Emergency medical care in Ecuador is limited by geographic, economic, political, and infrastructural barriers. Afflictions of the developing world (eg, tropical infections and natural disasters) combine with ailments of the developed world (eg, trauma and cardiovascular disease) to mandate improved emergency medical systems. The nation has recently initiated FASBASE, a program dedicated to the enhancement of both prehospital and emergency department (ED) services. Furthermore, a dedicated residency program in Emergency and Disaster Medicine recently graduated its first class. Although more programs and funding are necessary to sustain the effort, Ecuador has begun to develop a modern emergency medical system.