• two ambulances on the street
  1. Home
  2. Topics
  3. Post-crash response

Post-crash response

Timely and quality emergency care can make the difference between life and death. In the Region of the Americas, thousands of people face critical situations every day that require Emergency Care Systems (ECS) that are better prepared, coordinated, and accessible to all.

An ECS is an organized network of teams, supplies, functions, and health professionals that works in a coordinated and integrated manner to respond to life-threatening situations. This system includes prehospital care (care at the scene of the incident, transport, and transfer), care provided in health facilities (from primary care services to critical and surgical care units), as well as preparedness mechanisms and institutional safety measures for emergencies.

Strengthening the ECS is essential for all critical conditions, but it is particularly relevant in post-crash care, where a rapid, coordinated, and effective response can prevent avoidable deaths and reduce disabilities resulting from road traffic incidents.

The ECS not only seeks to provide clinical care but also to ensure that every person receives appropriate care in the right place and at the right time, through an organization that integrates governance, financing, information systems, and continuous quality improvement.

Through the Pan American Health Organization (PAHO), with the support of the United Nations Road Safety Fund (UNRSF) and other strategic partners, we are advancing an agenda to strengthen emergency care systems, with a focus on post-crash response, based on the essential components of the Emergency Care Systems Framework.

  • The most recent data were published in Saving lives by promoting a safe systems approach to road safety in the Americas.
  • Policy and governance:
    • Six countries have a universal access provision law that mandates financial protection or requires free emergency care.
    • Seventeen countries have a national law requiring health care facilities to provide care to any person experiencing an emergency.
    • Canada, the United States, and Panama have a national Good Samaritan law.
    • Thirteen countries report having a single national emergency access number with nationwide coverage.
    • Fifteen countries reported including a response-time target in their road safety strategies; however, only Chile and Mexico included a response-time target defined in minutes.
    • Twenty-five countries have an office, agency, or leading unit within the Ministry of Health or another ministry responsible for emergency care.
    • Thirteen countries have a single emergency access number with nationwide coverage.
  • National assessment (as of February 2026):
    • Seven countries (Belize, Bolivia, Costa Rica, Guatemala, Jamaica, Paraguay, and Trinidad and Tobago) completed the Emergency and Critical Care System Assessment (ECCSA).
  • Capacity strengthening (as of January 2026):
    • Seven countries (Argentina, Bolivia, Colombia, Costa Rica, Jamaica, Mexico, and Paraguay) have implemented the cascade training program for the Basic Emergency Care (BEC) course.
    • A total of 671 health professionals have been certified as BEC providers, and 182 facilitators have been trained to replicate the course in their respective countries.
    • Belize implemented the Basic Critical Care (BCC) course.
    • Costa Rica was the first country to implement the pilot phase of the Community First Aid Responder (CFAR) course. A total of 183 people have been trained in CFAR: 119 in Costa Rica and 64 police officers in Belize.

International commitment to the integration of emergency, critical, and surgical care has strengthened in recent years.

World Health Assembly resolution WHA76.2 (2023) highlighted the need to integrate emergency, critical, and surgical care services within health systems as key elements of universal health coverage and emergency preparedness. That same year, the United Nations General Assembly adopted resolution A/RES/78/4, reaffirming countries’ commitment to ensuring equitable access to essential health services.

In 2024, resolution WHA77.8 requested the development of a global strategy for 2026–2035 to integrate surgical, critical, and emergency care. In the Region of the Americas, these mandates are reflected in resolution CD61.R11 (2024), which approved the Integration Strategy 2025–2030, aimed at strengthening Emergency Care Systems at all levels of care. This strategy guides joint work with countries to build more resilient, equitable, and emergency-ready health systems.

PAHO works alongside countries in the Region of the Americas to strengthen emergency response capacity by promoting coordinated actions that save lives. These actions include the deployment of technical cooperation, the training of health professionals, the generation of evidence for decision-making, and the promotion of reforms that improve the preparedness and safety of Emergency Care Systems.

The essential components of an emergency care system

Areas of work

PAHO supports countries in integrating emergency care into national health plans and consolidating integrated primary health care models. It also promotes the establishment of institutional structures and sustainable mechanisms to ensure the training and retention of specialized professionals. 

This work is aligned with intersectoral policies that engage ministries of health, finance, transport, and security, ensuring the necessary coordination for an effective response. Additionally, PAHO advocates for the adoption of international standards, the allocation of dedicated funding, and the establishment of clear regulatory frameworks to strengthen governance and reduce fragmentation. 

Recommended strategies: 

  • Ensure sustainable financing for the Emergency Care System (ECS). 

  • Integrate emergency care as a key component within national health plans or primary health care models. 

  • Designate an office or unit responsible for emergency care within the Ministry of Health. 

  • Create mechanisms to guarantee the sustainable training and retention of specialized professionals. 

Tools related to the topic:

To strengthen ECSs, it is essential to have national assessments that provide an objective understanding of system response capacity. Tools such as the Emergency and Critical Care System Assessment (ECCSA) offer a structured framework to evaluate essential system components, identify strengths, weaknesses, and critical gaps, and prioritize areas for improvement. 

The situational analysis becomes a key instrument to translate findings into concrete actions that enhance coverage, accessibility, and quality of emergency care across the Region of the Americas. 

Recommended strategies: 

  • Conduct a standardized national assessment of emergency care, including legal and regulatory frameworks, to identify areas for improvement. 

