Shopping on line can be easy, simple and save you lots of money. It can also take a lot of your time, frustrate you, and result in unwanted purchases. Now the same can be said for regular high street shopping, but with the vast opportunity presented by the Internet it will pay you to spend a few minutes reading this and understanding how to better optimize your Emergency Medical Services shopping experience:

1. Compare - without doubt the biggest advantage that the Emergency Medical Services offers shoppers today is the ability to compare thousands of Emergency Medical Services at a time. This is a great thing, but not necessarily all the time! Too much can be daunting at times so take advantage of the great comparison sites and where possible let them do the hard work for you.

2. Research - if it has been said it will be on the internet. Ignorance is no longer a justifiable reason for buying the wrong thing. Take the time to research in detail everything that you could possible want to know about

3. Testimonials - don't know anybody that has bought a Emergency Medical Services? Wrong! If the Emergency Medical Services is good the internet will let you know. Use the Internet as a friend and get testimonials before you buy.

4. Questions - Got a question about Emergency Medical Services then search the Forums, FAQ's, Blogs etc. Don't be afraid to ask .....

5. Reputation - Never heard of the company selling Emergency Medical Services? Don't worry, no reason why you should know every company in the world, but you know someone that does! Use the internet to find out what people are saying about Emergency Medical Services and build up a picture of their reputation for sales, returns, customer service, delivery etc.

6. Returns - still worried that even after all of the above your Emergency Medical Services wont be what you want? Check out the returns policy. There is so much competition now that someone, somewhere is bound to offer the terms that you are comfortable with.

7. Feedback - happy with your Emergency Medical Services then let people know, after all you are depending on others people input in your buying decision, so why not give a little back.

8. Security - check for the yellow padlock on the Emergency Medical Services site before you buy, and the s after http:/ /i.e. https:// = a secure site

9. Contact - got a question about Emergency Medical Services, or want to leave a comment then check out the sites contact page. Reputable companies have them and respond.

10. Payment - ready to pay for your Emergency Medical Services, then use your credit card or PayPal! Be aware of companies that don't accept them, there may be genuine reasons but given the huge amount of choice you have when buying online there is no reason at all not to buy via credit card or PayPal.



An Emergency medical service (abbreviated to Acronym and initialism "EMS" in many countries) is a service providing out-of-hospital Acute (medical) care and transport to definitive care, to patients with illnesses and injuries which the patient believes constitutes a medical emergency. The most common and recognized EMS type is an ambulance organization.

In some places, an EMS organization may also be called a first aid squad, emergency squad, rescue squad, ambulance squad, ambulance service, ambulance corps or life squad.

The aim of EMS is to provide treatment to those in need of urgent medical care, with the goal of either satisfactorily treating the malady, or arranging for timely removal of the patient to the next point of definitive care. This is most likely an emergency department at a hospital or another place where physicians are available. In some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue.

In most places in the world, the EMS is summoned by members of the public (or other emergency services, businesses or authority) via an emergency telephone number which puts them in contact with the control centre for the EMS, who will then dispatch a suitable resource to deal with the situation.

Throughout the world, there are many differing qualification levels which may be held by members of an EMS, from drivers with no medical training, or a basic first aid certificate, to a fully qualified paramedic or physician

History Emergency care in the field has been rendered in different forms since the beginning of recorded history. The New Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10:34 (NIV) - "He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him." Also during the Middle Ages, the Knights Hospitaller, also known as the Knights of Malta, began to help their injured comrades, forming the basis of the modern Order of Malta Ambulance Corps and St John Ambulance movements.

The first record of ambulances being used for emergency purposes was the use by Queen Isabella of Spain, in 1487. The Spanish army of the time was treated extremely well and attracted volunteers from across the continent, and part of this was the first military hospitals or 'ambulancias', although injured soldiers were not picked up for treatment until after the cessation of the battle, resulting in many dying on the field.

A major change in usage of ambulances in battle came about with the ambulances volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte’s chief physician. Larrey was present at the battle of Spires, between the France and Prussians, and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, and set about developing a new ambulance system.Barkley, Katherine T. 1990. "The Ambulance". Exposition Press. ISBN 0-682-48983-2 Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the (active) battlefield after they had received early treatment in the field. These 'flying ambulances' were first used by Napoleon's Army of the Rhine is 1793. Larrey subsequently developed similar services for Napoleon's other armies, and adapted his ambulances to the conditions, including developing a litter which could be carried by a camel for a campaign in Egypt.

