One of the most important health care services is emergency medical service as it plays a vital role in saving people's lives and reducing the rate of mortality and morbidity. Over the last years, many review papers have discussed emergency medical services (EMS) location problems, however, only few review papers consider the full range of EMS systems. This review paper tries to fill this gap. Our review introduces the concept of emergency care pathway following the current trend in health care systems, i.e., shifting the central role from health care providers to patients. Considering the emergency care pathway, we provide a broad literature review and analysis in order to identify emerging challenges for future research.

Organization and practices of ambulance services in 14 European countries.

The EERC is the main innovation stemming from the 2013 EU legislation on the Civil Protection Mechanism. Interested countries can pre-commit different types of response capacities for participation in coordinated EU civil protection missions. When disaster strikes, the Emergency Response Coordination Centre will facilitate a coordinated deployment of these assets, in close cooperation with Member States. This will greatly enhance the availability of response capacities in times of need, bring more predictability in the assistance and significantly reduce deployment times. Member States and the Commission are working closely together to develop quality criteria and a certification process for the different teams, thus ensuring that all teams meet minimum quality and interoperability criteria and can effectively work together in the field. Trainings and exercises are available to test and further improve performance and coordination.

In 2009, medical training in emergency medicine in the Netherlands was approved by the Medical Specialist Registration Committee (MSRC) of the Royal Dutch Society for Medicine (KNMG). Emergency medicine is therefore a young and newly independent discipline. Even taking into account the initiation period during the previous years, this is still the case. What were the reasons and objectives to train physicians working in the emergency department (ED) back then? What role does the emergency physician have at the moment? What are the future challenges for emergency physicians in the Netherlands? In this article, we review the current situation and speculate about the future of our specialty.

There currently are five policy areas where the European Union (EU) has exclusive competence to legislate. In all other policy areas, the EU shares competence with the member states or supports member state action. Healthcare, and more specifically pre-hospital emergency medical services (pre-hospital EMS) is such a policy field, where the EU does not have exclusive competence and is only allowed to support member state action. This, however, does not mean that the EU does not legislate in this field. Nevertheless, scientific studies on the exact extent to which the powers of the EU have influenced policy areas such as pre-hospital EMS remain scarce.

Even in countries such as France and Germany, with apparently well developed EMS Systems, the delivery of care is not uniform. For example, in France, the SAMU (System d’aid Medical d’ Urgence) does not cover the whole of the country. In many areas, services are provided by the Fire Services (Sappeurs Pompiers). The training of doctors is not standardised. Most are in a speciality training programme for emergency medicine. There is a reliance on general practitioners and indeed doctors from other specialties working in a part time and often ad hoc manner.

All countries, irrespective of their level of economic development or risk reduction efforts, are vulnerable to natural disasters. While vulnerability to outbreaks is heightened by poor surveillance and weak health systems, several recent instances of highly infectious diseases have also had an impact on high income countries (such as Ebola in the USA or SARS in Hong Kong and Canada). While most disasters are national incidents that can be managed with local resources, a few are of such catastrophic magnitude and impact as to attract considerable international coverage and humanitarian response.

Abstract Objective:

We examined temporal variations in overall Emergency Medical Services (EMS) demand, as well as medical and trauma cases separately. We analyzed cases according to time of day and day of week to determine whether population level demand demonstrates temporal patterns that will increase baseline knowledge for EMS planning. Methods. We conducted a secondary analysis of data from the Ambulance Victoria data warehouse covering the period 2008-2011. We included all cases of EMS attendance which resulted in 1,203,803 cases for review. Data elements comprised age, gender, date and time of call to the EMS emergency number along with the clinical condition of the patient. We employed Poisson regression to analyze case numbers and trigonometric regression to quantify distribution patterns. Results. EMS demand exhibited a bimodal distribution with the highest peak at 10:00 and a second smaller peak at 19:00. The highest number of cases occurred on Fridays, and the lowest on Tuesdays and Wednesdays. However, the distribution of cases throughout the day differed by day of week. Distribution patterns on Fridays, Saturdays and Sundays differed significantly from the rest of the week (p < 0.001). When categorized into medical or trauma cases, medical cases were more frequent during working hours and involved patients of higher mean age (57 years vs. 49 years for trauma, p < 0.001). Trauma cases peaked on Friday and Saturday nights around midnight. Conclusion. Day of week EMS demand distribution patterns reveal differences that can be masked in aggregate data. Day of week EMS demand distribution patterns showed not only which days have differences in demand but the times of day at which the demand changes. Patterns differed by case type as well. These differences in distribution are important for EMS demand planning. Increased understanding of EMS demand patterns is imperative in a climate of ever-increasing demand and fiscal constraints. Further research is needed into the effect of age and case type on EMS demand.

The emergency medical services (EMS) community faces many challenges in providing patient care while maintaining the safety of their patients and themselves. One factor that influences patient care and safety is the ability of the EMS provider operating the ambulance to quickly but safely maneuver to the site of the medical emergency and subsequently transport the patient(s) to the hospital. The Department of Homeland Security (DHS) and the Emergency Medical Services Community identified a need to research best practices for ambulance operators and identify safety gaps. This research report coincides with the DHS Science and Technology Directorate’s First Responders Group and the Resilient Systems Division’s partnership with the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, BMT Designers and Planners (D&P), and Carlow International’s project to develop ambulance safety and design standards and recommendations.

The potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS).