Emergency Medical Services (EMS) agencies are a microcosm of medicine throughout the world. Although there is some variation in the details, EMS units in all industrialized countries are much the same as in the United States. The main variation is the nature of the staff providing care – i.e., some systems provide advanced care using responders such as paramedics, while others have physicians who respond to the scene of an accident or incident.
All of these systems more or less work, but are still the outgrowth of the social and political environment from which they were developed. None are perfect and all have room for improvement. However, the level of service provided and the model used to provide it mesh with the needs, resources, and political will of the community.
EMS in what used to be called “The Third World” – underdeveloped nations, in other words – is another matter entirely. Many third-world nations can afford little in the way of EMS resources and some have almost none. In order to be effective in those nations, EMS units must fulfill a variety of functions for the community, and are therefore often interwoven with units or agencies providing other significant needs. Largely for that reason, the solutions must also be similarly interconnected, requiring support by other political and/or economic structures both inside and outside the community. Among the functions of a viable EMS agency are training the public, recruiting and developing staff, and maintaining a viable funding base.
OSJ: A Proper and Orderly Sense of Priorities
There are a number of international EMS agencies; one of the most remarkable and best known of them is supported by the Order of Saint John (OSJ), an outgrowth of a chivalric order of Knights Hospitaller that has been operating ambulance services in emergency situations for over 120 years. Today, OSJ is actively providing EMS care in 17 countries, both industrialized and non-industrialized.
OSJ is a nonprofit organization. One of the order’s criteria for expansion into a new area is that the organization in that area must be self-sustaining. As with many other nonprofit NGOs (nongovernmental organizations), the OSJ receives part of its funding and other support needed through private donations and the use of volunteer staff.
The OSJ provides a variety of training programs available to the public. Among them are those traditionally associated with EMS such as first aid, CPR (cardiopulmonary resuscitation), and AED (automated external defibrillation). Other programs reflect more recent health problems, medical advances, and personalized approaches: the prevention of acquired immune deficiency syndrome (AIDS), for example; caring for the sick at home; an emphasis on personal and group hygiene; and anti-drug abuse programs.
The OSJ also offers an active youth training program through which the organization recruits volunteer members and develops them into effective EMS providers. Such programs vary from country to country, of course, but all (or almost all) focus on training young people in first aid as well as preparing them both for service within the OSJ and for life as an adult.
One of the several ways OSJ works in the communities where medical care is unavailable is to provide first-aid posts and clinics as well as other facilities that provide primary care directly to the community. In a number of countries, the OSJ also maintains and operates mobile clinical vehicles both for general medical purposes as well as for more specialized services.
To briefly summarize: The OSJ is a remarkable, and remarkably charitable, medical organization that provides primary care, EMS, preventive care, and other community-based health programs as an integrated whole, based on the needs of the communities the organization is serving. The OSJ’s model is based on building a self-sustaining organization both financially and by recruiting young members within the community.
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.