In civilian ambulances, 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 cholera patients in London during 1832. The statement on the carriage, as printed in The Times, 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 spaced further apart, displays itself in modern emergency medical planning.

The first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio (now the Cincinnati General) by 1865. This was soon followed by other services, notably the New York service provided out of Bellvue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine.

, then modified it to turn it into an ambulance. The resemblance to a hearse is obvious. (see text)Also in the late 19th century, the automobile was being developed, and in addition to horse-drawn models, early 20th century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. However, the first motorised ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated by 500 prominent local businessmen, in February 1899. This was followed in 1900 by New York city, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two automobile ambulances were electrically powered with 2hp motors on the rear axle.

During World War One, further advances were made in providing care before and during transport – traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and death of patients with leg fractures. Two-way radios became available shortly after World War I, enabling for more efficient radio Dispatch (logistics) of ambulances in some areas. Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses - the only available vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars.Kuehl, Alexander E. (Ed.). Prehospital Systems and Medical Oversight, 3rd edition. National Association of EMS Physicians. 2002. @ ch. 1. "Miller-Meteor History". Miller-Meteor. n.d. Retrieved 23 February 2007

Advances in the 1960s, especially the development of CPR & defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances. In Ireland, a mobile coronary care ambulance successfully resuscitated patients using these technologies; and well-developed studies demonstrated the need for overhauling ambulance services. One well-known report in the USA during that time was Accidental Death and Disability: The Neglected Disease of Modern Society. This report is commonly known as The White Paper. These studies, along with the White Paper report, placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. Part of the result was the creation of Standardizations in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), in the equipment (and thus weight) that an ambulance had to carry, and several other factors. Few, or perhaps none, of the then-available ambulances could meet these standards.

The purpose of EMS An EMS exists to fulfil the basic principles of First Aid, which are to Preserve Life, Prevent Further Injury and Promote Recovery.

This can be built on further, and one commonly used system is outlined here:

This system is signified by the Star of Life shown here, where each of the 'arms' to the star represent one of the 6 points

EMS providers Depending on your country, area within in country, or clinical need, EMS may be provided by one (or several) organisations, with different reasons for operating the service. Some countries closely regulate the industry (and may require anyone operating the EMS to be qualified to a set level), whereas others allow quite wide differences between types of operator.

  • Government EMS - Operating separately from (although alongside) the fire and police service of the area, these ambulances are funded by local or national government. In some countries, these only tend to be found in big cities, whereas in countries such as the United Kingdom, almost all emergency ambulances are part of the NHS
  • Fire or Police Linked Service - In many countries (USA, France, Germany, Japan), many ambulances are 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.
  • Voluntary EMS - Some charities or non-profit companies operate ambulances, both the an emergency and patient transport function. This may be along similar lines to volunteer Fire companies and either community or privately owned. They may be linked to a voluntary fire service, with volunteers providing both services. There are also charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). 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 organisations such as St John Ambulance. In some countries, these volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency.
  • Private Ambulance Service - Normal commercial 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. non urgent), but in some places, they are also 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, such as "pick up and put back" calls, which are made when a person falls without injury, but needs help getting up. Dependant on their contract they might also provide "first aid only" services, such as providing bandages (but not a trip to the hospital emergency room) to a child who skinned his/her knees at a playground. They may also be contracted by private clients to provide standby EMS for large events such as sports, conventions, or parades.
  • 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 also be found in some smaller towns and cities which do not have the resource or requirement for separate services. This multifunctionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.
  • Hospital Based Service - Some hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.


    • Rural/Frontier EMS The face of rural/frontier EMS has changed dramatically since the 1966 National Academy of Sciences, National Research Council (NAS-NRC) white paper “Accidental Death and Disability: the Neglected Disease of Modern Society” marked the conception of modern EMS. Ambulance service of that era was more about a fast ride than medical care. It was provided as a low-investment by-product service of funeral homes and others whose primary business already had the requisite type of vehicle.

    The NAS-NRC white paper revealed the ill-equipped, ill-trained nature of these services, as well as the potential to do more harm than good. Subsequent reforms led to the birth of modern EMS with the Emergency Medical Services Systems Act of 1973. As standards for training, equipment and care changed, so, too, did the providers of rural/frontier EMS. Dedicated ambulance vehicles staffed by trained EMTs operated by independent volunteer organizations, volunteer fire departments, local hospitals, and others replaced hearses. Many of the previous operators balked at the required investment to meet emerging standards.

