Sri Lanka has emerged as a regional leader in healthcare within South Asia, achieving some of the lowest maternal and neonatal mortality rates in the region. Despite these successes, the absence of an organized pre-hospital care system has hindered improvements in overall mortality rates. This narrative review explores the development of Sri Lanka’s Emergency Medical Services (EMS) over the past decade, highlighting historical challenges and the pivotal impact of the national ambulance service, “1990 Suwa Seriya,” on morbidity and mortality outcomes, including out-of-hospital cardiac arrest (OHCA). The review traces the rapid progression from a non-existent pre-hospital system in 2015 to a nationwide, publicly accessible, and free emergency ambulance service covering 22 million people within six years. Key factors contributing to this transformation include collaborations with emergency medicine specialists, innovative training and credentialing programs, and emerging research initiatives, providing a model for other countries developing pre-hospital care systems. The service’s response during the COVID-19 pandemic, its effect on public trust, and strategies to mitigate OHCA-related morbidity and mortality are also discussed. Overall, 1990 Suwa Seriya exemplifies a commitment to continuous enhancement of pre-hospital care and serves as a potential blueprint for strengthening emergency healthcare in lower-middle-income countries (LMICs).
