MEMBERS

The History of EMS 

In many ways, the growth of the Nation's EMS is the result of public demand. Prehospital care did not surface as a national concern until the 1960s. Prior to that, the victim of a medical emergency did not receive much medical assistance, other than transportation to the hospital. Often staffed only by a driver, ambulance services at that time offered little in the way of lifesaving care. Hospitals also were not set up to treat life-threatening emergencies. Emergency rooms did not have trained medical staff or equipment available on a round-the-clock basis to treat serious illnesses or injuries. 

The first recorded ambulances date back to the Crusades, and the first actual prehospital care was created during the Napoleonic Wars in 1792, when the first care and the first air evacuation --by hot air balloon --occurred. Many of the concepts of modern EMS were introduced by military medicine in Korea and Vietnam. The lifesaving benefits of rapid field evacuation and paramedics, and medical advances in stabilization and resuscitation, were proven as a result of the medical care provided to our troops. 

In 1966, however, the National Research Council published a report that concluded that more than 50,000 Americans died as a result of traffic accidents. This report established EMS as a national priority. The U. S. Department of Transportation began the development of a national standard curricula for Emergency Medical Technicians, which became the nucleus for forming EMS systems nationwide. 

In 1973, the Emergency Medical Services Systems (EMSS) Act designated Federal dollars for the development of regional EMS systems. Specific requirements outlined by this Act --training and certification, interagency cooperation, equipment development, communications, and public education --are recognized today as the key elements of effective EMS. 

As a result of the development of accepted standards and guidelines, much like those that characterize other professions, citizens throughout the country now benefit from the expertise of EMS providers that have been trained and certified in providing lifesaving care. 

Individuals who are involved in EMS --whether career or volunteer --commit to anywhere from 40 to 1,000 hours of training initially, and years of continuing education, as part of their professional commitment as providers of quality patient care. 

A highly skilled force of EMS providers is just one of the results of the standards and guidelines developed as a result of the EMSS Act. Similar guidelines contribute to advances in equipment, communication, and administration. 

The medical community recognized that the ability to provide immediate lifesaving care required the full-time availability of physicians and nurses with specialized skills and knowledge, as well as fully equipped emergency facilities. Emergency medicine, the specialty of evaluating, stabilizing and initiating treatment for life and limb threatening conditions, was established in 1968 and became a medical specialty in 1979. 

Emergency rooms themselves have evolved into emergency departments that are fully-staffed and equipped 24 hours a day, seven days a week. Trauma centers are staffed and equipped to provide immediate care --including surgery --to the most seriously injured or ill patients, also on a round-the-clock basis. 


Pre-Hospital EMS Today 

Fire departments provided a ready model for the development of regional EMS systems. Fire departments offered an example of localized training and certification programs. And, fire departments are set up --using communications technology and strategically located fire stations --to be able to reach anywhere in the community within minutes. 

As a result the resources that were already available, many communities housed responsibility for EMS within the fire department. Today, 60-80% of the 34,000 fire departments in the United States provide EMS to the citizens they serve. EMS can be provided in a number of ways and by organizations other than the fire department. In many communities, the fire department responds to medical emergencies in a fire engine as "first responders" --at either the basic life support (BLS) or advanced life support (ALS) level. Further care and transportation to a medical facility is provided by a private, for-profit ambulance company, separate municipal-based EMS department, or hospital-based systems are the sole providers of EMS. The EMS personnel may be career or volunteer emergency responders, and may respond in BLS ambulances, mobile intensive care units, ALS ambulances, or aeromedical ambulances. 

Approximately 60% of the more than 750,000 emergency medical providers in the United States are volunteers. Unlike disciplines that only use volunteers to support the career workforce, volunteer EMS providers have exactly the same training and responsibilities of their career counterparts. Many communities are served exclusively by a volunteer EMS service. 

The role of volunteers in EMS reflects a history of volunteerism in safety and rescue: examples include the fire service and the Red Cross. 

The Government's Role in EMS 

The Highway Safety Act of 1966 led to the formation of the U. S. Department of Transportation's National Highway Traffic Safety Administration (NHTSA), which helped many states and localities start their own coordinated EMS programs. Over the years, NHTSA has provided funding and technical assistance to help improve EMS system development in the areas of planning, training, and personnel, communications, resource management, trauma system development, transportation, and public information and education. 

In 1973, the Emergency Medical Services Act called for the Federal Government to spend millions of dollars in the development of regional EMS systems through a Department of Health and Human Services (DHHS) categorical grant program. The programs focused on creating systems, purchasing equipment, and training staff. In the mid-1980's, much of the funding for Federal EMS programs was reduced or eliminated. As a result, EMS systems became more dependent on state and local funding. Many of the differences in levels of service that persist today --the lack of universal 9-l-l service, for example --can be traced to the decline in Federal funding. 

Since its creation in 1974, the USFA recognized and acknowledged its responsibility to assist the fire service in its lifesaving role. As a part of the Federal Emergency Management Agency (FEMA), USFA took a leadership role in EMS management research and information dissemination, because EMS is such an important part of the fire service. 

Currently, Federal leadership in EMS is provided through NHTSA and USFA. As a result of the Trauma Care Systems Planning and Development Act of 1990, the Department of Health and Human Services is again becoming a partner in EMS. 

The USFA has become a, keystone for all of the organizations and Federal agencies dealing with EMS management issues faced by the emergency services today. In 1991, the role USFA in EMS was reaffirmed with the following Mission Statement: 

USFA Emergency Medical Services Program 

The Nation's fire service is recognized as first responders to medical and other emergencies. The vast majority of fire departments in this country provide some level of emergency medical service, and the majority of the emergency activity within these departments is medical-related. Thus, a critical part of fire service management is the management of pre-hospital emergency medical services. 

The mission of the United States Fire Administration (USFA) is, in part, to increase the efficiency and effectiveness of fire service management across the country. The purpose of the Emergency Medical Services Program of the USFA is to address a major component of this issue --the management of emergency medical services. USFA will conduct research, produce publications, disseminate information, and cooperate with other agencies and organizations in an ongoing effort to increase the efficiency and effectiveness of the management of pre-hospital emergency medical services. 
Since 10.10.04