There is a version of international EMS capacity-building that looks impressive on paper and leaves little behind. A team arrives, delivers training, departs. The certificate photo is taken. The report is filed.

That is not what we are doing in Mongolia.

After many missions since 2017, what distinguishes EMS Global Foundation’s programme in Ulaanbaatar is not the curriculum, though the curriculum matters. It is the architecture underneath it: the institutional relationships with the Ministry of Health and the 103 Ambulance Directorate, the Mongolian doctors who now co-teach, and the trust that has been built across years of return visits.

The image above captures three things that all have to be present for this to work.

The partnership is the foundation - the formal meetings with leadership, the planning, the accountability frameworks. Without that, there is no programme.

The delivery is the point - instructors and Mongolian clinicians working through trauma assessment, airway management, resuscitation, and scene command in environments that reflect what these providers will actually face.

But the relationship is what makes it last.

Outside Ulaanbaatar, near Bornuur, the team spent an evening around a campfire with Mongolian EMS colleagues - leadership, clinicians, instructors from three countries - away from the packed programme schedule. The UB Ambulance Service brought their station cooks out to Bornuur. Inside the ger, the meal was prepared, smoke rising through the roof ring, everyone crowded around - Mongolian colleagues and international faculty together, watching it come together. No restaurant could have staged it. This was the ambulance service saying: this is who we are, and we want you to know it.

There was food and conversation that had nothing to do with intubation or scene management. That is not time away from the mission. It is part of it.

Since 2017, relationships keep deepening. That is the only way this works.

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What we’re seeing now, two years in, is that the relationship itself has become an asset. Participants aren’t just better at the clinical skills - they know each other. They’ve worked through high-pressure scenarios together. When they meet on scene, that history matters.

70% of the UB City Ambulance workforce has now completed training through this programme. We’re on track for full coverage by 2027.

This is the kind of progress that doesn’t make headlines, but it’s exactly what sustainable emergency system strengthening looks like. Not a single intervention, not a one-off training day, but a programme that returns, builds relationships, and leaves something behind that lasts beyond our time on the ground.

We’ll have more to share from the 2025 mission in the weeks ahead.

We’re proud to introduce Dolly McPherson (UK), our newly appointed Director of Education at EMS Global Foundation.

With more than a decade of paramedic experience across frontline, critical care, and advanced clinical practice and a PhD focused on measuring quality in bystander CPR, Dolly brings exactly the kind of evidence-based leadership global EMS education needs.

Her focus is clear: building strong educators, delivering context-appropriate training, and using education as a lever to improve patient outcomes in resource-constrained settings.

Welcome to the leadership team, Dolly.

Key takeaway: Systemic reform in prehospital care depends less on importing high-income technology and more on bridging the data infrastructure gap while empowering a local, sustainable workforce of first contact healthcare providers.

For systems researchers, the significance lies not just in the doubling of provider confidence but in the creation of a sustainable, regionalised infrastructure of 26 provisional trainers. This shift reduces reliance on expensive, "copy-paste" international missions and empowers local health systems to manage acute conditions such as trauma, sepsis, and obstetric emergencies at the first point of contact. Ultimately, these findings provide the evidence-oriented roadmap necessary to move beyond fragmented care toward a politically realistic and resilient prehospital framework.

• Above: Algerian Civil Protection (Protection Civile) ambulance.

The study examined training across Cameroon, Djibouti, Haiti, Morocco, and Tunisia. The initiative successfully targeted first-contact healthcare workers, including physicians and nurses.

Knowledge Gains: Median pre-test scores of 70% rose significantly to 88% upon completion (p<0.001).

Confidence Surge: Participant self-confidence in executing essential emergency skills increased from 34% to 85%.

Systems Impact: The session produced 26 provisional trainers and one Master Trainer to support regional expansion.

Practitioners’ Feedback: While the course was universally acclaimed, 30% of participants identified a need for more time dedicated to practical skills components.