    In the past three decades, the EMS field, with its capabilities and role as a unique discipline at the crossroads of medicine, public health and public safety, has matured dramatically. At a rural car crash, the gold standard medical response has gone from hearse to helicopter. The pressure to provide advanced life support (ALS), created at first by enthusiastic EMTs within EMS agencies themselves, has become compounded by media-generated public expectation. The drive to provide ALS has had an effect similar to that experienced by funeral home ambulance operators pressed to provide safe, basic care in the early 1970s.

    EMS agencies dependent on volunteers for staffing and fund-raising for revenue, have found advancement difficult. Indeed, it is often a challenge to continue to assure the timely response of a basic life support ambulance in these settings. In the current era of preparingpublic safety for effective response to manage terrorist and other events, the reality of rural/frontier EMS is that the infrastructure upon which to build such a response is itself in jeopardy. The 1996 NHTSA “EMS Agenda for the Future,”41 the visionary guide upon which this document is based, states that “EMS of the future will be community-based health management which is fully integrated with the overall health care system.” A theme running through the Rural/Frontier EMS Agenda for the Future is that such EMS integration is not only a reasonable approach to making community health care more seamless and to meeting community health care needs that might not otherwise be met, but that providing a variety of EMS-based community health services may be crucial to the survival and advancement of many rural/frontier EMS agencies.

    Another related theme is that EMS should not only weave itself into the local health care system but into the fabric of the community itself. Communities can objectively assess and publicly discuss the level and type of EMS care available, consider other options and accompanying costs, and then select a model to subsidize. Where this happens through a well-orchestrated and timely process of informed self-determination, community EMS can be preserved and advanced levels of care can be attained.

    The National Rural Health Association National Rural and Frontier Emergency Medical ServicesAgenda for the Future document suggests other means of maintaining an effective EMS presence as well such as alternative methods of delivering advanced life support back-up, and the formation of regional cooperatives for medical oversight, quality improvement, data collection and processing. This document can be accessed here and was used to sorces the above information.

    Levels of care exercise of the Magen David Adom involving Paramedics and Emergency medical technicians, and certified first responders utilising Advanced Life Support equipment like Electrocardiograms as well as a Long spine board.Dependent on the country and area in which the service operates, and what type of provider it is, there may be any one of several levels of EMS crew. They can broadly be divided in to Basic Life Support (BLS) qualifications (responders, ambulance technicians) which usually involves non-invasive procedures and Advanced Life Support (ALS) qualifications (higher level technicians and paramedics) which includes more invasive procedures (such as intubation and infusion).Some of the most common qualification terms are:
  • First Responder - A person who arrives first at the scene of an incidenthttp://www.resus.org.uk/pages/FirstRsp.htm, and whose job is to provide early critical care such as CPR or using an Automated external defibrillator. First responders may be dispatched by the ambulance service, may be passers-by, or may be dispatched to the scene from other agencies, such as the police or fire departments.
  • Ambulance Driver - Some services employ staff with no medical qualification (or just a first aid certificate) whose job is to simply drive the patients from place to place
  • Ambulance Care Assistant - Have varying levels of training across the world, but these staff are usually only required to perform patient transport duties (which can include stretcher or wheelchair cases), rather than acute carehttp://www.surrey-ambulance.nhs.uk/careers/acapts. Dependant on provider, they may be trained in first aid or extended stills such as use of an Automated external defibrillator, oxygen therapy and other live saving or palliative skills. In some services, they may provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic.
  • Emergency medical technician - Also known as Ambulance Technician. Technicians are usually able to perform a wide range of emergency care skills, such as defibrillation, spinal care, and oxygen therapy. Some countries split this term in to several levels (such as in the US, where there is EMT-I and EMT-II)http://bhpr.hrsa.gov/kidscareers/emt.htm. This title is not protected in all countries, such as in Great Britain, where anyone can legally call themselves an EMT, even without any training.
  • Paramedic - This is a high level of medical training and usually involves key skills not permissible for technicians, including Intravenous therapy (and with it the ability to use a range of drugs such as morphine), intubation and other skills such as performing a cricothyrotomyhttp://www.prospects.ac.uk/cms/ShowPage/Home_page/Explore_types_of_jobs/Types_of_Job/p!eipaL?state=showocc&pageno=1&idno=205. In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecutionhttp://www.hpc-uk.org/aboutregistration/protectedtitles/.
  • Emergency Care Practitioner - This is a position sometimes called a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are university graduates in Emergency Medical Carehttp://www.uj.ac.za/emc/index.asp?page=detail&id=4792 or qualified paramedics who have undergone further traininghttp://www.swast.nhs.uk/careersandvac/careers.htm#ECP, and are authorized to perform specialized emergency techniques using expert emergency drugs. 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.
  • Registered nurse (RN) - Some services use nurses for ambulance work, and as with doctors, this is mostly as air-medical rescuers or critical care transport providers, often in conjunction with a technician or paramedic. They may bring extra skills to the care of the patient, especially those who may be critically ill or injured in locations that do not enjoy close proximity to a high level of definitive care such as trauma, cardiac, or stroke centers.
  • Physician - Some ambulance services - most notably air ambulanceshttp://www.londonsairambulance.com/SecureStore/welcome.aspx?Q1788=30&J847=x30&A988=&NL477=&S9=0&UT1=&R=1&S=&RE=www.altavista.com&D=32http://www.surreyairambulance.co.uk/crew.aspx- will employ physicians to attend on the ambulances, bringing a full range of additional skills such as use of prescription medicines


