Air Ambulance - VIBHA - THE FAMILY HOSPITAL MUMBAI

aircharters india aircraft charters air ambulance

Air Ambulance - Asia

Air Ambulance India.

An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot easily or quickly reach the scene or the patient needs to be repositioned at a distance where air transportation is most practical. Air ambulance crews are supplied with equipment that enables them to provide medical treatment to a critically injured or ill patient. Common equipment for air ambulances includes ventilators, medication, an ECG and monitoring unit, CPR equipment, and stretchers.

Vibha LIfesavers- affiliate of The Family Hospital - Mumbai - India.

We provide 24 hours a day, 7 days a week services of highly trained group of qualifed doctors and paramedics for emergency transfer of patients by commercial airline, chartered planes or helicopters through out the world.

Our services extend from medical escorts to commercial airline stretcher services to evacuation of critically ill patients on ventilators by chartered flights to any destination in India and abroad.

Our doctors are available 24 hours a day on our medical HOTLINE to respond to your request and propose the most suitable and economical solution for your transport.

Our Mission

To provide and assure the highest level of Emergency Medical Services in an effective, caring, and professional manner.

To demonstrate empathy and compassion to one and all.

To treat all with understanding, dignity, and respect.

To work as a team to give our best to our patients.

We promote individual, family and community well being.

We take pride in our achievements and accomplishments.

Our Motto

Care Of The Patient

Respect To Doctors

Strive For Excellence

Medical escorts

Medical Escort Services are great and economical for patients who have recovered from a serious illness and are stable and do not require critical care management on flights. Usually a qualified doctor, a trained nurse or a paramedic accompany the patient who receive basic monitoring of vital parameters, bathroom and travel assistance and administration of medications.

We take care of all formalities associated with the transport which includes:

Booking of tickets for patient and relatives; Priority boarding and seating of the patient; Ground transportation at origin and final destination and all Documentation procedures.
This service works out to be very economical for the right patient.

Air stretcher services is ideal for patients who are stable for transportation in Commercial Airline and eligible for our economical Air stretcher services.

Commercial Airline Stretcher transfer

Air stretcher services includes: Obtaining clearance from airline medical department; Co ordinating ground transportation at the origin and the final destination; Arranging for lifesaving medication, oxygen and emergency lifesaving equipments which include cardiac monitors, pulseoximeters, pacemakers, nebulisers and ventilators.
The patient is accompanied by an intensive care doctor and trained nurse and necessary medical management is done throughout the transport process.

Air Medical Charters

This services are for the critically ill who do not qualify for the above services. We have our own set of Transport airplanes which are safe and ideal for transportation of critical patients to any destination in India and abroad.

The equipments includes all lifesaving apparatus including cardiac monitor, pulseoximeter, multi parameter monitors, pacemakers, ventilators, nebulisers, defibmonitors, suction machines which are suitable for air transport.

The doctors are qualified and experienced to carry out air evacuation operation and selected carefully depending on the requirement of the patients. The doctors are intensive care and emergency physicians, anesthesiologists, pediatricians, cardiologists, neurologists, registered nurses who have minimum 5 years experience in the field of emergency medicine. They are capable of carrying out all lifesaving emergency medical procedures and international in flight repatriation.

The doctors have the working experience in most of the hospitals in India , UK and USA and well tuned to the working of the hospital procedures and management of patients in their medical system.

Most of the doctors have their visa status eligible to transport patients in most of countries of the world including Asian, European, American, Australian countries.

Event Medical Cover

We provide medical cover for major events like party meetings, company seminars, cultural and sport events, official receptions and large marriages, stunt shootings and major entertainment shows.

Medical cover is in the form of standby well equipped ambulances, team of doctors and paramedics and essential medications. We also install medical cubicles and stalls to look after the common needs of people who attend to these events. Emergency evacuation of serious patients to the nearest medical center including admission formalities can be arranged.