Go to: Nteungue Kouomogne, B. A., Tania, B. L., Ndongo, C. B., Noulala, A. C., Ntembwa, H. K., Kariyo, P. C., ... & Wallis, L. (2025). Improving emergency care capacity with the WHO-ICRC Basic Emergency Care (BEC) course. African Journal of Emergency Medicine, 15(100892), 1-5. https://doi.org/10.1016/j.afjem.2025.100892

A pair of systematic studies from Maastricht University provides the most comprehensive evaluation to date of Artificial Intelligence’s role in LMIC emergency medical services (EMS). While AI holds significant potential for dispatch optimisation and disease prediction, particularly in middle-income settings like China, major barriers persist.

A qualitative study identified five core obstacles to adoption:

• Data quality: Inconsistent or non-existent digital records.

• Resource gaps: Lack of hardware and stable connectivity.

• Human-centred design: Systems that do not account for local provider workflows.

• Cultural relevance: Algorithmic biases that ignore local context.

• Evolutionary speed: AI technology outpacing the legislative and regulatory capacity of low-income nations.

The Takeaway: Closing the data infrastructure gap is the essential precondition for AI utility in these regions.

Go to: Mallon, O., Lippert, F., Stassen, W., Ong, M. E. H., Dolkart, C., Krafft, T., & Pilot, E. (2025). Utilising artificial intelligence in prehospital emergency care systems in low- and middle-income countries: A scoping review. Frontiers in Public Health, 13, 1604231. https://doi.org/10.3389/fpubh.2025.1604231

Go to: Mallon, O., Lippert, F., & Pilot, E. (2025). Artificial intelligence in prehospital emergency care systems in low- and middle-income countries: Cure or curiosity? Insights from a qualitative study. Frontiers in Public Health, 13, 1632029. https://doi.org/10.3389/fpubh.2025.1632029

Across 15 nations - and growing - we’ve seen a consistent truth: without strong EMS, the human and financial toll of amenable mortality is devastating. In Mongolia alone, more than 200 people per 100,000 die each year from causes that effective EMS could prevent. That translates into an annual economic loss of 7–9% of GDP. Numbers like these change the conversation from “humanitarian aid” to economic necessity .

What we’ve learned so far

• Reform must be system-wide. Romania shows that expanding ambulance fleets isn’t enough without stronger emergency departments and hospitals.

• Financing models matter. Countries relying on out-of-pocket payments, like parts of Uzbekistan and Ghana, lag in sustainability compared to tax-based or insurance systems.

• Urban–rural gaps persist. Even with national coverage, remote areas remain at higher risk without hub-and-spoke networks or aeromedical services.

• Digital tools save lives. Estonia’s integration of EMS with health records demonstrates how data improves accountability and outcomes .

Why it matters now

EMS reform is not charity work. It is nation-building. It protects families, stabilises economies, and strengthens resilience in the face of disasters.

We’ve brought this message to governments, ministries, and global health funders -but we want to bring it to you, too. Because the future of emergency care depends on collective understanding that EMS is the backbone of health security.

That’s the gap EMS Global is stepping into. In Mongolia, our teams are working alongside government, universities, and frontline clinicians to build a system that not only saves lives but also prevents avoidable deaths from overwhelming hospitals. The numbers are stark: ambulance coverage in Ulaanbaatar exceeds some international benchmarks, but high call volumes and limited triage mean physicians are pulled into non-emergency cases. Rural provinces face even greater strain, with some of the highest amenable mortality rates in the country.

The lesson from elsewhere is clear. In Monterrey, Mexico, a modest 16% increase in budget for basic EMS reduced trauma mortality from 10% to 7% . In Guatemala, training firefighters in prehospital care improved survival and response efficiency . These aren’t luxury interventions - they’re cost-effective, proven, and adaptable to Mongolia’s unique challenges.

