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To the Editor: In 1993 Valparaíso San Antonio Health Service initiated an Organizational Development Programme that included all facilities, extending from the six major hospitals to the 26 primary care clinics of the region. The programme adopted Quality Management as its model, without discarding other concepts and methods of proven effectiveness (see Walton 1992; Al‐Asaf 1993; Ishikawa 1993). In 1994 the Health Service Council identified the emergency care system as a model in need of great improvement and considered the incorporation of pre‐hospital care as a top priority. The challenge was to implement a new system, affordable with a small budget, with greater satisfaction for staff and users, better coordinated and more responsive to local needs (see Ministère de la Santé 1992). „Quality management techniques were used to adapt and develop a new model, essentially designed by local staff, based on the Advanced Trauma Life Support (ATLS) and other relevant literature (Burnett & Grover 1996; Grijseels et al. 1996; Gwinnutt & Driscoll 1996; Hu & Kao 1996; Jabbour et al. 1996; Boyington 1995). A ‘network’ model rather than a centralized one was chosen and implemented at a very low direct cost, optimizing existing resources.