Emergency medical services (EMS) function to provide first response services in medical emergencies on the scene or in transport to a hospital, non-emergency medical care out-of-hospital, and transport to a medical center. EMS works to arrive in the crucial moments of an emergency equipped with necessary equipment, including automated external defibrillators (AED), oxygen, airway management supplies, spinal immobilization equipment, trauma supplies, and emergency medications (such as those used for severe allergic reactions). These services include paramedics and ambulance service professionals who are trained to reach and retrieve injured individuals from the scene of an emergency. Further, some EMS technicians are defined by the environment in which they operate.
As an industry, EMS has been growing, with some estimates suggesting it continues to grow at a CAGR of 6.2 percent. This comes as the global trend of injuries and trauma, high demand for emergency care, and increased hospital investment in ambulance facilities to deliver enhanced patient outcomes in an emergency continue to expand the industry. The industry is also expected to continue to develop as modern technologies, especially information and communication technology, continue to develop at a rapid pace. And with aging societies, disabled individuals, natural disasters, new diseases, urbanization, and the effects of climate change, the global healthcare burden continues to rise.
The goal of EMS is to provide emergency medical care to those who need it. Advances in technology have been able to expand the parameters of what has been originally in the domain of emergency services, extending beyond in-hospital treatment from arrival to stabilization, to include pre-hospital care and transportation. Despite the efforts of all involved, medical emergencies will happen, and neglecting the role of community and facility care or the role of the ambulance in the care of individuals in emergencies does not reduce the need for emergency medical services.
Instead, these services will shift to other segments, such as taxis that can suddenly provide emergency transportation for an individual. Therefore, planning EMS can increase the effectiveness of the services and its strategies through addressing the unique local challenges, such as those posed by a large city versus those posed by a rural community.
Emergency medical services can be reflected by a holistic system, which requires multiple services to work together. These services include emergency medical services provided through land and air ambulance; ambulance communication services to connect patients with ambulance care; and hospital programs that support paramedics and the ambulance system. Depending on the region in which these systems are being used, the programs may be regulated under different laws and acts, despite the services' reliance on the different parts.
Calling an emergency line is often a patient's first contact with emergency medical services. Through a dispatcher, also known as a prehospital service, a patient can receive early care or be talked through emergency medical instructions to the caller to help stabilize a patient. Further, the dispatch services can direct ambulances and paramedics to the scene of an accident or to a patient and ready them for the potential situation at hand. In some cases, a dispatcher is also required to juggle the various emergency assets in order to respond to multiple emergencies at a given time.
Also known as ambulance services, ground-based ambulance services can be provided through private, public, or hospital-based operators; generally, this depends on the healthcare service structure of a given region. These services are responsible for patient care, often expected to show up to the site of an accident or medical emergency and render care on-site and through transportation. The providers of the service are also responsible for supervising staff, maintaining vehicles and care equipment, and assuring the quality of service delivery. The healthcare equipment on an ambulance can be critical in conditions where having the right equipment can be the difference between effective and ineffective care. Specialized ambulances can also be deployed to support the transportation of critically ill patients, neonates, or children from hospitals or to hospitals.
Similar to ground ambulance services, air ambulance services or air medical services are used to transfer critically ill patients between healthcare facilities, and they show up to sites of accidents or medical emergencies to provide care and transport patients from an emergency site to a hospital. Fixed-wing and rotary-wing vehicles can be used to reach remote locations and places not traversable by ground-based transports and can provide fast-paced transport or inter-continental transport when this is necessary.
Ambulance communication services are used to provide essential support to the ambulance system as the first point of contact for a person in need of emergency medical services. These services can connect paramedics from an ambulance to a patient and guide them through basic first aid. Further, when paired with a base hospital program, ambulance communication services can provide support to the paramedics on an ambulance and prepare the hospital for the patient and their specific condition upon arrival.
Hospitals offer a base of operations, annual training, and certification while also overseeing controlled medical acts performed by paramedics. Depending on the region, these can be considered base hospitals, which operate under a host hospital responsible for the delegation of controlled medical acts, training, and quality assurance of patient care provided. But any hospital remains an important part of the emergency medical services system as it is often the end-point of the services, and based on communication services, can guide the paramedics or EMTs on necessary treatment en route and offer timely service upon the arrival of a patient.
Community paramedicine and related healthcare programs seek to provide care instructions to various communities, often over the phone, in order to reduce non-emergency EMS transport to hospitals, lower hospital admissions and readmissions, and provide appropriate medical resources for community members based on their needs. These programs can assist in clinical care coordination between patients and providers, provide medication inventory and compliance, offer community resource navigation, offer home safety checks, and provide post-discharge education.
This can be especially helpful to elderly individuals, individuals with comorbidities or chronic health conditions (for which travel can be a complicating factor), and those suffering from an opioid overdose. Community paramedicine can also enable individuals for whom hospital admittance can represent a risk, such as immuno-suppressed individuals, to still receive care in an emergency situation.
Emergency medical services workers are vital to the EMS system. These include first-responders, emergency medical technicians (EMTs), paramedics, and others whose duties bring them into the EMS system. These are the individuals responsible for responding to emergency calls and treating and transporting people in crisis health situations. They encounter a wide variety of patients in various situations, including car accidents, drownings, incidents of cardiac arrest, strokes, overdoses, traumas, and mass casualty incidents. This can cause a lot of stress and difficulty for the workers, leading to high worker turnover throughout the industry.
Emergency medical services are staffed by trained medical professionals called emergency medical technicians (EMTs). There are many requirements to be an EMT, with various levels of EMT training depending on the location and regulations of the industry. EMTs are trained to do important life-saving functions, such as stopping a bleed, treating burns, performing CPR, and stabilizing broken bones, neck fractures, and spine injuries. EMTs are also employed to transport patients in non-emergency situations when a patient requires critical care during transport between medical facilities.
Paramedics have advanced life support (ALS) training. They tend to require more schooling than EMTs, which can take as little as two years, depending on the region's requirements. A paramedic will perform live-saving procedures both at a scene and during transport, which can include endotracheal intubation or IV support, on top of all the functions of an EMT. Depending on regional regulations, ambulances tend to require a minimum number of paramedics on board in order to provide a certain quality of care. In many regions, this means an ambulance is staffed with one EMT and one paramedic. Some units will be staffed with an extra paramedic.
As the name suggests, flight paramedics work on airborne emergency vehicles, such as helicopters, and respond to emergencies in similar ways to ambulance services. An air medical service can be staffed by a combination of flight paramedics, EMTs, doctors, or nurses, depending on the situation. And often, flight paramedics require specific training as they can be expected to respond to emergencies such as wilderness rescues, airplane crashes, and other situations where airborne transportation is considered the difference between life and death.