VIP Medical Escorts

This is an exclusive medical security service for your prominent guests and VIPs traveling anywhere in India and abroad.

This service is essential from the view of fatigue, stress associated with travel, jetlag, business stress, individual medical problem both acute and chronic.

This services are important during travel in countries with poor medical infrastructure.

Ground Ambulance

We Provide Ground Ambulances to cater to the needs of all patients.

Simple transport ambulances
Air conditioned ambulances Ambulances with nurse & oxygen
ICU mobile ambulances with all Lifesaving Equipments.
Team of intensivist/trained nurses/paramedics to handle any medical & surgical emergencies during transport.

ICU on wheels: Well equipped ICU mobile ambulances for fast & efficient transportation in & outside Mumbai.

All Lifesaving Equipments including: Cardiac monitors, pulseoximeters, multi parameter monitors, defibmonitors, ventilators, suction machine, nebulisers, pacemakers, bipap, oxygen and emergency medicines.

Our clients includes
Tertiary Care Hospitals. Private Medical Organisations. Indian & Foreign Insurance Companies. Multinational / Corporates. Adventure Tourism Industry. Various Travel Agencies Operating Globally. Individual. Embassies

Allied Services offered by Vibha Lifesavers
Medical management of disaster situations:

Natural (Earthquake, Floods, Cyclones etc.)

Man made (Bombings, Riots & other adverse situation.)

Medical & Logistics management at Sporting events, rally’s conference meeting etc.

First Aid, CPR and trauma management training

Medical site surveys

Remote site medical cover

Provide medical referrals

Assistance to organ transplant patients

Repatriation of mortal remains-RMR

Emergency call +91 9821150889.

Get in touch with us!

Message from the Medical Director

Dr Nitin Yende MD BLS ACLS Provider and Instructor (AHA)

I wish to thank all the doctors who appreciated our services and for their feedback and support which has gone a long way to our success!

When the ambulance team comes back having accomplished a successful transport, the look of the faces tells me the story of a mission accomplished - a life saved. The faces beaming with happiness when a critical patient had reached the destination; from an ill equipped center to a tertiary care center for a lifesaving procedure.

The best part of this service is the positive feedback we receive from the patient himself when he walks in to the center just to say thanks to our service- that is the time when we feel all our hard efforts is worthwhile in spite of all the odds and hardships.

I had always emphasized on 3 basic principles; care of our patients, respect to all doctors and strive for excellence.

Our mission is to provide and assure the highest level of emergency medical services in an effective caring and professional manner; to demonstrate empathy and compassion to one and all, to treat all with understanding, dignity and respect; to work as a team to give our best to the patient.

We promote individual, family and community well-being and we take pride in our achievements and accomplishments and look forward to the many challenges of the future.

Dr Nitin Yende MD Vibha Lifesavers- Air Ambulance

Contact us

VIBHA LIFESAVERS

HI FLYING AVIATION, A 101, MANGAL ARAMBH, KORA KENDRA, BORIVLI WEST, MUMBAI 400092, INDIA.
EMERGENCY TEL NO - +91 98211 50889 .
TELEFAX NOS 24/7-
+91222 8999991/ +91 222 8333331 .

USA CONTACT-
756, FAIRVIEW ROAD, FOXCHAPEL, PITTSBURGH , PA 15236, USA.

EMAIL - nitin@hiflyingllc.com
www.flyingairambulance.com

VIBHA LIFESAVERS - HI FLYING LLC CAN BE CONTACTED 24/7/365-
via phone, fax, email or post. If you are contacting for medical service, please have the following information available:

Patient: name, date of birth, permanent address
Patient's current location: address, name of hospital or clinic, phone/fax numbers
Contact Person: name, address and phone/fax numbers, relation
Information about patient's medical condition: status, illness or injury, cause of current condition
Treating Physician: name, address, language(s) spoken, phone/fax numbers
Insurance Company: contact name, address, phone/fax numbers, language(s) spoken, policy number.

