Emergency medical services, also known as EMS, are responsible for providing out-of-hospital medical care and transportation to definitive care. There are different types of emergency medical services, as they vary from state to state. It is an intricate system that is integrated with other services to keep and to enhance the health and safety of the community. Let’s take a closer look at the components and the types of EMS there are.

What Is EMS?

Emergency medical services are one of the multiple types of emergency services that are dedicated to providing transport to patients that have illnesses and injuries which don’t allow for self-transportation. Furthermore, EMS provides out-of-hospital acute medical care. They are also known as ambulance services, ambulance squad, ambulance corps, first aid squad, FAST squad, rescue squad, emergency squat, life squad, or paramedic services.

An EMS system encompasses the following sub-systems, services, and professionals:

• Agencies.
• Organizations.
• Communication networks.
• Transportation networks.
• Rehabilitation facilities.
• Trauma centers and systems.
• Hospitals.
• Specialty care centers.
• Physicians, nurses, volunteers, therapists.
• Administrators, government officials.

Types of Emergency Medical Services

There are five EMS systems that communities are providing to their citizens:

• Ambulance organizations.
• Fire department.
• Voluntary EMS.
• Combined emergency service agencies.
• Hospital-based services.

The U.S. emergency medical services network copies the Anglo-American model. This means that they provide means to bring the patient to the hospital.  This is different from the Franco-German one, where medical care is being brought to the patient. It is extremely uncommon to have a physician respond to the emergency scene.

The delivery of emergency medical services in the United States is based on multiple models. Some are publicly funded while others are offered by a third-party such as a private company. The standard emergency medical services are operated by the municipality. It can either be provided by the local government or the state government. In most cases, the EMS is part of another municipal department. More often, it is integrated into the Public Health department.

In a different operating mode, the EMS is organized as a separate department within the municipality. It is viewed as a third emergency service, separate from the fire or police departments.

The emergency medical services system can also be integrated into fire or the police department, either partially or fully integrated. When it is partially integrated into another municipal EMS, the staff may share several services and quarters. When it is fully integrated, the staff can be cross-trained to perform other emergency services, either firefighting or policing.

As for the private ambulance service, there are currently only a few remaining private companies. Thousands of private ambulance companies have been merged into regional companies over the year. There are only two multinational companies that dominate the private ambulance industry at the moment.

Air ambulances are operated by various sources in the United States. Some are hospital-operators, others are operated by the federal, local, or state government, and others can be operated through multiple departments such as the United States Park Service, state police, or fire departments. They are either offered by these EMS systems or contracted to an aircraft charter company or a similar third-party company. Air ambulances include a mix of personnel, such as nurses, paramedics, physicians.

There’s also voluntary EMS, where charities and non-profit companies can operate ambulances and provide patient transport services. These are either run by the community or privately owned. It is not uncommon for them to be linked to voluntary fire services. The Red Cross is usually the main provider of this type of EMS in most countries across the globe. In some countries, these ambulances work alongside the full-time ambulances during emergency times.

Some hospital can also provide their own ambulance service. However, the use of this service is dependent on using the providing hospital’s services.

EMS Vehicles

There are multiple categories of ambulances in the United States. They are defined by Federal Specification for the Star-of-Life Ambulance, and they are classified as type:

• I – based on the chassis-cabs of light duty pickup trucks.
• II – also known as Vanbulances, based on modern passenger vans.
• III – based on chassis-cabs of light duty vans.
• III – AD – a cutaway van with an inbuilt modular body and increased gross vehicle weight rating, payload, and storage.

Large cities in the United States have multiple ambulance services that use all of the types listed above. Most ambulances that are certified for emergency response are marked with the symbol designed and controlled by the U.S. National Highway Traffic Safety Administration – the Star of Life.

EMS Staff

In the United States, the ambulances must provide a minimum of two personnel – an EMT and an EMR. This is a called a Basic Life Support Unit because it cannot provide Advanced Life Support interventions. If the patient’s condition justifies the need of an ALS provider, it can be summoned to aid the ambulance staff during transport to the hospital.

There are several certifications in EMS. The emergency medical responder, or first responder, is the member of the staff that can perform immediate care until a higher trained provider reaches the scene. Some of the life-saving skills they must provide include CPR, hemorrhage control, and spinal stabilization.

The emergency medical technician (EMT) is usually in charge of performing a broad range of skills, such as oxygen therapy, spinal care, and defibrillation. The emergency medical technician – intermediate (EMT-I) is a certification that allows the technician to perform IVs and IO cannulation, more advanced airway procedures, limited cardiac monitoring, manual defibrillation, and to administer a limited number of medications and analgesic.  A new certification level also includes the advanced emergency medical technician (AEMT). An AEMT possesses the skills to perform advanced airway procedures, start IVs, and administer certain medications.

The paramedic is highly trained, and their skills usually involve those that are not performed by technicians. This includes cannulation, the administration of a broader range of drugs (morphine, for example), intubation, cardiac monitoring, and more. Paramedics constitute the highest level of pre-hospital care in most parts of the United States. There are several certifications for paramedics: Critical Care EMT-Paramedic, Flight Paramedic Certification, and Wilderness ALS Care.

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