This three year project with a budget of $149,888 aims to carry out an observational study of the current status of the county-level pre-hospital care in Hunan province and explore the feasibility of a provincial-wide model for strengthening pre-hospital care services. Based on the observational study, standardized web-based pre-hospital care training will be developed and carried out in regional pre-hospitals centers, half of which will be randomly selected to receive in-person training. Evaluation of knowledge and critical actions performed by pre-hospital service providers, as well as some key health outcome variables, will be compared to produce suggestions for improving pre-hospital care quality.