Chapter 1: Emergency Medical Services

INTRODUCTION

EMS is the extension of emergency medical care into the prehospital setting. The concept of bringing care to the sick or injured dates back to Roman times. However, today's EMS systems have their roots in legislative and clinical developments of the 1960s and 1970s. The 1966 report "Accidental Death and Disability—The Neglected Disease of Modern Society" highlighted the deficiencies of prehospital care for trauma victims, which were attributable to inadequate equipment and provider training. Up until that time, more than half of ambulance services were run by funeral homes because hearses were among the few vehicles able to transport a stretcher. The National Highway Safety Act of 1966 established the Department of Transportation and made it the lead agency responsible for upgrading EMS systems nationwide.¹

In 1967, J. F. Pantridge began using a physician-staffed mobile coronary care unit in Belfast, Northern Ireland, to extend cardiac care into the prehospital setting. By doing so, he was able to reduce mortality among myocardial infarction patients.² Using physicians to staff ambulances never gained popularity in the United States. However, in the late 1960s and 1970s, nonphysician prehospital personnel in the United States began to learn advanced medical skills, including IV placement, administration of medications, cardiac rhythm interpretation, and defibrillation.³

The U.S. EMS Systems Act of 1973 set aside large federal grants to develop regional EMS systems across the country. Approximately 300 EMS regions were established and became eligible for federal funding. To receive funding, the Act required that EMS systems address 15 key elements (Table 1-1). These elements form the foundation of many EMS systems today.⁴

The 1970s became something of a Golden Age for EMS in the United States. The U.S. Department of Transportation developed curricula for emergency medical technicians, paramedics, and first responders. EMS communications systems were formalized. In 1972, the Federal Communications Commission recommended that 9-1-1 be implemented as the emergency telephone number nationwide. The concept of designated trauma centers within EMS systems was introduced, the idea being that EMS personnel would transport seriously injured patients preferentially to these facilities.

The Omnibus Budget Reconciliation Act of 1981 eliminated direct federal funding for EMS. Instead, federal funds were given to states in the form of block grants. The result was a decrease in overall funding of EMS as well as decreased coordination of EMS systems. EMS systems took on a decidedly local flavor, with great variation between systems ...