History of EMS

The Making of EMS: Three Decades of Change

 

It's a dark and stormy night. You drive your ambulance to the scene of the accident. As you step out into the rain, the police officer says, "There's only one, but he looks pretty bad." You look for a cervical collar, but can't find any. There's no KED. There is a backboard, so you take that to the crumpled vehicle. You and your partner carefully remove the patient and try to stabilize his spine, as best you can. There's a lot of blood in the vehicle, and you decide to apply the MAST, but you can't find that, either. You try to call Medical Control, but there's no radio in your vehicle. In fact, your vehicle seems awfully small -- there's no room to stand up.

Suddenly, you wake up and realize it was all just a dream. But wait -- was it? Thirty years ago, this was what EMS was about: get the patient into the ambulance and get to the hospital as fast as you can. We've come a long way.

Emergency care in the mid-20th century was inadequate and chaotic. Station wagons or hearses often served as ambulances, staffed by untrained personnel and dispatched by municipal hospitals, fire services, private services, or funeral homes. Patients arrived at hospital emergency wards staffed at most by a nurse or intern with no formal training in emergency care. No guidelines existed for training or equipment for emergency personnel.

Ambulances in the 1960s were often called horizontal taxicabs. They were designed to carry patients to the hospital in a horizontal position but did not allow room for attendants to perform CPR or other medical procedures. Many ambulance services were run by morticians, and few vehicles carried any medical supplies or equipment. At night, many hospital emergency wards were dark and the doors were locked, forcing ambulance services -- even those with critically ill patients -- to ring the bell and wait for admittance.

In 1966, most ambulance attendants had little or no medical training. The emergency medical technician first came into being in 1969 with the introduction of an 81-hour training course by the National Academy of Sciences and the American Academy of Orthopedic Surgeons. The EMT is trained for basic life support (BLS) procedures: maintaining airways, treating shock, immobilizing patients for transport to the hospital, and administering CPR.

In 1966 the National Academy of Sciences/National Research Council released a report on trauma that initiated the modern era of emergency medical services systems. The report, titled Accidental Death and Disability, the Neglected Disease of Modern Society, found that accidental death resulting from Trauma was the fourth leading killer in the United States, and the leading killer between ages 1-37. The authors estimated that a person's chances of being killed were higher on American roads than in the battlefields of Vietnam.

This report was instrumental in the passage of the Highway Safety Act of 1966, which established the cabinet level Department of Transportation and placed it in charge of emergency medical services improvement through its National High Traffic Safety Administration. The act authorized the DOT to develop national standards for EMS and to grant funds for research and development of EMS systems.

At the same time, cardiologist J. F. Pantridge and his colleagues discovered that patients' chances of surviving cardiac arrest were significantly greater if they were resuscitated in the field, than in the hospital. The mobile cardiac care unit created by Pantridge inspired physicians in New York, Seattle, Los Angeles, and elsewhere, to begin prehospital cardiac care services, ushering in the era of advanced life support.

In the late 1960s, systems were developed that could transmit a patient's electrocardiogram to the hospital emergency department by radio, in addition to allowing EMS personnel to speak directly with a doctor in the ED. When these telemetry systems proved successful, EMS systems around the country began using radio for telemetry and for ambulance dispatch.

With the development of paramedic units and mobile intensive care units, rescue personnel could administer drugs, defibrillate patients, and perform other medical procedures in the field and en route to the hospital.

In 1974, President Gerald Ford signed the first National Emergency Medical Services Week proclamation. The observance has grown to include events in every state and territory in the U.S. honoring emergency personnel and educating the public about the EMS system.

The past thirty years have brought widespread change in the availability and quality of emergency care in the United States. Due to the efforts of EMS providers and the support of the American public, we have seen the development of a nationwide system for delivery of emergency care by trained individuals using specialized equipment. Emergency care has developed into a medical specialty and a professional occupation.