It was established on 1 April 1998 and as of December 2018[update] has 3,400 staff providing ambulance and related services to the 3 million residents of Wales.

As of 2013[update], the majority of the EMS fleet consists of Wilker Mercedes Benz 519 Sprinter Ambulances and Honda CRV or Ford Focus rapid response vehicles (RRV).

They are used by the ambulance service mostly in rural areas to provide basic care, such as cardiopulmonary resuscitation (CPR) before an EMS crew arrives.

As a CFR is usually only sent to local calls in specified communities, they often arrive before an EMS ambulance crew, even without the use of blue lights and sirens.

In 2012, a strategic review of the service was commissioned by the Welsh Government and was conducted by Professor Siobhan McClelland and published in April 2013.