The hospital district may provide the service by themselves or source it from another organisation. Usually, this organisation is the local rescue department or private ambulance services. The hospital district decides on the level of service, which determines the structure and targets of the emergency medical service.
The emergency medical service is led by hospital districts and regional emergency chief physicians. In the field, the emergency medical services are managed by field commanders and supervisors of emergency care. The emergency medical service is formed by a fleet of appropriately equipped ambulances and their staff. The system may include vehicles of different levels of equipment. Some vehicles are not for transporting patients and are used for taking an prehospital care team to the scene of the incident, as patients do not always need transportation to a hospital following the assessment.
Immediate first aid and initial care are also given by the first response units, or rescue units, which carry emergency care equipment and are staffed by rescue personnel with emergency care skills.
First response personnel include Border Guard units and contracted voluntary firefighters and/or other volunteer organisations.
Care Level ambulances
Care Level ambulances are staffed by qualified paramedics and nurses with additional training in prehospital care. Care Level ambulances usually carry a more extensive supply of medicines and instruments for rare and more demanding situations.
The field commander
The field commander is a Care Level paramedic with additional leadership or other training. Their role is to act as operative managers, participate in demanding situations and be in charge of emergency medical services on site in special situations.
Emergency doctor unit
Emergency doctor ambulances, which can be cars or helicopters, are staffed with emergency care physicians and paramedic teams. Emergency doctor units attend to the most serious incidents and illnesses. They have the skills and instruments to manage rarely occurring situations and initiate intensive care before arrival at the hospital. Besides field work, the duty emergency physician provides consultations to other ambulances and acute prehospital care calls outside the hospital.
Emergency care services
Emergency care services do not offer prebooked services, such as patient transportations to other departments or home. Non-urgent assistance and assessments are usually carried out by private contractors.
Follow Mary through emergency medical service
Mary is lying in the recovery position and breathing normally. Sally tries to talk to Mary and ask questions, but she does not respond and seems confused. Soon the paramedics arrive, guided by the security guard. They take over Mary’s care and ask Sally about what happened and take note of Mary’s personal details. Sally also tells the paramedics about Mary’s condition and previous events of that day.
While talking to Sally, the paramedics examine Mary by taking her blood pressure, blood sugar and oxygen levels. Mary starts to wake up but remembers nothing about what happened. Soon Mary feels a bit more alert, and the paramedics tell her that she has had a seizure. She is exhausted but can answer paramedics’ questions sensibly.
Mary tells the paramedics about her medication and the brief episode of convulsions she had had earlier that morning. One of the paramedics takes the details about the episode and takes note of the patient interview and fills in the emergency care record. The paramedics work according to care guidelines. They recommend that Mary travels on the ambulance to receive further care and/or monitoring at the local emergency department because she has had convulsions twice in the same day. Mary agrees that it is best to visit the emergency department…