The growth of emergency services in Singapore over years in terms of volume and complexity is relentless. In the pre-hospital environment, ambulance call volumes have more than doubled from 62,095 in 1997 to 142,549 cases in 2012. The use of emergency ambulances services should be commensurate with the timeframe of which the medical condition is deteriorating or the potential for sudden catastrophic outcomes. Activation of the EAS ambulance for STEMIs and strokes help to reduce the D2B time and time to thrombolysis. Patients at risk of AMI or stroke often fail to recognise the symptoms and hence fail to activate the EMS system. Physicians do have a role to identify those at risk to educate them to achieve better outcomes. Good documentation of positive and significant negative findings and relevant tests provides a baseline to expedite patient assessment at the ED. An understanding of the available ED resources as well as the access to services, especially when sub-specialty consultation is needed, helps to improve the appropriateness of referrals.