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The Golden Hour concept- Emergency care

In emergency medicine, the golden hour is the first sixty minutes after the occurrence of multi-system trauma. It is widely believed that the victim's chances of survival are greatest if they receive definitive care in the operating room within the first hour after a severe injury. Recent scrutiny has questioned the validity of the “golden hour” as a rigidly defined timeframe, although its core principle of rapid intervention in trauma cases remains universally accepted.

In cases of severe trauma, especially internal bleeding, nothing can replace surgery. Complications such as shock may occur if the patient is not managed appropriately and expeditiously. It is therefore necessary to transport victims as fast as possible to specialists who are most often found at a hospital trauma center. Because some injuries can cause a trauma victim to decompensate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum; over time, this lag time was further clarified to a now-standard time frame of no more than 60 minutes, after which time the survival rate for traumatic patients is alleged to fall off dramatically.

While the golden hour is a trauma treatment concept, two emergency medical conditions have well-documented time-critical treatment considerations: stroke and myocardial infarction (heart attack). In the case of stroke, there is a window of three hours within which the benefit of clot-busting drugs outweighs the risk of major bleeding. In the case of a heart attack, rapid stabilization of fatal arrhythmias can prevent sudden cardiac death. In addition, there is a direct relationship between time-to-treatment and the success of reperfusion (restoration of blood flow to the heart), including a time dependent reduction in the mortality and morbidity.

EMS concept-Air Ambulance

Emergency medical services (abbreviated to the initialism "EMS" in many countries) are a branch of Emergency services dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the First responder, believes constitutes a medical emergency.

Emergency medical services may also be locally known as: First aid squad, Emergency squad,Rescue squad, Ambulance squad,Ambulance service, Ambulance corps or Life squad.

The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the malady, or arranging for timely removal of the patient to the next point of definitive care. This is most likely an emergency department at a hospital or another place where physicians are available. In some developing regions, the emergency medical service does not provide treatment to the patients, but only the provision of transport to the point of care.

In most places in the world, the EMS is summoned by members of the public (or other emergency services, businesses or authority) via an emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource to deal with the situation.

EMS also encompass services developed to move patients from one medical facility to an alternative which usually includes transferring the patient to a higher level of care. These specilized hospitals that provide higher level of care included services such as neonatal intensive care (NICU) state regional burn centers specilized care for spinal injury and/or neurosurgeryregional stroke centers specialized cardiac care (cardiac catherization, and specialized/regional trauma care.

In some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue. Training and qualification levels for members and employees of emergency medical services varies widely throughout the world. EMS in many systems provide members that are qualified to to drive only with no medical training. In contrast, most systems have personnel that retain, at a minimum, a basic first aid certificate (Basic Life Support (BLS)), additionally most EMS systems are staffed with Advanced Life Support (ALS) personnel including fully qualified paramedics, nurses, or, less commonly, physicians.

EMS theme- Air Ambulance

Emergency medical services exists to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery.

This common theme in medicine is demonstrated by the star of life. The Star of Life where each of the 'arms' to the star represent one of the 6 points. These 6 points are used to represent the six stages of high quality pre-hospital care, which are

Early Detection- Members of the public, or another agency, find the incident and understand the problem

Early Reporting The first persons on scene make a call to the emergency medical services and provide details to enable a response to be mounted.