    • Depending on the service provider, but most commonly in the Fire and Police linked or combined services, the EMS crew members may also be certified or trained in skills such as water rescue or motor vehicle extrication using the jaws of life in medically directed rescue. Some EMS providers offer different kinds of rescue service including rope rescue, cave rescue, water rescue, extrication, search and rescue and more. Some EMS organisations may have a whole variety of vehicles including boats, response cars and ambulances to deal with the demands of their particular service.

    In some places, law requires that all rescue team members be medically certified and in others the main rescue service (such as a Fire Department) do not have medical staff and leave all rescue up to an EMS department.

    Clinical governance In most areas, the EMS crews will work under the auspices of a medical director, usually a medical doctor, who will set and enforce the standards of clinical care expected of them. In some areas, such as the United Kingdom, the ambulance crew will be independent clinicians with their own clinical discretion and liability for their own actions.

    Prehospital care strategies See Organization of the emergency medical assistance#Prehospital care strategies.

    See also

    References

    External links



    An Emergency medical service (abbreviated to Acronym and initialism "EMS" in many countries) is a service providing out-of-hospital Acute (medical) care and transport to definitive care, to patients with illnesses and injuries which the patient believes constitutes a medical emergency. The most common and recognized EMS type is an ambulance organization.

    In some places, an EMS organization may also be called a first aid squad, emergency squad, rescue squad, ambulance squad, ambulance service, ambulance corps or life squad.

    The aim of EMS is to provide treatment to those in need of urgent medical care, with the goal of either satisfactorily treating the malady, or arranging for timely removal of the patient to the next point of definitive care. This is most likely an emergency department at a hospital or another place where physicians are available. In some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue.

    In most places in the world, the EMS is summoned by members of the public (or other emergency services, businesses or authority) via an emergency telephone number which puts them in contact with the control centre for the EMS, who will then dispatch a suitable resource to deal with the situation.

    Throughout the world, there are many differing qualification levels which may be held by members of an EMS, from drivers with no medical training, or a basic first aid certificate, to a fully qualified paramedic or physician

    History Emergency care in the field has been rendered in different forms since the beginning of recorded history. The New Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10:34 (NIV) - "He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him." Also during the Middle Ages, the Knights Hospitaller, also known as the Knights of Malta, began to help their injured comrades, forming the basis of the modern Order of Malta Ambulance Corps and St John Ambulance movements.

    The first record of ambulances being used for emergency purposes was the use by Queen Isabella of Spain, in 1487. The Spanish army of the time was treated extremely well and attracted volunteers from across the continent, and part of this was the first military hospitals or 'ambulancias', although injured soldiers were not picked up for treatment until after the cessation of the battle, resulting in many dying on the field.

