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Background:Over the past decade, the rapid increase in population and economic development are likely to have affected pre-hospital emergency care demand in Beijing. This retrospective study aimed to determine pre-hospital emergency care needs and response time from 2005 to 2014. Methods:All pre-hospital service data were collected from January 2005 to December 2014 from the Beijing Emergency Center and Beijing Red Cross Emergency Center, which oversaw all pre-hospital care in Beijing. The major illnesses were classified by the Medical Priority Dispatch System. Data on pre-hospital emergency demand and emergency care-related time were analyzed to determine trends over the period. Findings:A total of 3,714,311 patients met the inclusion criteria. Pre-hospital emergency call demand increased significantly from 235,810 in 2005 to 478,825 in 2014(p<0.001). The rate of pre-hospital emergency call demand also increased significantly from 1,533.22/100,000 in 2005 to 2,225.02/100,000 in 2014(p<0.001). The growth rate was 45.12%. The response rates improved or were maintained. The mean pre-hospital emergency response time was 17 minutes in 2005 and 16 minutes in 2014 (p>0.05). The active response time halved from 4 minutes in 2005 to 2 minutes in 2014 (p<0.05), while the passive response time was 13 minutes in 2005 and 14 minutes in 2014 (p>0.05).Pre-hospital emergency call demand increased for 21 illnesses, particularly Sick Person, Heart Problems/Failure, Falls, Traumatic Injuries, and Traffic/Transportation Incidents. Heart Problems accounted for 12.27% of the total emergency needs. Emergency calls per 100,000 people significantly increased from 183.39 in 2005 to 277.72 in 2014 (p<0.001), an annual growth rate of 12.13%. Trauma-related illness accounted for 26.32% of the total in the past 10 years, increasing from 64,426 in 2005 to 124,538 in 2014 (p<0.001), a growth rate of 19.35% per annum, and the rate of pre-hospital emergency call demand was 578.71 per 100,000 population in 2014. Interpretation:Over the past 10 years, the pre-hospital emergency call demands and disease spectrum significantly changed in Beijing and the city achieved major success in meeting demand. Trauma and cardiovascular disease accounted for a significant proportion and increased quickly, which suggested that Beijing was not only a rapidly developing city, but also an aging society. The growth of pre-hospital care and change in disease spectrum provide a reference for the allocation of pre-hospital emergency resources. An increase in emergency resources, improved response times, improved road management, and greater social concern may further improve pre-hospital emergency capability.