Emergency Medical Systems

Volunteer or professional emergency medical systems (EMS) follow one of five models: hospital based, municipal, private, volunteer, and complex. These organizations vary in training, equipment, and their ability to reach the injured person. More advanced units utilize highly trained personnel and sophisticated treatment protocols and equipment. Also important is advanced training in machinery extraction, tractor rollovers, and enclosed space rescue (35-37). There are three basic treatment philosophies in operating EMS systems:

1. Scoop and swoop: This system utilizes minimal or no stabilization of the injured person at the scene of the accident, evacuating the person to a hospital as quickly as possible.

2. Treat and swoop: These systems engage in advanced treatment at the injury site, including intravenous fluids, advanced airway control, antishock suits, and chest tubes. Some systems utilize physicians to perform advanced procedures on injured people in the field.

3. A combination of the two. Most systems use a combination of the two EMS systems depending upon the level of training of the response personnel and the complexity of equipment they are provided with (38,39).

Helicopters and "flying squads" have provided a new dimension to EMS services. Not only can they rapidly evacuate injured persons over difficult terrain but they can utilize aircraft to transport injured persons to specialty hospitals in other areas, even on other continents (40).

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