    A major change in usage of ambulances in battle came about with the ambulances volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte’s chief physician. Larrey was present at the battle of Spires, between the France and Prussians, and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, and set about developing a new ambulance system.Barkley, Katherine T. 1990. "The Ambulance". Exposition Press. ISBN 0-682-48983-2 Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the (active) battlefield after they had received early treatment in the field. These 'flying ambulances' were first used by Napoleon's Army of the Rhine is 1793. Larrey subsequently developed similar services for Napoleon's other armies, and adapted his ambulances to the conditions, including developing a litter which could be carried by a camel for a campaign in Egypt.

    In civilian ambulances, 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 cholera patients in London during 1832. The statement on the carriage, as printed in The Times, 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 spaced further apart, displays itself in modern emergency medical planning.

    The first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio (now the Cincinnati General) by 1865. This was soon followed by other services, notably the New York service provided out of Bellvue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine.

    , then modified it to turn it into an ambulance. The resemblance to a hearse is obvious. (see text)Also in the late 19th century, the automobile was being developed, and in addition to horse-drawn models, early 20th century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. However, the first motorised ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated by 500 prominent local businessmen, in February 1899. This was followed in 1900 by New York city, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two automobile ambulances were electrically powered with 2hp motors on the rear axle.

    During World War One, further advances were made in providing care before and during transport – traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and death of patients with leg fractures. Two-way radios became available shortly after World War I, enabling for more efficient radio Dispatch (logistics) of ambulances in some areas. Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses - the only available vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars.Kuehl, Alexander E. (Ed.). Prehospital Systems and Medical Oversight, 3rd edition. National Association of EMS Physicians. 2002. @ ch. 1. "Miller-Meteor History". Miller-Meteor. n.d. Retrieved 23 February 2007

    Advances in the 1960s, especially the development of CPR & defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances. In Ireland, a mobile coronary care ambulance successfully resuscitated patients using these technologies; and well-developed studies demonstrated the need for overhauling ambulance services. One well-known report in the USA during that time was Accidental Death and Disability: The Neglected Disease of Modern Society. This report is commonly known as The White Paper. These studies, along with the White Paper report, placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. Part of the result was the creation of Standardizations in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), in the equipment (and thus weight) that an ambulance had to carry, and several other factors. Few, or perhaps none, of the then-available ambulances could meet these standards.

    The purpose of EMS An EMS exists to fulfil the basic principles of First Aid, which are to Preserve Life, Prevent Further Injury and Promote Recovery.

    This can be built on further, and one commonly used system is outlined here:

    This system is signified by the Star of Life shown here, where each of the 'arms' to the star represent one of the 6 points

    EMS providers Depending on your country, area within in country, or clinical need, EMS may be provided by one (or several) organisations, with different reasons for operating the service. Some countries closely regulate the industry (and may require anyone operating the EMS to be qualified to a set level), whereas others allow quite wide differences between types of operator.

  • Government EMS - Operating separately from (although alongside) the fire and police service of the area, these ambulances are funded by local or national government. In some countries, these only tend to be found in big cities, whereas in countries such as the United Kingdom, almost all emergency ambulances are part of the NHS
  • Fire or Police Linked Service - In many countries (USA, France, Germany, Japan), many ambulances are 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.
  • Voluntary EMS - Some charities or non-profit companies operate ambulances, both the an emergency and patient transport function. This may be along similar lines to volunteer Fire companies and either community or privately owned. They may be linked to a voluntary fire service, with volunteers providing both services. There are also charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). 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 organisations such as St John Ambulance. In some countries, these volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency.
  • Private Ambulance Service - Normal commercial 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. non urgent), but in some places, they are also 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, such as "pick up and put back" calls, which are made when a person falls without injury, but needs help getting up. Dependant on their contract they might also provide "first aid only" services, such as providing bandages (but not a trip to the hospital emergency room) to a child who skinned his/her knees at a playground. They may also be contracted by private clients to provide standby EMS for large events such as sports, conventions, or parades.
  • 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 also be found in some smaller towns and cities which do not have the resource or requirement for separate services. This multifunctionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.
  • Hospital Based Service - Some hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.


    • Rural/Frontier EMS The face of rural/frontier EMS has changed dramatically since the 1966 National Academy of Sciences, National Research Council (NAS-NRC) white paper “Accidental Death and Disability: the Neglected Disease of Modern Society” marked the conception of modern EMS. Ambulance service of that era was more about a fast ride than medical care. It was provided as a low-investment by-product service of funeral homes and others whose primary business already had the requisite type of vehicle.

