THE NEED FOR EMERGENCY DEPARTMENT FOR HAN D INJURIES

Every year in France there are 500,000 hand injuries; the number of in juries has remained constant over the last ten years and constitutes o ne-third of all work-related accidents. At the emergency department fo r hand surgery from Nancy University Hospital the treatment of hand in juries is the third part of the global activity. There have been signi ficant advancements in the field of hand surgery in the last twenty ye ars due to development of mircrosurgical techniques which make it poss ible to revascularize tissue that otherwise would die. Surgeons who tr eat hand injuries usually have been trained in the fields of orthopedi cs, traumatology, plastic surgery, and microsurgery. The improved resu lts--attributable to new techniques and early treatment-pointed to the need for organizing emergency services for hand injuries that would o perate on a 24-hour basis. In 1979, a group of French surgeons founded the Federation of Emergency Treatment of Hand Injuries that today rep resents 27 centers in France and 19 others in countries of the Europea n Community. These emergency wards work in conjunction with other cent ers dealing with emergency service, e.g., the Fire Department, Ambulan ce service, Industrial Medicine, etc... Over a period of 15 years, the benefits reaped from treating these injuries as true emergencies (les s than 6 hours ischemia) based on the principle of Immediate Repair wi th Early Mobilization (IREM) are both functional and social in nature : in 90 % of cases, the patient resumes professional and economic acti vity and the rate of partial disability is 30 % lower than that observ ed in cases treated in non-specialized centers. Given these results th at are acknowledged by all who work in emergency service in general, w e think that emergency wards for hand injuries should be an integral p art of the overall plan coordinating emergency services in France.