Nations around the world have an EMSS that is appropriate for their own situation. Since the various EMSS have their own pros and cons, it is hard to decide which is better. These EMSS can largely be divided into an Anglo-American model and Franco-German model, but there exist numerous different models that do not fit into these two categories.

The main characteristic of this model is that doctors are not in charge of treatment in the pre-hospital phase. Emergency medical technicians (EMT), especially paramedics, are mainly in charge of this task. Therefore, medical guidance that is directly and indirectly managed and evaluated by emergency medicine specialists is significant. This model can be found in Australia, Canada, Costa Rica, Hong Kong, New Zealand, Singapore, Taiwan, the UK, USA, etc.

In this model, doctors provide treatment in the pre-hospital phase.
Doctors participate as members in the EMSS, but in certain cases professional emergency medical technicians provide treatment at the scene under the guidance of doctors.
In France, Spain, and South America, doctors also serve as call operators (dispatchers) that connect calls from the scene to an EMSS. The difference with the Anglo-American model is that emergency medicine does not have an independent clinical and academic status in the Franco-German model. Accordingly, young doctors are not devoted to an EMSS or the emergency medical field, not to mention that it is difficult to secure sufficient and high-quality manpower. This model is found in most European and South American countries.

In Holland’s model, nurses are in charge of treatment in the pre-hospital phase.
The ambulance nurse can be compared to a nurse practitioner in the United States. They are allowed to conduct all types of treatment in the pre-hospital phase without the supervision of doctors.
In general, Holland’s model is similar to the Franco-German model in that emergency medicine is not clinically independent. This type of model can also be found in Thailand.

In the Sarajevo model, emergency centers based in a region are in charge of EMS. Besides the traditional role as a base for ambulances, they are also in charge of report registration and consultation, education on EMS, and treatment of various emergency patients. This model can be found in Eastern Europe and Asia.

The Japanese model is also based on emergency centers, but in this case, they are more of an independent ICU rather than an ER. Only very serious emergency patients can have access to an emergency center via ambulance. In this model, the ER is equipped with around 20-30 sickbeds, an operation room, ICU, cardiac examination room, etc. The point is that this model has a standardized triage standard in which patients can be transported to this kind of ER. There are around 150 emergency centers across Japan. This model can also be found in China and Russia.