Every training session we deliver in Ulaanbaatar, every push for rural coverage, is about shifting the balance: from treatable loss to survivable outcomes, from under-resourced systems to sustainable models.

Above: Prof. Kelly-Ann Bowles and Clinical Resource Learning Coordinator Carlos Garcia Gonzalez with some of the donated training equipment.

More Than Just Equipment

The donation includes crucial simulation training equipment that will directly support educational delivery in Mongolia's capital. But this isn't just about sending gear overseas - it's about building sustainable capacity in communities that need it most.

Behind the boxes of equipment lies a bigger story: Senior Lecturer Leon Baranowski is preparing to depart for Mongolia at the end of September, where he'll spend two weeks delivering intensive training alongside an international instructor team featuring educators from Canada, the UK, and Australia.

A Model for Global EMS Development

What makes this initiative particularly compelling is its comprehensive approach. Rather than working in isolation, the project has secured backing from some of the world's most influential organisations, including the Australian Department of Foreign Affairs and Trade.

Transforming EMS Structure Through Education

The training program focuses on two critical areas:

Advancing Clinical Care: Providing further education for ambulance doctors in pre-hospital care techniques, ensuring patients receive the best possible treatment from the moment help arrives.

Supporting System Development: Upskilling drivers to support as ambulance attendants, creating a more robust and efficient emergency response structure.

This dual approach recognises that sustainable EMS improvement requires both clinical excellence and operational efficiency.

The Ripple Effect

When we invest in EMS education internationally, we're not just helping one service, we're contributing to a global knowledge network that ultimately benefits everyone. The techniques, protocols, and systems developed through these partnerships often find their way back to improve services worldwide.

Leon Baranowski's upcoming deployment represents more than a teaching assignment; it's an opportunity to learn, share, and build relationships that will strengthen emergency medical services across borders.

Looking Forward

As EMS Global Foundation continues its vital work in Mongolia, initiatives like this Monash University donation demonstrate how academic institutions can play a crucial role in global health development. The combination of equipment donation, expert instruction, and international collaboration creates a model that other universities and EMS services might well consider replicating.

In a world where emergencies don't respect borders, neither should our efforts to improve emergency response.

Tania Johnston (Canada), a paramedic and emergency nurse specialising in EMS education, was struck by the professionalism she witnessed reflecting on "how professional, hardworking and dedicated the doctors and drivers are to their roles." Her most memorable moment? "The pride and sense of accomplishment from the ambulance 103 and MAF (Mongolian Armed Forces) doctors and drivers when they received their course certificates."

James Stubley (UK), a Specialist Paramedic in Critical Care, emphasises the human element: "Despite EMS system differences, the motivation and commitment of the people is what defines the service." He's inspired by their work ethic under challenging conditions - 24-hour shifts handling 30-40 calls compared to other EMS services globally.

The mission's impact extends beyond immediate training. Dolly McPherson (Uk/Australia) is currently completing her PhD and working in helicopter emergency medical services. Initially wondered if they could create meaningful change. "The first day teaching I thought that we were such a tiny drop in the ocean," she recalls. But watching doctors apply their learning in a major incident exercises changed her perspective entirely.

Jarrod Bell (Australia), an intensive care paramedic, found cultural exchange equally valuable as clinical education. His standout memory involves traditional yurts, shared meals by the river and experiencing Mongolian hospitality after training days.

These four return to Mongolia September 27 - October 11, joining our mission to train 40 doctors and 40 drivers at the UB Ambulance Centre. Participants include NEMA, The Mongolian Armed Forces and other EMS units. Our team’s collective word sfor the experience? “Humbling, inspirational, indelible, and career-adjusting”.

In Mongolia, where ambulance doctors are often the only medical personnel on scene, packaging is not an optional skill - it is foundational. Patients may need to be carried long distances from apartments without lifts, across uneven ground, or through winter conditions that complicate every movement. Any mistake in packaging can add to spinal or limb injuries, compromise breathing, or make vital signs harder to monitor.

