Emergency medical services represent one of the most robust and essential pillars of healthcare systems. Over the past 150 years, they have evolved from horse-drawn patient transport to high-tech, near–real-time systems incorporating telemedicine, digital dispatch, and mobile diagnostics. This lecture explores the evolution of emergency care in Russia — how its mission, workforce, technologies, and organizational models have changed — and why the field is now entering a phase of accelerated technological advancement. It examines the historical context, the state of ambulance services in Russia as of 2026 (including workforce, organization, and technology), and future scenarios — from AI-assisted dispatch systems and wearable sensors to fundamentally new models of emergency care delivery.