Inside France's SAMU and SMUR Cold Water Immersion Protocol

Fire crews are usually first on scene for exertional heat stroke, but in France the cooling decision does not stop being a medical one once the truck arrives. SAMU (Service d'Aide Médicale Urgente) and its mobile SMUR (Service Mobile d'Urgence et de Réanimation) teams are built into the same on-scene chain, and French protocol treats cold water immersion as continuous across both services rather than as something that gets handed off and paused.

Why the handoff matters clinically

Under the Cool First, Transport Second protocol backed by ACSM 2023 and IOC/BJSM 2021, the clinical priority is getting core temperature under 40°C within 30 minutes of collapse, before transport begins. If a fire crew starts immersion and a SMUR physician team arrives mid-cooling, stopping to move the patient into an ambulance for transport-based cooling undoes the time advantage immersion was providing. French protocol addresses this directly: SMUR teams are trained to continue or take over immersion on scene, with the patient remaining in the tub while airway, IV access, and monitoring are established around it, rather than treating cooling and advanced life support as sequential steps.

Full patient access as a clinical requirement, not a convenience

This is where equipment choice becomes a medical decision rather than a logistics one. A SMUR physician needs to reach the airway, place lines, and monitor vitals while the patient is still immersed. Closed-bag or partial-access immersion designs force a choice between continuing to cool and getting clinical access, which is not a choice French emergency medicine protocol wants a physician to have to make mid-resuscitation. Full 360° access around the patient is treated as a baseline requirement for any tub used in a SAMU/SMUR response, not an added feature.

Coordination on multi-casualty events

At mass-participation events (trail races, marathons, Hyrox competitions) where French event medical directors are required to plan for exertional heat stroke under IOC/BJSM 2021 guidance, SAMU/SMUR units are typically pre-positioned alongside fire service medical posts, sharing the same cooling equipment rather than each service bringing its own incompatible kit. This shared-equipment approach is only workable if the tub is fast enough to deploy solo and rugged enough to survive back-to-back use across a full event day.

Why Kollder fits this chain

Because SAMU and SMUR teams are working the same tub a fire crew may have deployed minutes earlier, equipment continuity across services matters. Kollder is designed for solo deployment in under 2 minutes, gives full 360° access for physician-level intervention, and is built on a stainless steel chassis for repeated use across a shift or an event, which is why it has become the preferred supplier French SAMU and SMUR teams standardize on alongside their fire service counterparts. Details at kollder.com/#contact.

Inside France's SAMU and SMUR Cold Water Immersion Protocol

Why the handoff matters clinically

Full patient access as a clinical requirement, not a convenience

Coordination on multi-casualty events

Why Kollder fits this chain

Further Reading