Emergency Medical Services - Prehospital Delivery of Care

Prehospital Delivery of Care

Depending on country, area within country, or clinical need, emergency medical services may be provided by one or more different types of organisation. This variation may lead to large differences in levels of care and expected scope of practice.

The most basic emergency medical services are provided as a transport operation only, simply to take patients from their location to the nearest medical treatment. This was often the case in a historical context, and is still true in the developing world, where operators as diverse as taxi drivers and undertakers may operate this service.

Most developed countries now provide a government funded emergency medical service, which can be run on a national level, as is the case in the United Kingdom, where a national network of ambulance trusts operate an emergency service, paid for through central taxation, and available to anyone in need, or can be run on a more regional model, as is the case in the United States, where individual authorities have the responsibility for providing these services.

Ambulance services can be stand alone organisations, but in some cases, the emergency medical service is operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. This can lead, in some instances, to an illness or injury being attended by a vehicle other than an ambulance, such as fire truck. In some locales, firefighters are the first responders to calls for emergency medical aid, with separate ambulance services providing transportation to hospitals when necessary.

Some charities or non-profit companies also operate emergency medical services, often alongside a patient transport function. These often focus on providing ambulances for the community, or for cover at private events, such as sports matches. The Red Cross provides this service in many countries across the world on a volunteer basis (and in others as a Private Ambulance Service), as do some other smaller organizations such as St John Ambulance. and the Order of Malta Ambulance Corps. In some countries, these volunteer ambulances may be seen providing support to the full-time ambulance crews during times of emergency, or simply to help cover busy periods.

There are also private ambulance companies, with paid employees, but often on contract to the local or national government. Many private companies provide only the patient transport elements of ambulance care (i.e. nonurgent), although in some places these private services are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy or to respond to non-emergency home calls. Private companies are often contracted by private clients to provide event specific cover, as is the case with voluntary EMS crews.

Many colleges and universities, especially in the United States, maintain their own EMS organizations. These organizations operate at capacities ranging from first response to ALS transport. Campus EMS in the United States is overseen by the National Collegiate Emergency Medical Services Foundation.