Emergency services are the lifeline to medical care in times of illness, injury and disaster. They are a highly-trained community of people and equipment, organized at the local, state and federal levels. They include law enforcement, fire departments and ambulance services. They also encompass the specialized rescue teams that work with ground search and rescue, bomb disposal units and hazardous materials crews. Governments worldwide are asking these professionals to do more with less, both in day-to-day operations and in response to sudden events.
Every year, millions of people visit hospital emergency departments (EDs). This is the front door to health care. It is where patients are evaluated and treated for everything from a broken bone to a heart attack or asthma flare-up, from an automobile accident to a natural disaster. ER crowding has been a major issue for many hospitals, with the number of visits rising faster than ER capacity.
Depending on the circumstances, an injured or sick person can be transported to an ER via ambulance or air or sea transport. Regardless of the type of transport, an EMS system has key elements that must be present: highly trained personnel; facilities and equipment; communication and transportation networks; life-saving data; and a dedication to evidence-based practices from EMS stakeholders at the national and international level.
While North Americans have become accustomed to seeing fire and police vehicles with lights and sirens, these types of specialized services are rare in many other parts of the world. This is especially true in rural and remote areas, where the closest emergency service may be hours away.
Primary emergency services are those that can be summoned directly by the public. They are often divided into three branches: police – Law enforcement, crime prevention and maintenance of order; fire – Fire suppression, fire prevention, technical rescue; and EMS – Emergency medical services, including basic life support, trauma care and advanced medical interventions.
Emergency services can be a combination of public and private professional services or entirely volunteer organizations. They can be staffed at the local, county or state level, or by an international nongovernmental organization such as the Red Cross or St. John Ambulance. Whether they are public or private, they must be fully integrated into the 9-1-1 system and have clear lines of authority.
The emergency service landscape is changing as well, with some ERs moving to a model called community paramedicine, in which EMS clinicians deliver patient-centered healthcare outside the emergency department, typically through scheduled home visits. It has been shown to reduce ED visits and improve patient outcomes. It is a strategy that should be embraced by all communities, large and small. It is important to support these efforts with unrestricted cash donations, particularly for volunteer-based programs. This will help ensure that they can continue to serve their communities in the future. In addition, fostering relationships between emergency services will help them find ways to cooperate during emergencies and share best practices and training.