Early Response - The first professional (EMS) rescuers arrive on scene as quickly as possible, enabling care to begin

Good On Scene Care - The emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident

Care in Transit- the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey

Transfer to Definitive Care- the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, in to the care of physicians

EMS - Levels of Care - Air Ambulance

Emergency Medical Service is provided by a variety of individuals, using a variety of methods. To some extent, these will be determined by country and locale, with each individual country having its own 'approach' to how EMS should be provided, and by whom. In some parts of Europe, for example, legislation insists that efforts at providing advanced life support (ALS) services must be physician-led, while other permit some elements of that skill set to specially trained nurses, but have no paramedics. Elsewhere, as in North America, the U.K., and Australia, ALS services are performed by paramedics, but rarely with the type of direct "hands-on" physician leadership seen in Europe. Increasingly, particularly in the U.K. and in South Africa, the role is being provided by specially-trained paramedics who are independent practitioners in their own right. Beyond the national model of care, the type Emergency Medical Service will be determined by local jurisdictions and medical authorities, based upon the needs of the community, and the economic resources to support it.

Generally speaking, the levels of service available will fall into one of three categories; Basic Life Support (BLS), Advanced Life Support (ALS), and care by traditional healthcare professionals, meaning nurses and/or physicians working in the pre-hospital setting, and even on ambulances. In some jurisdictions, a fourth level, Intermediate Life Support (ILS), which is essentially a BLS provider with a moderately expanded skill set, may be present, but this level rarely functions independently, and where it is present may replace BLS in the emergency part of the service. When this occurs, any remaining staff at the BLS level is usually relegated to the non-emergency transportation function. Job titles typically include Emergency Medical Technician, Ambulance Technician, or Paramedic. While these job titles are protected by legislation in some countries, this protection is by no means universal, and anyone might, for example, call themselves an 'EMT' or a 'paramedic', regardless of their training, or the lack of it. In some jurisdictions, both technicians and paramedics may be further defined by the environment in which they operate, including such designations as 'Wilderness', 'Tactical', and so on.

Basic LIfe Support - BLS- Air Ambulance

First Responder A first responder person who arrives first at the scene of an incident, and whose job is to provide early critical care such as CPR or using an AED.First responders may be dispatched by the ambulance service, may be passers-by, citizen volunteers, or may be members of other agencies such as the police, fire department, or search and rescue.

Ambulance Driver Some jurisdictions separate the 'driver' and 'attendant' functions, employing ambulance driving staff with no medical qualification (or just a first aid certificate), whose job is to drive the ambulance. While this approach persists in some countries, such as Italy and India, it is generally becoming increasingly rare. Ambulance drivers may be trained in radio communications, ambulance operations and emergency response driving skills.

Ambulance Care Assistant (ACA) Ambulance Care Assistants have varying levels of training across the world. In many countries, such staff are usually only required to perform patient transport duties (which can include stretcher or wheelchair cases), rather than acute care. However, there remain both countries and individual jurisdictions in which economics will not support ALS service, and the efforts of such individuals may represent the only EMS available. Dependent on the provider (and resources available), they may be trained in first aid or extended skills such as use of an AED, oxygen therapy and other live-saving or palliative skills. In some services, they may also provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic.

EMT's loading a patient
Emergency Medical Technician (EMT) Emergency medical technicians, also known as Ambulance Technicians in the UK and EMT in the United States. Now known as Primary Care Paramedics in parts of Canada. Technicians are usually able to perform a wide range of emergency care skills, such as defibrillation, care of spinal injuries and oxygen therapy. In some jurisdictions, some EMTs are able to perform duties as IV and IO cannulation, administration of a limited number of drugs, more advanced airway procedures, CPAP, Analgesic Administration, and limited cardiac monitoring and manual defibrillator capabilities.Most advanced procedures and skills are not within the national scope of practice for an EMT-B. As such most states require additional training and certifications to perform above the national curriculum standards.

