Fire service and private company ambulances provide basic care

Emergency medical services From Wikipedia, the free encyclopedia

Three ambulances and a specialist response vehicle (right) in .

Emergency medical services (EMS), also known as ambulance
services or paramedic services, are that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other such as EMAS or EMARS.

In most places, the EMS can be summoned by members of the public (as well as medical facilities, other emergency services, businesses and authorities) via
an which puts them in contact with a control facility, which will then dispatch a suitable resource for the situation. are the primary vehicles for delivering EMS, though some also use , , , or . EMS agencies may also operate a non-emergency service, and some have to provide services.

Precursors[]

Emergency care in the field has been rendered in different forms since the beginning of recorded history. The contains the , in which a man who has been beaten is cared for by a passing Samaritan. Luke 10:34

A major advance was made (which in future years would come to shape policy on hospitals and ambulances) with the introduction of a transport carriage
for patients in London during 1832. The statement on the carriage, as printed in , said "The curative process commences the instant the patient is put in to the carriage; time is saved which can be given to the care of the patient; the patient may be driven to the hospital so speedily that the hospitals may be less numerous and located at greater distances from each other". This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, displays itself in modern emergency medical planning.

Rise of modern EMS[]

Advances in the 1960s, especially the development of and as the standard form of care for out-of-hospital , along with new , led to changes in the tasks of the ambulances. In , the first experimental mobile coronary care ambulance successfully resuscitated patients using these technologies. was the first civilian
emergency medical service in the United States to be staffed by , most of which were black.

Organization[]

Depending on country, area within country, or clinical need, emergency medical services may be provided by one or more different types of organization. This variation may lead to large differences in levels of care and expected scope of practice. Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.

basic and advanced life support levels, such as the and the .

Fire- or police-linked service[]

The is the largest charity in the world that provides emergency medicine. (in some countries, it operates as a private ambulance service). Other organisations include , the and , as well as small local volunteer agencies. In the United States, volunteer ambulances are rarer, but can still be seen in both metropolitan and rural areas (e.g. ). Charities such as , specialise in facilitating training medical professionals to volunteer to assist the statutory ambulance services in the care of patients, through their attendance at those with serious illnesses or injuries.

A few charities provide ambulances for taking patients on trips or vacations away from hospitals, hospices or care homes where they are in long-term care. Examples include the UK's project.

Combined emergency service[]

These are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where demand or budget is too low to support separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.

Purpose[]

Six points on the Star of Life

4. Good on-scene/field care – the emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident without doing further harm.

5. Care in transit -– the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey

Studies have been inconclusive as to whether one model delivers better results than the other. A 2010 study in the suggested that rapid transport was a better strategy for trauma cases, while stabilization at the scene was a better strategy for cardiac arrests.

ambulance crew are known as or .

as , and interpreting an . The scope of this higher tier response varies considerably by
country. commonly provide ALS, but some countries require it to be a higher level of care and instead employ in this role.

 Critical Care Transport (CCT), also known as medical retrieval or rendez vous MICU protocol in some countries (Australia, NZ, Great Britain, and Francophone Canada) refers to the critical care transport of patients between hospitals (as opposed to pre-hospital). Such services are a key element in regionalized systems of hospital care where intensive care services are centralized to a few specialist hospitals. An example of this is the in Scotland. This level of care is likely to involve traditional healthcare professionals (in addition to or instead of critical care-trained paramedics), meaning and/or physicians working in the pre-hospital setting and even on ambulances.

Transport-centered EMS[]

The essential decision in prehospital care is whether the patient should be immediately taken to the , or advanced care resources are taken to the patient where they lie. The "scoop and run" approach is exemplified by the aeromedical evacuation , whereas the "stay and play" is exemplified by the French and Belgian or the German "Notarzt"-System (preclinical emergency physician).

The strategy developed for prehospital trauma care in North America is based on the theory, i.e., that a trauma victim's best chance for survival is in an , with the goal of having the patient in surgery within an hour of the traumatic event. This appears to be true in cases of internal , especially penetrating trauma such as gunshot or stab wounds. Thus, minimal time is spent providing prehospital care (spine immobilization; "ABCs", i.e. ensure airway, breathing

Physician-led EMS is also known as the Franco-German model, "stay and play", "stay and stabilize" or "delay and treat". In a physician-led system, doctors respond directly to all major emergencies requiring more than simple . The physicians will attempt to treat casualties at the scene and will only transport them to hospital if it is deemed necessary. If patients are transported to hospital, they are more likely to go straight to a ward rather than to an . Countries that use this model include Austria, France, Belgium, Luxembourg, Italy, Spain, Brazil and Chile.

In some cases in this model, such as France, there is no direct equivalent to a paramedic. Physicians and (in some cases) provide all medical interventions for the patient. Other ambulance personnel are not non-medically trained and only provide driving and heavy lifting. In other applications of this model, as in Germany, a paramedic equivalent does exist, but is an assistant to the physician with a

Ambulance personnel are generally professionals and in some countries their use is controlled through training and registration. While these job titles are protected by legislation in some countries, this protection is by no means universal, and anyone might, for example, call themselves an 'EMT' or a 'paramedic', regardless of their training, or the lack of it. In some jurisdictions, both technicians and paramedics may be further defined by the environment in which they operate, including such designations as 'Wilderness', 'Tactical', and so on.]

A unique aspect of EMS is that there are two hierarchies of authority, as the is separate to medical authority.

Some EMS agencies have set up volunteer schemes, who can be dispatched to a medical emergency before the ambulance arrives. Examples of this include schemes run by ambulance services the UK and operated by the fire services in France. In some countries such as the US, there may be autonomous groups of volunteer responders such as
. and who are on duty for another emergency service may also be deployed in this role, though some firefighters are trained to a more advanced medical level.

Besides first responders who are deployed to an emergency, there are others who may be stationed at public events. The
and both provide first aiders in these roles.

Emergency medical technician[]

Such a system provides, in essence, a "zero response time," and can have an enormous impact on positive patient outcomes.

Advanced life support (ALS)[]

Paramedic practitioner / emergency care practitioner[]

In the United Kingdom and South Africa, some serving receive additional university education to become practitioners in their own right, which gives them absolute responsibility for their clinical judgement, including the ability to autonomously prescribe medications, including drugs usually reserved for doctors, such as courses of antibiotics. An is a position sometimes referred to as a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a . ECPs are university graduates in Emergency Medical Care or qualified paramedics who have undergone further training, and are authorized to perform specialized techniques. Additionally some may prescribe medicines (from a limited list) for longer-term care, such as antibiotics. With respect to a Primary Health Care setting, they are also educated in a range of Diagnostic techniques.

Physician[]

In countries with a -led EMS model, such as France, Italy, the German-speaking countries (Germany, Switzerland, Austria), and Spain, physicians respond to all cases that require more than basic first aid. In some versions of this model (such as France, Italy, and Spain), there is no direct equivalent to a , as ALS is performed by physicians. In the German-speaking countries, paramedics are assistants to ambulance physicians (called Notarzt). In these countries, if a physician is present, paramedics require permission from the physician to administer treatments such as defibrillation and drugs. If there is no physician on scene and a life-threatening condition is present, they may administer treatments that follow the physician's instructions.