That is why correct packaging is one of the most emphasised lessons in our training program. The focus is not simply on strapping a patient down. It is on ensuring alignment of the spine, secure immobilisation, balanced weight distribution and clear team communication during every lift and transfer. It is about protecting the patient’s dignity as well as their safety.

During our recent sessions, Mongolian EMS doctors worked through packaging drills again and again, refining their movements until they became instinctive. The feedback was clear: practicing these fundamentals built confidence and teamwork. Doctors noted how packaging ties directly into clinical outcomes — a well-packaged patient allows airway management, IV access, and monitoring to continue with less disruption during transport.

The lesson is simple but powerful. Packaging is not “basic” or “secondary” care. It is the bridge that makes every other intervention possible. Without it, even the best treatments can falter on the journey.

By investing in this level of training, Mongolia’s EMS is building a stronger foundation for patient survival. Each correct lift, each secure fastening, and each smooth transfer reduces risk and improves the odds of recovery. That is the essence of our program: strengthening the basics so that advanced care has the chance to succeed.

Later this month, we return to train another 40 drivers. The aim is simple: to reduce treatable mortality, which continues to claim around 7,000 Mongolian lives every year. These are deaths that can be prevented with stronger outside hospital care and more capable emergency systems.

What begins in one crowded classroom is part of a bigger push for reform. Each driver trained adds to the national effort to build a modern, effective EMS, one that delivers faster, safer, and more reliable care to every patient who needs it.

None of this would be possible without the outstanding cooperation of the UB Ambulance Centres, the Mongolian Ministry of Health, the Mongolian Armed Forces, NEMA and the Australian Embassy.

This September, EMS Global Foundation returns to Mongolia for our 2025 mission, working alongside local partners to strengthen emergency medical capabilities across the country.

The Challenge and Opportunity

Like many nations transitioning their healthcare infrastructure, Mongolia faces unique challenges in developing robust emergency medical services. The country's vast geography, dispersed population, and evolving healthcare system create both obstacles and opportunities for emergency care delivery.

Mongolia's emergency medical system is founded on the Semashko model—a centralised healthcare approach developed during the Soviet era that emphasised state-provided medical services and physician-led care. While this model provided important foundations for healthcare delivery, modern emergency medical systems benefit from integration of contemporary prehospital care practices, enhanced training for all team members, and updated protocols that complement the existing physician-led structure.

International health organisations have identified emergency medical systems as critical components of healthcare infrastructure, particularly in settings where rapid access to definitive care can mean the difference between good and poor patient outcomes. This is where targeted, culturally appropriate training and system development become essential.

Our 2025 Mission

From 27 September to 11 October, EMS Global will deploy a specialised team of volunteer instructors to Ulaanbaatar, working directly with the UB Ambulance Centre to deliver structured prehospital care training to frontline providers.

Our comprehensive program includes:

Week 1 (30 September - 3 October): Doctor training for 103 emergency physicians and 10 MAF doctors, focusing on prehospital and retrieval medicine competencies including trauma management, airway techniques, triage protocols, and coordinated team response.

Week 2 (6-9 October): Driver and EMS personnel training for 30 ambulance drivers and 10 additional staff, emphasising foundational skills in first aid, patient handling, communication protocols, and scene safety.

What Makes Our Approach Different

EMS Global operates on the principle that sustainable improvement comes from within. Rather than imposing external solutions, we work as partners with local providers to build capacity that remains long after our departure.

Local Partnership: Every aspect of our training is developed in collaboration with Mongolian colleagues who understand their system's specific needs and constraints.

Practical Focus: Our curriculum emphasises immediately applicable skills that enhance patient care within existing resource parameters.

Volunteer Excellence: Our instructors are elite practitioners from Australia, the United Kingdom, and Canada who volunteer their time and expertise. They bring experience from some of the world's most demanding emergency environments, including critical care transport, trauma management, and mass casualty coordination.

