Main Hospitals or larger hospital systems may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Many hospital-based EMS departments operate solely with their hospital

The physicians will attempt to treat casualties at the scene and will only transport them to hospital if it is deemed necessary. If patients are transported to hospital, they are more likely to go straight to a ward rather than to an emergency department . Countries that use this model include Austria, France, Belgium, Luxembourg, Italy, Spain, Brazil and Chile.

The Anglo-American model is also known as , ambulances are staffed by paramedics and/or emergency medical technicians. , but not to the same level as a physician. In this model it is rare to find a physician actually Specialized medical training working routinely in ambulances.