How To Build an EMS System in Six Basic Steps

Communications is the Achilles’ heel of basic EMS development in resource-limited settings.


Ambulance services shine most brightly in preventing premature death and disability by way of basic life support (BLS). While advanced life support (ALS) may be more effective in treating certain medical conditions, there’s little argument that BLS does the greatest good for the greatest number and is the most cost-effective way of saving lives in any community.

More than 75% of the global population won’t ever have to consider a debate about the benefits of BLS vs. ALS. Many countries, particularly poorer nations, are a long way from providing ALS care in the prehospital environment. Generally speaking, they simply can’t afford it. However, they can afford BLS, and they need it desperately.

This realization came to me when I was deployed to Haiti shortly after the 2010 earthquake. Looking around it was clear to see beneath the rubble that even if there had been no earthquake, and Haiti had had all the ambulances in the world dispatched using the most advanced systems, it would have made very little difference in that environment. The EMS systems utilized in wealthy countries just would most likely have failed. Haiti did not have the underlying infrastructure to respond to emergencies, i.e., door-to-door ambulance services, every time someone calls. Even if they had had a fleet of ambulances in every community, they were still missing the roads, mechanics, spare parts, street names, house numbers, maps, and landlines to operate as developed nations do.

But anywhere there is a hospital, people are going to want to get there and as prehospital providers, our core function is to keep problems from getting worse. We figuratively and literally stop the bleeding, and every now and then, our efforts may pull someone from the edge. Yet, in each case our objective is to preserve life until definitive treatment or hospice is available.

This is something every community wants to do. And considering just how cost-effective BLS care is, it is something we’re convinced is possible to provide in any community in any country where someone needs emergency medical assistance and urgent transport. We work in partnership with communities that can’t afford the systems we run in communities in North American, UK and Australia. Haiti has been our most recent focus, and there we have learned that improving access to basic emergency care is much easier without the expectation of ALS, high-tech ambulances and 9-1-1 dispatch. Just answer these six questions and the most feasible solutions to your problems will become a lot clearer:

1. What types of medical emergencies does your community suffer most? Ask the people on the street, and the doctors and nurses in the clinics and hospitals, what acute problems they see most. Trauma, childbirth and diseases in the childhood cluster will likely be at the top of the list. Re-focus the care on those patients.

2. How is help alerted? When someone does need help, how do they get it? By phone, by yelling, by flagging down a passer-by? Find all the people who might be contacted and you’ll be led to the core of your workforce.

3. Who responds? Whether the system is dependent on a professional or volunteer force, or even random do-gooders, these are the people who need to be trained and coordinated—preferably via a single means of communication.

4. What do they do? Understand what happens at the scene of an emergency, who does what, how and why. There’s a whole lot of culture going on at the scene of a car accident or childbirth case, so work to understand the behaviors, attitudes and perspectives of the community members in response to medical emergencies. While BLS is certainly a major objective of training, there are a lot of other practices going on that need to be understood too.

5. How do they transport? Whether it’s an ambulance, a pick-up, a rickshaw or a donkey, if it’s being used, it’s for a reason, so multiply and coordinate these existing resources.

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