The paramedic-based prehospital emergency care system, commonly referred to as the “Anglo-American System” (AAS), puts physician extenders in charge of the out-of-hospital emergency care. Around the same time as Europe, the United States implemented a nationwide prehospital emergency care system in the 70’s based on a totally different approach than the physician-based FGS. The approach was somewhat different in the United States because of the physician shortage of the 1960’s where physician-led units were replaced by paramedic-led units. It was assumed that paramedics could be trained to stabilize patients and transport them to a hospital. Another reason for simply using paramedical staff and not higher qualified physicians was mainly based on the financial thought that doctors are more expensive to educate and employ than non-academical staff. Although paramedics are not as educated as EPs, they are equipped with a wide range of treatment options (“scope of practice”). A paramedic’s education in the U.S. is highly sophisticated; after first receiving their “high school diploma” and after becoming a certified Emergency Medical Technician (EMT), a paramedic student is required to participate in ambulance calls for at least 3 years before being able to begin their 2,150 hour (9 month) internship of paramedic education at a University. A practicing paramedic delivers definitive patient care in the prehospital setting before and during transport to the ER using mainly treatment algorithms defined by medical advisors. To guarantee individual patient treatment in more severe cases, an EP at the ER where the patient is being brought is contacted via phone to validate the prehospital therapy. Patients with less severe diseases are mostly treated and transported by first-responder units (FRU) or EMTs. First responders and EMTs are often fire-fighters and paramedic students with an additional 120 hour education in basic life-support. Medical care by a physician begins as soon as the patient reaches the hospital’s ER. Almost every patient is immediately brought to an ER, and then after triage sent to a specialist for the continued treatment. That’s why ERs in countries with the AAS are usually well-equipped with modern technology, as well as physicians and nurses. In the AAS, emergency medicine is officially recognized under the control of EPs. Countries or regions with this type of emergency system in place are shown in red in the world map (see Videoconference Based Emergency Medicine).
