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EMS is changing ‘where emergency care begins’

Because of EMS, emergency care begins closer to the point of illness or injury than ever before


“EMS out-of-hospital care isn’t a location, it is a capability of the EMTs, AEMTs and paramedics already serving in every town, village, city and the spaces in between, to save lives and reduce suffering,” writes Friese.

Photo/Wikimedia Commons

Before EMS, emergency care began at the doors of the hospital. More than 50 years ago, the early pioneers in EMS advanced emergency care from the hospital to the streets, homes and businesses in their communities. Paramedics were trained to perform lifesaving interventions, like defibrillation, removing foreign body airway obstructions and controlling severe bleeding in the out-of-hospital environment. Ever since, EMS has been advancing the initiation of emergency care closer to the point of injury or illness.

Because of EMS, emergency care now begins sooner than ever before and that emergency care isn’t limited to a small cadre of highly-trained paramedics, but an ever-growing number of other public safety personnel and lay people.

Emergency care for cardiac arrest, because of EMS, now begins when a layperson recognizes a spouse, friend or stranger in cardiac arrest and knows to call 911. EMS has led the way in training dispatchers to deliver CPR instructions by phone. EMS has advocated for and promoted the placement of AEDs in businesses, parks and other mass gathering spaces. Rapid defibrillation increases the chances of survival.

EMS has advanced the chain of survival for cardiac arrest closer to the moment of collapse, and in 2023, athletic trainers, police officers and business-based employee first aid teams often begin emergency care for sudden cardiac arrest before EMS arrives.

Because of EMS, emergency care for drug overdose begins sooner than ever. Lay people, often using naloxone nasal spray they were given and taught to use by EMTs and paramedics, are reversing opioid overdose and preventing an untold number of premature deaths.

In a growing number of communities, because of EMS, people who overdose on opioids receive follow-up visits from paramedic-led opioid overdose response teams. EMS educates the person struggling with addiction, as well as their friends and family, about the dangers of using alone, available addiction treatment resources and how to use naloxone. EMS is also leading how public safety personnel understand addiction, demonstrating compassionate care for people who are addicted, and most importantly, keeping people living with addiction alive until they are ready to begin treatment.

Because of EMS, emergency care for severe bleeding begins with self-care and lay rescuer care. The Stop the Bleed program, along with increasingly ubiquitous bleeding control kits, empowers the application of direct pressure, tourniquet placement and wound packing by friends, family, coworkers and strangers before EMTs and paramedics arrive.

Police officers and soldiers, often taught by paramedics, EMTs and combat medics, regularly practice the self-care and buddy-care skills of tourniquet application and wound packing. Police, because of EMS, use their bleeding-control skills to save the lives and limbs of their partners, crime victims and suspects.

Because of EMS, community paramedicine is spreading to communities of all sizes. EMS didn’t wait for permission from doctors, hospitals or healthcare payors to innovate these new response and care models. Instead, EMS, the experts in out-of-hospital care, demonstrated our ability to provide cost-saving follow-up care and preventative care that also improves patient outcomes and patient satisfaction.

The lessons learned from community paramedicine are helping advance the diffusion of telehealth technology, using paramedics to bridge the gap between patients and in-hospital care providers. Paramedics, extending the reach of physicians, can more efficiently and accurately triage patients to the facilities and providers best able to treat time-sensitive conditions, like stroke and myocardial infarction.

‘Out-of-hospital care isn’t a location, it is a capability’

Because of EMS, our partners across public safety, as well as in public health and hospital-based healthcare, understand where emergency care begins, who provides that emergency care and how that care is provided differently than they did 50 years ago or 10 years ago. EMS leaders and field providers have profoundly advanced where emergency care begins. EMS out-of-hospital care isn’t a location, it is a capability of the EMTs, AEMTs and paramedics already serving in every town, village, city and the spaces in between, to save lives and reduce suffering.

On this EMS Week and the 51-weeks until the next EMS Week, thanks for serving your community and making the difference in the lives of others. The service, care and compassion you provide to patients and their loved ones is important and it matters. Thanks.


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Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on PoliceOne, FireRescue1, Corrections1, EMS1 and Gov1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on Twitter or LinkedIn and submit an article idea or ask questions by emailing him at