Advance Life Support - ALS- Air Ambulance

Paramedic (EMT-P) A paramedic has a high level of prehospital medical training and usually involves key skills not performed by technicians, often including cannulation (and with it the ability to use a range of drugs such as morphine), cardiac monitoring, intubation and other skills such as performing a cricothyrotomy.In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecution.In the United States, paramedics represent the highest licensure level of prehospital emergency care. In addition, several certifications exist for Paramedics such as Wilderness ALS CareFlight Paramedic Certification (FP-C),and Critical Care EMT-Paramedic

Critical Care Paramedic (CCEMTP) CCEMTP's in the United States A critical care paramedic, also called an advanced practice Paramedic in some US States, represents a higher level of licensure above that of the DOT and NREMT-Paramedic curriculum.These Paramedics receive at least six months of additional training beyond normal EMS medicine in a Critical Care Emergency Medical Transport Program, including critical care use of devices and life support systems normally restricted to the ICU or critical care hospital setting, placement and use of UVCs, UACs, surgical airways, Rapid Sequence Intubation (RSI) intubation, blood administration, and chest tube insertion. The Critical Care Transport role exists in the U.S., and also in a number of other countries (including Canada). The training, permitted skills, and certification requirements vary from one jurisdiction to the next.

Paramedic Practitioner or Emergency Care Practitioner In the United Kingdom and South Africa, some serving paramedics receive additional univeristy education to become practitioners in their own right, which gives them absolute responsibility for their clinical judgement, including the ability to autonomously prescribe medications, including drugs usually reserved for doctors, such as courses of antibiotics. An emergency care practitioner is a position sometimes referred to as a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are university graduates in Emergency Medical Care or qualified paramedics who have undergone further training and are authorized to perform specialized techniques. Additionally some may prescribe medicines (from a limited list) for longer term care, such as antibiotics. With respect to a Primary Health Care setting, they are also educated in a range of Diagnostic techniques

Regitered Nurse - RN - Air Ambulance

Registered Nurse (RN) The use of registered nurses in the pre-hospital setting is more common in countries that have a limited EMS infastructure in place. Some European countries such as France or Italy, which do not use paramedics as we understand them, also use nurses as a means of providing ALS services. These nurses may work under the direct supervision of a physician, or, in rarer cases, independently. In some places in Europe, notably Norway, paramedics do exist, but the role of the 'ambulance nurse' continues to be developed as it is felt that nurses may bring unique skills to some situations encountered by ambulance crews. In North America, and to a lesser extent elsewhere in the English-speaking world, some jurisdictions use specially trained nurses for medical transport work. These are mostly air-medical personnel or critical care transport providers, often working in conjunction with a technician or paramedic or physician on emergency interfacility transports. In the United States, the most common uses of ambulance-based Registered nurses is in the Critical Care/Mobile Intensive Care transport, and in Aeromedical EMS. Such nurses are normally required by their employers (in the US) to seek additional certifications beyond basic nursing registration .

Medical Doctor - MD- Air Ambulance

There are many places in Europe, most notably in France, Italy, and the German-speaking countries (Germany, Switzerland, Austria) where the model of EMS is different, and physicians take a more direct, 'hands-on' approach to pre-hospital care. In France and Italy, response to high-acuity emergency calls is physician-led, as with the French SMUR teams. Paramedics do not exist within those systems, and most ALS is performed by physicians. In the German-speaking countries, paramedics DO exist, but special physicians (called Notarzt) respond directly to high-acuity calls, supervising the paramedics ALS procedures directly. Indeed, in these countries paramedics are not typically legally permitted to practice their ALS procedures unless the physician is physically present, except in immediately life-threatening emergencies. Some systems - most notably air ambulances in the U.K. will employ physicians to take the clinical lead in the ambulance; bringing a full range of additional skills such as use of medications that are beyond the paramedic skill set. The response of physicians to emergency calls is routine in many parts of Europe, and not uncommon in the U.K.

