Prehospital emergency care in Sweden has undergone dramatic changes in recent decades from the role of being a primary transport organization to a more differentiated approach to health care. The Swedish prehospital emergency nurse must therefore today make prehospital assessments to be able to decide whether patients should be transported to hospital with »fast-track« or sent to primary care or stay at home with advice on self-care. Therefore, »patient safety« has become a key issue and primary data indicate that there is a risk of a potential adverse event in approximately four percent of the primary assignments. Computer based decision support tools are under development and time-sensitive conditions need to be defined. We also need to further develop symptom-relieving therapy and the possibility of starting causal therapy already on the spot. Future perspectives include the use of biochemical markers as well as simple X-ray examinations to further improve pre-hospital assessment.