Increasing industrialization in the developing world has contributed to an epidemiological transition in disease pattern from infectious disease as a primary cause of morbidity and mortality, to more chronic illness such as heart disease and trauma. This study was done in order to assess the effectiveness of pre-hospital and emergency care as the health care needs of the population changes and to make recommendations to meet the growing need for organized emergency services in that community. Sundaram Medical Foundation Hospital in the town of Annanagar, Chennai, India was our study site. Statistics describing the health status, demographic, and socio-ecoomic profiles of the community were obtained from a published community survey. Information regarding availability of resources in the hospitals for management of trauma and cardio-vascular emergencies was obtained from unpublished survey results of the local hospitals. Retrospective data was obtained from trauma and ambulance registries regarding trauma related admissions, death and pre-hospital assistance. Data analysis revealed increasing mortality from trauma and cardiovascular etiologies. Hospital statistics showed that 1/3 of the annual hospitalizations were from trauma and acute coronary syndromes. Half the trauma victims had no formal prehospital intervention. Standard of care in the emergency departments varied considerably with less than half of them carrying defibrillators and only a third of them carrying defirbillators and only a third of them carrying intubation equipment. As developing countries begin to urbanize and grow, so do their health care needs. The current system does not meet the needs of increased mortality from trauma and cardiovascular disease. We have suggested necessary changes for establishment of emergency medical services to meet the evolving health care needs.