and the rapid evolution of professional recommendations. Furthermore, fully integrating new technologies requires adapting equipment, but also supporting healthcare staff in their appropriation.

Finally, data management and respect for medical confidentiality in a digitized environment must be constantly assured to preserve the trust of patients and intervention teams.

Conclusion

Emergency Nursing Care Protocols (PISU) play an essential role in the intervention of fire-fighter nurses, allowing them to act quickly, safely and effectively in critical situations. Thanks to a strict legal framework, adapted training and the integration of technological innovations, these protocols guarantee optimal care for victims.

It is important to continue to strengthen these protocols and keep your skills up to date to ensure the quality of emergency care. Take the initiative now to engage in specialized training to master the PISU and actively contribute to saving lives.

FAQ

What are the main objectives of Emergency Nursing Protocols (ENCP)?

The objective of Emergency Nursing Care Protocols (PISU) is to standardize and secure emergency care. They allow for the rapid identification of immediate distress, prioritize essential actions, and ensure effective coordination with the medical team. Thanks to these protocols, care is clear, adapted and optimized for maximum effectiveness.

Who can initiate a PISU protocol and under what conditions?

A PISU protocol can be initiated by a Nurse Fire Fighter (NFF) before the arrival of a doctor, when an urgent benefit for the patient is expected. The PSI must be properly trained to implement the protocol, and must immediately inform the SAMU regulating physician. In addition, the protocol is validated and signed by the fire and rescue service's chief medical officer.

How should nurses adapt their care plan in an emergency situation according to the ILCOR guidelines?

In emergency situations, nurses must adapt their care plan in accordance with the Emergency Nursing Care Protocols (PISU). This involves rapidly performing diagnostic assistance procedures and appropriate therapeutic actions. They ensure early management, particularly of pain, while transmitting clinical assessments to the supervising physician, sometimes via telemedicine. This approach allows for a graduated response to the emergency in the immediate absence of a physician, thus ensuring the quality and safety of care.

What resources and equipment are needed to ensure the effective implementation of SIPs?

A number of resources and equipment are required for the optimal implementation of SIPs:

• Priority care nurses (PCN) initially and regularly trained.
• Immediate information to the SAMU regulating doctor.
• Close coordination between emergency services.
• Adapted communication and telemedicine tools.
• Written, validated, and easily accessible protocols, accompanied by regular monitoring and evaluation.
• Equipment for urgent care.
• Harmonized local action plans.

These elements are essential to ensure rapid and effective emergency care.