[Smart emergencies: when artifi cial intelligence transforms the 118 emergency service].

. Smart emergencies: when artificial intelligence transforms the 118 emergency service. Artificial intelligence (AI) is increasingly being applied to the Italian emergency medical service (118 EMS), reshaping triage, dispatching, clinical support, and training. The aim of this paper is to describe the current applications of AI in prehospital emergency care and analyze future perspectives, limitations, and ethical-legal implications. The contents are based on the international literature and real-world case studies, focusing on peer-reviewed research and ongoing pilot projects in emergency medical systems. AI systems demonstrate higher accuracy in early recognition of time-critical conditions (cardiac arrest, stroke, severe trauma); improved resource allocation and reduced response times; predictive capacity of emergency demand, supporting workforce and vehicle planning; innovative training through generative AI-based simulations. Key challenges remain in clinical validation, workflow integration, and data protection.AI is an emerging ally for enhancing the efficiency and quality of EMS while preserving the centrality of professional judgment. Its responsible adoption requires staff training, algorithmic transparency, and clear regulations. Future integration with Internet of Things (IoT) and predictive systems may establish a more proactive, resilient, and patient-centered emergency care model.