    The NAS-NRC white paper revealed the ill-equipped, ill-trained nature of these services, as well as the potential to do more harm than good. Subsequent reforms led to the birth of modern EMS with the Emergency Medical Services Systems Act of 1973. As standards for training, equipment and care changed, so, too, did the providers of rural/frontier EMS. Dedicated ambulance vehicles staffed by trained EMTs operated by independent volunteer organizations, volunteer fire departments, local hospitals, and others replaced hearses. Many of the previous operators balked at the required investment to meet emerging standards.

    In the past three decades, the EMS field, with its capabilities and role as a unique discipline at the crossroads of medicine, public health and public safety, has matured dramatically. At a rural car crash, the gold standard medical response has gone from hearse to helicopter. The pressure to provide advanced life support (ALS), created at first by enthusiastic EMTs within EMS agencies themselves, has become compounded by media-generated public expectation. The drive to provide ALS has had an effect similar to that experienced by funeral home ambulance operators pressed to provide safe, basic care in the early 1970s.

    EMS agencies dependent on volunteers for staffing and fund-raising for revenue, have found advancement difficult. Indeed, it is often a challenge to continue to assure the timely response of a basic life support ambulance in these settings. In the current era of preparingpublic safety for effective response to manage terrorist and other events, the reality of rural/frontier EMS is that the infrastructure upon which to build such a response is itself in jeopardy. The 1996 NHTSA “EMS Agenda for the Future,”41 the visionary guide upon which this document is based, states that “EMS of the future will be community-based health management which is fully integrated with the overall health care system.” A theme running through the Rural/Frontier EMS Agenda for the Future is that such EMS integration is not only a reasonable approach to making community health care more seamless and to meeting community health care needs that might not otherwise be met, but that providing a variety of EMS-based community health services may be crucial to the survival and advancement of many rural/frontier EMS agencies.

    Another related theme is that EMS should not only weave itself into the local health care system but into the fabric of the community itself. Communities can objectively assess and publicly discuss the level and type of EMS care available, consider other options and accompanying costs, and then select a model to subsidize. Where this happens through a well-orchestrated and timely process of informed self-determination, community EMS can be preserved and advanced levels of care can be attained.

    The National Rural Health Association National Rural and Frontier Emergency Medical ServicesAgenda for the Future document suggests other means of maintaining an effective EMS presence as well such as alternative methods of delivering advanced life support back-up, and the formation of regional cooperatives for medical oversight, quality improvement, data collection and processing. This document can be accessed here and was used to sorces the above information.

    Levels of care exercise of the Magen David Adom involving Paramedics and Emergency medical technicians, and certified first responders utilising Advanced Life Support equipment like Electrocardiograms as well as a Long spine board.Dependent on the country and area in which the service operates, and what type of provider it is, there may be any one of several levels of EMS crew. They can broadly be divided in to Basic Life Support (BLS) qualifications (responders, ambulance technicians) which usually involves non-invasive procedures and Advanced Life Support (ALS) qualifications (higher level technicians and paramedics) which includes more invasive procedures (such as intubation and infusion).Some of the most common qualification terms are:
  • First Responder - A person who arrives first at the scene of an incidenthttp://www.resus.org.uk/pages/FirstRsp.htm, and whose job is to provide early critical care such as CPR or using an Automated external defibrillator. First responders may be dispatched by the ambulance service, may be passers-by, or may be dispatched to the scene from other agencies, such as the police or fire departments.
  • Ambulance Driver - Some services employ staff with no medical qualification (or just a first aid certificate) whose job is to simply drive the patients from place to place
  • Ambulance Care Assistant - Have varying levels of training across the world, but these staff are usually only required to perform patient transport duties (which can include stretcher or wheelchair cases), rather than acute carehttp://www.surrey-ambulance.nhs.uk/careers/acapts. Dependant on provider, they may be trained in first aid or extended stills such as use of an Automated external defibrillator, oxygen therapy and other live saving or palliative skills. In some services, they may provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic.
  • Emergency medical technician - Also known as Ambulance Technician. Technicians are usually able to perform a wide range of emergency care skills, such as defibrillation, spinal care, and oxygen therapy. Some countries split this term in to several levels (such as in the US, where there is EMT-I and EMT-II)http://bhpr.hrsa.gov/kidscareers/emt.htm. This title is not protected in all countries, such as in Great Britain, where anyone can legally call themselves an EMT, even without any training.
  • Paramedic - This is a high level of medical training and usually involves key skills not permissible for technicians, including Intravenous therapy (and with it the ability to use a range of drugs such as morphine), intubation and other skills such as performing a cricothyrotomyhttp://www.prospects.ac.uk/cms/ShowPage/Home_page/Explore_types_of_jobs/Types_of_Job/p!eipaL?state=showocc&pageno=1&idno=205. In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecutionhttp://www.hpc-uk.org/aboutregistration/protectedtitles/.
  • Emergency Care Practitioner - This is a position sometimes called a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are university graduates in Emergency Medical Carehttp://www.uj.ac.za/emc/index.asp?page=detail&id=4792 or qualified paramedics who have undergone further traininghttp://www.swast.nhs.uk/careersandvac/careers.htm#ECP, and are authorized to perform specialized emergency techniques using expert emergency drugs. 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.
  • Registered nurse (RN) - Some services use nurses for ambulance work, and as with doctors, this is mostly as air-medical rescuers or critical care transport providers, often in conjunction with a technician or paramedic. They may bring extra skills to the care of the patient, especially those who may be critically ill or injured in locations that do not enjoy close proximity to a high level of definitive care such as trauma, cardiac, or stroke centers.
  • Physician - Some ambulance services - most notably air ambulanceshttp://www.londonsairambulance.com/SecureStore/welcome.aspx?Q1788=30&J847=x30&A988=&NL477=&S9=0&UT1=&R=1&S=&RE=www.altavista.com&D=32http://www.surreyairambulance.co.uk/crew.aspx- will employ physicians to attend on the ambulances, bringing a full range of additional skills such as use of prescription medicines


