The complexity of comparing different EMS systems--a survey of EMS systems in Europe

In Europe, emergency medical care has developed since the Middle Ages in each country, even within regions of a country, resulting in a patchwork of definitions, legislations, and systems. As a consequence, emergency medical care was implemented differently according to sociocultural, geographic, political, and religious differences between and within individual European countries. The objective of this survey was to describe the emergency medical services (EMS) systems in place throughout Europe, the type and qualification of the personnel, citizen-CPR knowledge, and experiences with automated external defibrillator programs. In many European countries, the active involvement in the field of physicians, as members of the first or the second tier, was observed as a major difference between European and US EMS systems. To evaluate and to compare performance of emergency medical care in different communities, detailed knowledge of all elements of the "cardiac arrest-resuscitation complex" is required: the demographics of the community served by the EMS system, the structure and characteristics of each individual system, the epidemiology of cardiac arrest, the intervention process, and the outcome. To describe the EMS system, a uniform nomenclature is required. The Utstein "template" style could be proposed as the guideline to describe individual systems. The European Resuscitation Council could contribute in coordinating and standardizing the various aspects of emergency medical care in Europe, with detailed registration, medical coordination, and medical regulation being the principal working rules.