Strengthening the WHO Emergency Care Systems Framework: insights from an integrated, patient-centered approach in the Copenhagen Emergency Medical Services system—a qualitative system analysis

Background
The World Health Organization Emergency Care Systems Framework (WHO ECSF) was designed to offer guidance in establishing and developing effective Emergency Medical Services (EMS) systems. However, evolving disease patterns, changing community needs, and a rising demand for emergency care services, highlight the need for more integrated and patient-centered EMS systems. This evolution should be mirrored in the WHO ECSF. Hence, this study explores system components of the Copenhagen (CPH) EMS that may enhance the WHO ECSF´s emphasis on integrated and patient-centered care.

Methods
A qualitative case study was conducted from April through June 2021, including (i) semi-structured interviews with researchers and professionals at the CPH EMS and (ii) a scoping literature review using PubMed, Google Scholar, expert recommendations and snowballing.

Results
Thirteen expert interviews and 35 records were analyzed, revealing key integrated care components within the CPH EMS. These include education and citizen participation programs, early triaging, differentiated care pathways coordinated with primary care and out-of-hours services, and specialized mobile care units complementing “traditional” ambulance services. Technology supports integrated and patient-centered care by facilitating early differentiation of care, efficient dispatching, and communication. Data-driven approaches were fostered through technology-aided data collection, supporting research, quality improvement, and patient safety. The identified components were mapped within the WHO ECSF´s four domains: scene, transport, facility, and cross-cutting elements. Due to the prehospital focus of the CPH EMS, limited data was available for the “facility” site.

Conclusions
The CPH EMS demonstrates an integrated, patient-centered systems approach that emphasizes seamless coordination along the patient care pathway, bridging EMS with broader health and social systems. Research-informed initiatives and intelligent technology solutions underscore the potential for enhancing the WHO ECSF. These findings highlight the importance of continued system integration and a holistic health perspective, including in emergency settings. Further research is needed to assess the transferability of these components across diverse global contexts.

Trial registration
Not applicable.