    • Depending on the service provider, but most commonly in the Fire and Police linked or combined services, the EMS crew members may also be certified or trained in skills such as water rescue or motor vehicle extrication using the jaws of life in medically directed rescue. Some EMS providers offer different kinds of rescue service including rope rescue, cave rescue, water rescue, extrication, search and rescue and more. Some EMS organisations may have a whole variety of vehicles including boats, response cars and ambulances to deal with the demands of their particular service.

    In some places, law requires that all rescue team members be medically certified and in others the main rescue service (such as a Fire Department) do not have medical staff and leave all rescue up to an EMS department.

    Clinical governance In most areas, the EMS crews will work under the auspices of a medical director, usually a medical doctor, who will set and enforce the standards of clinical care expected of them. In some areas, such as the United Kingdom, the ambulance crew will be independent clinicians with their own clinical discretion and liability for their own actions.

    Prehospital care strategies See Organization of the emergency medical assistance#Prehospital care strategies.

    See also

    References

    External links



    Emergency medical services - Wikipedia, the free encyclopedia
    Emergency medical services (abbreviated to the initialism "EMS" in many countries) are a branch of Emergency services dedicated to providing out-of-hospital acute medical care and ...

    Nottingham Emergency Medical Services Out of Hours System
    Welcome to the Nottingham Emergency Medical Services Out of Hours Website. If you have a login and password click on "Login" above, otherwise, please use the "Register" link in ...

    MedlinePlus: Emergency Medical Services
    Emergency Medical Services ... If you get very sick or badly hurt and need help right away, you should use emergency medical services.

    Nottingham Health Community - Nottingham Emergency Medical Services
    What is NEMS?   Nottingham Emergency Medical Services (NEMS) is a non-commercial, out of hours GP co-operative, dedicated to providing comprehensive, high quality out of hours GP ...

    NEMS
    NEMS Community Benefit Services Limited Registered under the Industrial and Provident Societies Act 1965 Register No. 29847R

    middletownems.org

    Sunstar Emergency Medical Services (EMS)
    Pinellas County's all-paramedic ambulance and emergency response service. The sole ambulance provider for Pinellas County. Many services offered.

    Nottingham Emergency Medical Services Out of Hours System
    Patient Information . In an Emergency eg collapse, Chest pain or Severe Breathlessness call 999 for an ambulance. If you need medical advice Out of Hours (ie when your surgery is ...

    MCG Dept. of Emergency Medicine and Emergency Medical Services
    Medical College of Georgia offers EMS, Critical Care Emergency Medical Transport Program (CCEMTP), and EMS training programs.

    Thames Emergency Medical Services
    Thames EMS is the emergency ambulance provider for Middlesex County and Elgin County.

     

    Emergency Medical Services



     
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