Proactive EMS combines the resources of EMS with the strategies of injury prevention and injury control. EMS provides knowledgeable, professional people and patient care records that contain valuable clues about the causes of preventable traumatic events. Using these we can identify the preventable injuries and correct the hazards that cause them. Injury prevention and injury control provide effective strategies, scientifically proven to prevent injury events from happening, or to reduce the injuring energy exchange during the event in order to lessen the severity. As a team, EMS and injury prevention/injury control (IP/IC) are a natural combination that work together to eliminate some fatal injuries before they happen, and to provide EMS with less critical patients by reducing the severity of injuries. The result is a dramatic reduction in traumatic fatalities.

EMS is a "Downstream," reactive strategy: We wait for an injury event to occur somewhere upstream, and then we react to the situation that we find when we arrive, farther downstream. With EMS we attempt to prevent any further injury to the patient, to minimize the damage that has already been done, and to halt the progression of shock syndrome from destroying vital organs. Therefore EMS is truly injury control after the fact (in the "post-injury phase").

EMS is designed to respond to, care for and transport injured patients that have some chance of survival. EMT’s are responsible for saving many thousands of lives every year. However, we cannot save those who have no chance of survival, and we can only save some of those whose chances are poor or fair. Despite our best efforts, there are some patients who will not make it. Nobody likes to admit defeat when there’s nothing to be done, and nobody likes to lose a patient we’ve tried hard to save, but it happens all the time.

Reactive strategies are complex and require a lot of manpower. They are also very expensive to improve. While it may be possible to upgrade your EMS, put on more personnel, open up bases in the outlying parts of the district, improve the local hospital’s treatment of critical pediatric trauma, establish on call surgery, etc., these improvements will still not save any people who are already dead, and they will only save some of those who are unstable.

Injury prevention and injury control are proactive or "Upstream" strategies:

Injuries that recur in the same place, under the same circumstances, and among the same population are often the result of an identifiable hazard. Injury prevention is a process of seeking out these hazards and eliminating them. Injury prevention takes place in the "upstream," or "pre-injury phase" before the injury event occurs. A hazard is identified and removed or modified in order to prevent any further injurious events from happening there. Re-engineering a deceptive turn in the road, removing a fixed object along the highway, and lighting a dark area in a residential zone that has a high incidence of night time auto vs. pedestrian fatalities are all examples of effective injury prevention. The modification removes the hazard and therefore prevents all future injury events from occurring at that location.

An excellent example of the effectiveness of injury prevention is childhood poisoning by medication. "An especially steep decline in childhood poisoning death rates occurred after childproof packaging was required on all drugs and medications beginning in 1973. The 50 percent decrease in poisoning by all drugs and medications in the first three years (1973-1976) was substantially greater than the decrease in poisonings by other solids and liquids, most of which were not required to be packaged in childproof containers…. During 1968-1979, the period analyzed for most causes of death in this book, the 80 percent decline in poisoning death rates (emphasis added) for children ages 1-4 exceeded that for any other major cause of childhood injury death." (Haddon, W. Jr. 1984. Forward to the Injury Fact Book, First Edition)

Injury control occurs during the actual injury event itself. Some environmental modification is made before the injury event that increases the protection to the patient during the event. Air bags are a good example of injury control. Just as many front-end collisions occur, but fewer result in fatal injuries because the air bags cushion the occupants during the crash.