SMURD

SMURD is the Romanian acronym for "Serviciul Mobil de Urgenţǎ, Reanimare şi Descarcerare", that means Mobile Emergency Service for Resuscitation and Extrication.

Short Description
SMURD is an emergency rescue service based in Romania. The first one was created in Tirgu-Mures, a city in the middle of Transilvania, in 1990 shortly after the revolution because of the critical situation of the traditional Ambulance System. Now SMURD is a complementar service, with a lot of bases in the whole Romania, still expanding, that deserves the worst emergency cases in a good collaboration with the traditional Ambulance (Serviciul de Ambulanta). Also HEMS (helicopter emergency medical system) has been implemented in 3 cities (Tirgu mures, Bucharest and Iasi) while in other cities the system is only ambulance based or in exceptional cases police and army helicopters are used. The emergency system is based on the 112 emergency number, now used in Romania for all the emergencies (police,firefighters,ambulance).

History
With the guidance of the Anaesthesiology and Intensive Care Clinic, in September 1990, an emergency system functional in other European countries was experimented. This system was based on the transfer of a full-equipped medical unit to the site where the critical patient was, in order to provide qualified emergency medical assistance. The unit is coordinated by a physician specialized in anaesthesiology, intensive care and emergency medicine. At this early stage, the new service, called SMUR or the Emergency and Resuscitation Mobile Service, was endowed with only one equipped intervention unit, which had no possibility of transporting the patient, the transport being left to be made by a vehicle belonging to the County Ambulance Service.]

1991
In 1991, SMUR received its first mobile resuscitation unit, donated from Germany. This unit brought a higher level of pre-hospital medical care, and easier one.

Until October 1990, the new system has functioned entirely based on volunteer work. The SMUR mobile unit's drivers were students at the Faculty of Medicine, physicians or Red Cross volunteers from Târgu-Mureş. After failed attempts of cooperation with several institutions, in October 1991 an experimental period of time started, placing SMUR under the operative coordination of the Mureş Fire Department, which, at that time, was responsible for the employment of the drivers for the mobile unit, and to provide accommodation and training rooms for SMUR's medical staff. This experiment, which was to be a success and to become a permanent solution, was based on the models found in many countries in the world, where firemen are directly involved in providing of emergency medical assistance and first-aid. These models are functional in Germany, France, Luxembourg, the United States, Canada, Japan, etc. In this new functional structure, SMUR was guided by the Anaesthesiology and Intensive Care Clinic from the medical point of view and by the Fire Department from the operative point of view.

1992
In 1992, SMUR kept on progressing, concentrating on the training of the mostly volunteer personnel and on developing international relations with similar services from other countries. The first countries to establish a long term cooperation, even from 1992 were Great Britain and Norway. The Norwegian Red Cross from Sauda started their support by donating SMUR mobile units and emergency medical equipment and the Emergency Service of the Royal Hospital in Edinburgh and the Strathclyde Fire Brigade in Glasgow have started an intensive support program for the development of emergency medical assistance and for the training and endowment of firemen in new fields, such as extrication and chemical hazards. In November 1992, following a training period of 3 weeks, with trainers from Germany, the Netherlands, Scotland and the United States, an exercise was performed to which were invited to participate the representatives of several Ministries and institutions. Following this exercise, the Minister of Health declared, by the Decision No. 1094 of November 5, 1992, the new system functioning in Târgu-Mureş as National Pilot Centre. This new status was to protect the new model, in the years 1993-1997, against the high level of opposition and the attempts to shut it down. As a part of the training in 1992, the first laboratory for emergency training was donated by the Foundation for Open Society, United States.

1993
In 1993, after SMUR had functioned for about two years providing emergency assistance in pre-hospital, a great development phase started in May, with the support of the colleagues at the Emergency Service of the Royal Hospital of Edinburgh. This development was the creation of the Intensive Care Room at the Mureş County Clinical Hospital, designed to continue the treatment of critical patients brought in by SMUR or arrived through other means, until their admission to the hospital's departments. The new Intensive Care Room staff members were the doctors, medical assistants and volunteers who worked in the pre-hospital emergency units. The new Intensive Care Room reduced the mortality within the Emergency Room of the Mureş County Hospital by approximately 50%.