Evidence-Based Methods: All training protocols are grounded in international best practices adapted for local context and capabilities.

Core Training Components

Our programs focus on foundational skills that form the backbone of effective emergency response:

• Structured patient assessment using systematic approaches

• Manual airway management and basic adjunct placement

• High-quality cardiopulmonary resuscitation techniques

• Bleeding control and basic trauma stabilisation

• Safe patient movement and transport protocols

• Recognition of time-critical conditions requiring rapid transport

• Team-based coordination and role clarity during emergencies

For ambulance drivers we provide specialised training in scene safety, patient support and coordinated care delivery alongside medical colleagues.

Building on Success

Our 2024 mission represented Mongolia's largest post-Soviet emergency medical training initiative, with over 200 participants and exceptional feedback from local partners. Ariunbold S., Director of UB Ambulance, noted: "The courses provided by your esteemed organisation have exceeded our expectations in every aspect."

More importantly, we've seen evidence of knowledge transfer and skill retention among participants, demonstrating the value of hands-on, culturally integrated training approaches.

International Partnership in Action

This mission exemplifies international development cooperation at its most practical level. Funded through the Australian Government's Direct Aid Program and supported by the Australian Embassy in Mongolia, the project brings together:

• Government of Mongolia

• National Emergency Management Agency

• Mongolian Armed Forces

• Ulaanbaatar City Ambulance Centre

This collaboration demonstrates how targeted technical assistance can strengthen local capabilities while respecting sovereignty and promoting sustainability.

The Volunteer Spirit

What makes this mission particularly meaningful is the volunteer commitment of our instructors. These are seasoned prehospital care professionals who dedicate their time to share expertise with international colleagues.

They bring advanced capabilities including:

• Drug-assisted airway management and mechanical ventilation

• Advanced trauma scene management and triage coordination

• Critical care transport for complex patients

• Culturally responsive care in challenging environments

• Educational expertise in adult learning and skill development

Their commitment reflects the global emergency medicine community's dedication to mutual support and knowledge sharing.

Looking Forward

Emergency medical system development is a long-term endeavour requiring sustained commitment from all stakeholders. Our September mission represents one component of ongoing collaboration with Mongolian partners to build resilient, locally-owned emergency medical capabilities.

The skills we share will multiply through local networks as trained providers become trainers themselves, protocols improve patient outcomes, and system confidence grows. This ripple effect is how sustainable change occurs in complex healthcare environments.

The Bigger Picture

Effective emergency medical systems serve as safety nets for entire populations. They provide crucial links between communities and healthcare facilities, deliver time-sensitive interventions that can prevent disabilities and save lives, and offer reassurance to families and communities that help is available when needed most.

In Mongolia's context, strengthening emergency medical capabilities supports broader healthcare system goals while addressing the unique challenges of serving a geographically dispersed population with limited infrastructure.

Partnership in Practice

As we prepare for our September deployment, we're reminded that the most meaningful international development occurs through genuine partnership, combining international expertise with local knowledge, external resources with indigenous leadership and technical skills with cultural understanding.

Mongolia's emergency medical providers demonstrate remarkable dedication under challenging circumstances. Our role is to support their efforts with additional skills, techniques, and knowledge that can enhance their already significant contributions to public health.

The collaboration continues, the learning flows both ways, and together we build stronger systems that serve resource-contraint communities more effectively.

Fire departments in Germany routinely serve as frontline medical responders. Firefighter-paramedics (“Feuerwehrsanitäter” or “Notfallsanitäter”) often provide initial emergency care, such as first aid, vital sign monitoring, and defibrillation, until the EMS arrives. Many smaller municipalities depend on the fire brigade to staff both emergency and non-emergency transports, including ambulances and patient transfers, making the fire department a versatile part of regional emergency medical services. This integration reduces response times, particularly in rural areas, ensuring medical assistance is delivered quickly and reliably.