This 'hands-on' approach is less common in the United States. While one will occasionally see a physician with an ambulance crew on an emergency call, this is much more likely to be the Medical Director or and associate, precepting newly trained paramedics, or performing routine medical quality assurance. In some jurisdictions adult or pediatric critical care transports sometimes use physicians, but generally only when it appears likely that the patient may require surgical or advanced pharmacologic intervention beyond the skills of an EMT, paramedic or nurse during transport. Physicians are leaders of medical retrieval teams in many western countries, where they may assist with the transport of a critically ill, injured, or special needs patient to a tertiary care hospital, particularly when longer transport times are invo

Prehospital care - concept Air Ambulance

Depending on country, area within in country, or clinical need, emergency medical services may be provided by one or more different types of organisation. This variation may lead to large differences in levels of care and expected scope of practice.

The most basic emergency medical services are provided as a transport operation only, simply to take patients from their location to the nearest medical treatment. This was often the case in a historical context, and is still true in the developing world, where operators as diverse as taxi drivers and undertakers may operate this service.

Most developed countries now provide a government funded emergency medical service, which can be run on a national level, as is the case in the United Kingdom, where a national network of ambulance trusts operate an emergency service, paid for through central taxation, and available to anyone in need,or can be run on a more regional model, as is the case in the United States, where individual authorities have the responsibility for providing these services.

Typical scene at a local emergency room Ambulance services can be stand alone organisations, but in some cases, the emergency medical service is operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. This can lead, in some instances, to an illness or injury being attended by a vehicle other than an ambulance, such as fire truck. In some locales, firefighters are the first responders to calls for emergency medical aid, with separate ambulance services providing transportation to hospitals when necessary.

Some charities or non-profit companies also operate emergency medical services, often alongside a patient transport function.These often focus on providing ambulances for the community, or for cover at private events, such as sports matches. The Red Cross provides this service in many countries across the world on a volunteer basis (and in others as a Private Ambulance Service), as do some other smaller organizations such as St John Ambulance ] and the Order of Malta Ambulance Corps. In some countries, these volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency, or simply to help cover busy periods

There are also private ambulance companies, with paid employees, but often on contract to the local or national government. Many private companies provide only the patient transport elements of ambulance care (i.e. non urgent), although in some places these private services are contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy or to respond to non-emergency home calls.Private companies are often contracted by private clients to provide event specific cover, as is the case with voluntary EMS crews

Medical Transport -Delivery system - Air Ambulance

The essential decision in prehospital care is whether the patient should be immediately taken to the hospital, or advanced care resources are taken to the patient where they lie. The "scoop and run" approach is exemplified by the MEDEVAC aeromedical evacuation helicopter, where the "stay and play" is exemplified by the French SMUR emergency mobile resuscitation unit.

The strategy developed for prehospital trauma care in North America is based on the Golden Hour theory, i.e., that a trauma victim's best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This appears to be true in cases of internal bleeding, especially penetrating trauma such as gunshot or stab wounds. Thus, minimal time is spent providing prehospital care ("ABCs", i.e. ensure airway, breathing and circulation; external bleeding control; spine immobilization; endotracheal intubation) and the victim is transported as fast as possible to a trauma center.

The aim in "Scoop and Run" treatment is generally to transport the patient within ten minutes of arrival, hence the birth of the phrase, "the platinum ten minutes" (in addition to the "golden hour"), now commonly used in EMT training programs. The "Scoop and Run" is a method developed to deal with trauma, rather than strictly medical situations (e.g. cardiac or respiratory emergencies), however, this may be changing. Increasingly, research into the management of S-T segment elevation myocardial infarctions (STEMI) occurring outside of the hospital, or even inside community hospitals without their own PCI labs, suggests that time to treatment is a clinically significant factor in heart attacks, and that trauma patients may not be the only patients for whom 'load and go' is clinically appropriate. In such conditions, the gold standard is the door to balloon time. The longer the time interval, the greater the damage to the myocardium, and the poorer the long-term prognosis for the patient Current research in Canada has suggested that door to balloon times are significantly lower when appropriate patients are identified by paramedics in the field, instead of the emergency room, and then transported directly to a waiting PCI lab. In a related program in Toronto, EMS has begun to use a procedure of 'rescuing' STEMI patients from the Emergency Rooms of hospitals without PCI labs, and transporting them, on an emergency basis, to waiting PCI labs in other hospitals

