The evolution of Emergency Medical Services in Developed & Developing Countries

 Today’s global EMS has advanced so much that it contributes widely to the overall function of health care systems. The World Health Organization regards EMS systems as an integral part of any effective and functional health care system. It is the first point of contact for the majority of people to health care services during emergencies and life-threatening injuries and act as a gate-keeping step for accessing secondary and tertiary services. Emergency medical providers around the world have developed an extended role to deal with medical and trauma emergencies utilizing advanced clinical technology.

Since 1970s, the mode of emergency health care delivery in pre-hospital environment evolved around two main models of EMS with distinct features. These are the Anglo-American and the Franco-German model. These categorical distinctions were obvious during the 1970s until the end of the 20th century. Today, most EMS systems around the world have varied compositions from each model. 

The delivery of emergency medical services in pre-hospital settings can be categorized broadly into Franco-German or Anglo-American models according to the philosophy of pre-hospital care delivery. Another method of EMS classification is according to the level of care provided into Basic Life Support and Advanced Life Support according to the level of care provided.

The Franco-German model of EMS delivery is based on the “stay and stabilize” philosophy. The motive of this model is to bring the hospital to patients.  It is usually run by physicians and they have extensive scope of practice with very advanced technology. The model utilizes more of other methods of transportations alongside land ambulance such as helicopters and coastal ambulances. This model is usually a sub-set of the wider health care system. This philosophy is widely implemented in Europe in which emergency medicine is relatively a young field. Therefore in Europe, pre-hospital emergency care is almost always provided by emergency physicians.  The attending emergency doctors in the field have the authority to make complex clinical judgment and treat patients in their homes or at the scene. This results in many EMS users being treated at the site of incident and less being transported to hospitals. The very few transported patients are usually directly admitted to hospital wards by the attending field emergency medicine physician bypassing the emergency department. Countries such as Germany, France, Greece, Malta and Austria have well-developed Franco-German EMS systems.

In contrast to the Franco-German model, the Anglo-American model is based around “scoop and run” philosophy. The aim of this model is to rapidly bring patients to the hospital with less pre-hospital interventions. It is usually allied with public safety services such as police or fire departments rather than public health services and hospitals. Trained paramedics and Emergency Medical Technicians (EMTs) run the system with a clinical oversight. It relies heavily on land ambulance and less so on aero-medical evacuation or coastal ambulance. In countries following this model, emergency medicine is well-developed and generally recognized as a separate medical specialty. Almost all patients in the Anglo-American model are transported by EMS personnel to developed Emergency Departments rather than hospital wards. Countries which use this model of EMS delivery include the United States, Canada, New Zealand, Sultanate of Oman and Australia.

In stark disparity, many developing nations struggle to provide basic emergency medical care to their citizens.  Adequate infrastructure is often lacking, and even in areas with significant financial and medical resources, emergency medical personnel training is limited. Furthermore, EM is often not recognized as a medical specialty overseas, making it unfeasible for interested care providers to obtain the skills required to deliver effective care.

An extrapolation from a report provided by the World Health Organisation(WHO) on emergency medical cases indicates that by 2020 road crashes will be a major killer in India, accounting for 546,000 deaths. Although India has only one per cent of the world’s motor vehicles, it still accounts for six per cent of the total global Road Traffic Accidental (RTA) deaths. Moreover, registered deaths due to other medical emergencies such as stroke, cardiac arrests, natural calamities and terrorist attacks are also mounting. Dr Kole in one of the white papers has mentioned that in India 98.5 per cent ambulances are used for transporting dead bodies, 90 per cent of ambulances are devoid of oxygen equipment, 95 per cent ambulances have untrained personnel, most ED doctors having no formal training in EM, there is misuse of government ambulances and 30 per cent mortality has been reported in recent times due to delay in care.

Also, in many developing countries the pre-hospital activities are not coordinated with hospital activities. Typically the patients are brought by private or by public transport (police ambulances, rescue services ambulances, mainly civil defense, etc.) without any information and without coordination among the various agencies. Often this leads to inappropriate transfer of patients to hospitals having not the technical capability (nor the capacity in the case of mass casualty situations) to treat these patients so that secondary transfer of patients is necessary. Most often all patients are brought to single hospital while the other nearby health care facility is not utilized or sometimes patients are brought to the nearest hospital to the emergency site which in most cases is unable to manage the patient properly due to lack of facilities and expertise to manage such a case. Often the receiving hospital cannot mobilize in due time its internal resources due to the lack of timely information regarding the arrival of patients in the case of mass casualty situations.

Thus, in such a scenario, specialized Ambulance services with trained personnels & evolved technology is a boon for an economy like us, headed towards becoming a global superpower, which help in securing, enhancing & enriching every life in need. A phenomenon crucial for maintaining the balance between progress & humanity.

What else can be done to improve the Emergency Medical Services in India?

·         To develop faculty out of other specialties 

·         To train the faculty in countries where emergency medicine is being practiced

·         To have exchange programmes 

·         To plan for EMS training, Paramedic training EM nursing

·         To formulate disaster plan

·         To form governing body and academic council