Recommended tools: 

Regional progress and actions

The Pan American Health Organization (PAHO) provides technical cooperation to countries to review, update, and harmonize laws, regulations, and protocols governing emergency care. This support aims not only to modernize legal frameworks but also to ensure their alignment with international standards and the priorities of national health systems.
Strengthening the regulatory framework improves institutional capacity for regulating critical resources such as prehospital transport, medicine and supply management, critical and surgical care, staff certification, and referral and counter-referral protocols. These actions provide legal certainty, promote accountability, and ensure the sustainability of services, contributing to the consolidation of emergency care as a priority in ministries of health.

Recommended strategies:

  • Explicitly include emergency care (prehospital, hospital, critical, and surgical care) in National Health Plans or National Strategies. 
  • Promote a legal framework to protect “good Samaritans” or bystanders who provide first aid.
  • Review and, where necessary, improve regulations for standardized clinical documentation in prehospital care and emergency units.
  • Review and, where necessary, improve regulations for establishing triage, clinical protocols, and referral and counter-referral pathways between prehospital services and hospitals, as well as “no refusal” policies.
  • Promote a single national number for activating the Emergency Response System (SAE).
  • Review and, where necessary, establish national standards for ambulances, equipment, medications, and personnel.
  • Review and, where necessary, establish national standards for first aid packages and national standards for emergency units (personnel, equipment, medications).

Regional Progress and Actions:

  • Three countries in the region (Canada, the United States, and Panama) have a “Good Samaritan Law.” 
  • Six countries (Barbados, Belize, Ecuador, the Virgin Islands, Paraguay, and Uruguay) have a Universal Access Law (financial protection or free emergency care). 
  • Thirteen countries in the region have a single national telephone number to activate the Emergency Assistance System (SAE).

Timely access to organized and efficient prehospital services is crucial for saving lives and reducing complications in emergency situations. PAHO is promoting the strengthening of this area by developing the Prehospital Toolkit, designed to standardize on-scene care protocols and optimize the work of first responders. This tool facilitates hands-on training and ensures that initial procedures are performed uniformly, in accordance with international standards.

The approach also includes promoting integrated coordination systems, which encompass the use of dispatch centers, transport protocols, and referral and counter-referral mechanisms. The goal is to guarantee that patients receive continuous and appropriate care from the scene of the incident to specialized hospital care.

Recommended strategies: 

  • Ensure access to organized prehospital emergency care, including a single emergency number and a coordination center with real-time mapping of available resources.

  • Establish community-based first response training programs. 

Tools: 

PAHO promotes the consolidation of 24/7 emergency units, ensuring continuous operation and strengthening both clinical and management capacities. These units are essential to guarantee immediate, safe, and effective care for emergency cases. 

Support includes the implementation of training tools such as the Emergency Unit Management (EUM) course, which optimizes organization and management of emergency services, and the Basic Critical Care (BCC) course, which provides essential competencies for managing critically ill patients. Both initiatives contribute to standardizing clinical practice, improving the quality of care, and ensuring continuity. 

Furthermore, efforts are being made to strengthen infrastructure, provide strategic supplies, and adopt evidence-based protocols, thereby increasing the capacity of emergency units to resolve cases. This includes key aspects such as patient flow management, coordination with referral and counter-referral systems, and collaboration with the pre-hospital network to ensure safe and timely transfers.

Developing professional competencies is a cornerstone for ensuring the delivery of quality emergency care. In this regard, the Pan American Health Organization (PAHO) promotes the regular updating and certification of emergency care providers to maintain up-to-date clinical and management competencies. 

This process includes the implementation of standardized and internationally validated courses, such as the Basic Emergency Care (BEC) course, the Basic Critical Care (BCC) course, and the Community First Aid Response (CFAR) course, among others. These trainings not only strengthen technical knowledge but also foster teamwork and inter-institutional coordination. 

Professional capacity strengthening is further complemented by the establishment of accreditation mechanisms and networks of local and regional instructors, which ensure the sustainability of installed capacities. This approach helps ensure that knowledge and skills are institutionalized within national health systems, rather than relying exclusively on external actors. Through these efforts, PAHO supports countries in developing a skilled and up-to-date health workforce, capable of providing effective and safe emergency and critical care. 

Recommended strategies: 

  • Integrate specific training on emergency and trauma care into medical and nursing curricula.
  • Implement ongoing training and periodic refresher programs for all frontline providers.
  • Establish pathways for regular certification of prehospital and hospital emergency care personnel. 

Recommended tools:

PAHO promotes the strengthening of reliable and standardized information systems that enable the monitoring of the performance of emergency and critical care services. To this end, PAHO advocates for the use of harmonized registries, facilitating data comparability across institutions and supporting evidence-based decision-making. 

A central component of this effort is the consolidation of key indicators, such as response times, quality of care, and health outcomes, which inform planning processes and resource allocation. These indicators help identify gaps in service delivery and form the foundation for continuous quality improvement programs, including clinical audits, accreditation processes, and ongoing training of health personnel. 

PAHO encourages the integration of data collection and analysis into the strategic management of health systems, ensuring a dynamic process of institutional learning. In this way, data are used not only to evaluate performance but also to optimize processes, strengthen governance, and continuously improve the quality and safety of emergency care. 

Recommended strategies: 

  • Develop standardized protocols and ensure their consistent implementation.
  • Establish information systems that integrate essential emergency care data. 
  • Analyze health system performance in key areas of emergency care delivery (e.g., response times). 
  • Promote continuous quality improvement programs, using available data and international guidance to strengthen emergency and trauma care.
  • Document and disseminate successful experiences. 
Resources

Latest news

Documents

All

Communication Materials

All

Mandates and Strategies

All

Events

View Events

More information