EMS Setup- Worldwide - Air Ambulance

a variety of differing philosophical approaches are used in the provision of EMS care around the world, they can generally be placed into one of two categories; one physician-led and the other paramedic-led with accompanying physician oversight. These models are typically identified by their locations of origin.The Franco-German model is physician-led, with doctors responding directly to all major emergencies requiring more than simple first aid. In some cases in this model, such as France, paramedics, as we understand them, do not exist at all. The term 'paramedic' is used generically in France, and those with that designation have training that is similar to an U.S. EMT-B. The team's physicians and in some cases, nurses, provide all medical interventions for the patient, and non-medical members of the team simply provide the driving and heavy lifting services. In other applications of this model, as in Germany, a paramedic equivalent does exist, but is sharply restricted in terms of scope of practice; often not permitted to perform Advanced Life Support (ALS) procedures unless the physician is physically present, except in cases of immediate life-threat. Ambulances in this model tend to be better equipped with more advanced medical devices, in essence, bringing the emergency department to the patient. High-speed transport to hospitals is considered, in most cases, to be unnecessarily unsafe, and the preference is to remain and provide definitive care to the patient until they are medically stable, and then accomplish transport. In this model, the physician and nurse may actually staff an ambulance along with a driver, or may staff a rapid response vehicle instead of an ambulance, providing medical support to multiple ambulances. The second model, the Anglo-American model, utilizes trained technicians, usually referred to as paramedics, to staff ambulances, which may be classified according to the varying skill levels of the crews. In this model it is rare to find a physician actually working in the pre-hospital setting. More typically, they provide medical oversight for the work of emergency medical technicians and paramedics, which may be accomplished in terms of off-line medical control, with protocols or 'standing orders' for certain types of medical procedures or care, or on-line medical control, in which the technician must establish contact with the physician, usually at the hospital, and receive direct orders for various types of medical interventions. Patients may be treated at the scene up to the level of the technician's skill set, and then transported to hospital, but in many cases, the limited skill set of the technician and the needs of the patient will result in the rapid and timely transport of the patient to a hospital, at which point definitive care will begin. As a new development in the Anglo-American model, some paramedics in some jurisdictions (U.K., South Africa, Australia) are evolving beyond the level of technician, and being permitted to provide more definitive primary care to patients, often including suturing, detailed assessment, in some cases limited authority to prescribe medications (usually from a limited list), and to function as independent practitioners in their own right.

Paramedics normally function under the authority (medical direction) of one or more physicians charged with legally establishing the emergency medical directives for a particular region. Paramedics are credentialed and authorized by these physicians to use their own clinical judgment and diagnostic tools to identify medical emergencies and to administer the appropriate treatment, including drugs that would normally require a physician order. Credentialing may occur as the result of a State Medical Board examination (U.S.) or the National Registry of Emergency Medical Technicians (U.S.). In England, and in some parts of Canada, credentialing may occur by means of a College of Paramedicine In these cases, paramedics are regarded as a self-regulating health profession. The final common method of credentialing is through certification by a Medical Director and permission to practice as an extension of the Medical Director's license to practice medicine. The authority to practice in this semi-autonomous manner is granted in the form of standing order protocols (off-line medical control) and in some cases direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with independent clinical decision-making authority that is typically enjoyed only by expert clinicians within the hospital setting. In some parts of Europe, most notably in Germany, those in the paramedic role are only permitted to practise many of their advanced skills while assisting a physician who is physically present, except in cases of immediately life-threatening emergencies. In other parts of Europe, most notably in France, all ALS skills in the pre-hospital setting are performed by physicians and nurses, and the role of paramedic is unknown. In certain other jurisdictions, such as the United Kingdom and South Africa, paramedics may be entirely autonomous practitioners capable of prescribing medications

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