Also in 1993, the Strathclyde Fire Brigade in Scotland has donated the first mobile extrication unit to the Mureş Fire Department, training the personnel within the Fire Department for the efficient and accurate use of the equipment. The first intervention the unit responded to took place in the exact same day as the donation ceremony.

Starting 1993, the Resuscitation and Emergency Mobile Service (SMUR) has become the Emergency Mobile Service for Resuscitation and Extrication (SMURD). Also in 1993, the first services following the Târgu-Mureş SMURD showed up at Oradea and Sibiu, adopting the functional mode of the Târgu-Mureş system.

1994
1994 was a very important year in the history of the development of emergency medical assistance in Mureş County and perhaps in the whole country. With the help of the Emergency Service of Edinburgh and of the London BBC, the first Emergency Department was built, following the models in Great Britain and the United States. The new department or "Emergency Service" was placed in the yard of the Mureş County Clinical Hospital and started its activity on July 31, 1994. Building this Emergency Service took almost a month and gathered lots of working people, from Scotland and Târgu-Mureş, from the Army, the Gendarmerie and the Fire Department, and from organizations and volunteers, all wanting to see the new service working as soon as possible.

From the Fire Department point of view, 1994 has brought a new activity. The Scotland firemen endowed and trained the Mureş firemen for chemical hazard interventions, creating the first operative unit of this kind in all the Fire Departments of Romania. Alongside the firemen, doctors from SMURD attended the training programs.

1995–1996
In 1995 and 1996 the system continued its development, especially in the field of training and professional growth of physicians and medical assistants coming from all corners of the country. In 1997 alone in Târgu-Mureş approximately 250 doctors, medical assistants and firemen were trained, and in 1998 this number surpassed 300. In October 1996, the Military Fire Corps Law no. 121 was promulgated by the President. For the first time in Romania, in this law at articles 9 and 18.k it was established that Military Firemen have a duty to provide emergency medical assistance and extrication. This law has put the system within legal boundaries after an experimentation period of approximately 5 years. Consequently, the Emergency Mobile Service for Resuscitation and Extrication was named the Intervention Station for Emergency Medical Assistance and Extrication (SIAMUD). In Mureş County, currently both names are in use, SMURD or SIAMUD.

1997
In 1997 and following a series of intensive training programs in the field of catastrophe medicine with the help of our colleagues in France, the Fast Response Group was created; it includes a number of 25 people wearing pagers which allow their calling in at any time in case of serious accidents. In 1998 this group was called in for the intervention on multiple victims accidents. The training in this area is continued with the help of the French Embassy in Bucharest, which is financing an annual training program in catastrophe medicine. Also in 1997 a new joined dispatch was founded, working for both the County Ambulance Service and SMURD. It is located within the Emergency Department and is staffed by County Ambulance Service personnel with the support from SMURD.

1998
1998 was a very special year for SMURD Târgu-Mureş. In June that year, the Fire Dept. was given an intervention boat, necessary for the drowning cases in the Mureş river. Only in August the same year, the Firemen and SMURD had 6 interventions using that boat.

In June 1998 a public fund-raising was organized, destined to gather funds necessary to purchase a new intensive care mobile unit, fully equipped. This fund-raising continued until December 1998 and was finalized with the acquisition of the most modern intensive care unit in Romania, at the cost of 183,000 DM, fully equipped by Miesen - Germany. The entire amount collected was donated by the people and the companies in Mureş County. The success of this project was and still is a measure of the community's perception of the SMURD activity.

Future plans
Now there are 2 SMURD stations (helicopters) with Eurocopter EC 135s, one based at Târgu-Mureş, and the other at Bucharest; there's also a SMURD helicopter rescue service at Iaşi but it unfortunately crashed on 10th January.

For the future the health ministry intend to expand to all the counties of the country the SMURD service, and to acquire another 2-3 helicopters; actually a lot of new SMURD bases are under organization on the whole Romanian territory, while the already working ones are doing a very good job.

SMURD Serviciul Mobil de Urgenţă Reanimare şi Descarcerare