RESUMO
Two decades of experience with out-of-hospital delivery of Emergency Health Care will be examined with particular reference to the development in North America, of Emergency Medicine as a clinical specialty. The influence of this experience on pre-hospital Emergency Care in the Province of Ontario, Canada, will be discussed. References will be made to the roles played by such organizations as the St. John Ambulance Association, Canadian Heart Foundation, and the Canadian Association of Emergency Physicians. Pilot programmes instituted in the cities of Hamilton and Toronto for the training of paramedics will be described. The place of the Paramedic in the Emergency Medical System, as envisioned and as realised, will be discussed. Difficulties of assessing efficacy and efficiency of current paramedic performance, and constraints of economics on health care programmes will be shown to have bearing on future methods of pre-hospital care delivery. These, as well as geographical factors, necessitate modifications for Emergency Medical Care across the province, and some of these modifications will be discussed (AU)
