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Development of modern prehospital emergency medical services (EMS) stem primarily from lessons learned from providing medical care to soldiers in military conflicts and from government mandates.

In the 1960s, the President’s Committee for Traffic Safety recognized the need to address health, transportation, and medical care in order to reduce fatalities and injuries on our nation’s roadways.

In 1966, the National Academy of Science published a report entitled Accidental Death and Disability: The Neglected Disease of Modern Society. It described deficiencies in prehospital care regarding ambulance systems and the hazardous conditions of emergency care provision. The issues raised in this survey compounded with public outcry prompted the drafting of federal legislation, the Highway Safety Act of 1966. The legislation was intended to help states develop programs to improve emergency care. It required each state to have a highway safety program that complied with uniform federal standards including emergency services. Initial National Highway Transportation Safety Administration (NHTSA) efforts were focused on improving the education of prehospital personnel. Funding was also provided to develop state emergency services offices. International activity around the same time included Professor Frank Pantridge (1916–2004) and colleagues demonstrating improvement in patient outcomes by outfitting cardiac defibrillators on ambulances in Belfast, Ireland.

The first national conference on EMS resulted in the development of a curriculum, certification process, and national registry for EMS personnel. In the 1970s, EMS systems were established by the Department of Transportation (DOT)–NHTSA in selected areas around the country to provide standardized ambulance services. As prehospital services expanded, so did the role of the EMS provider. Along with this role change came increased training and an expanded scope of practice. Today, the EMS provider is an important player in the continuum of emergency medical treatment from the prehospital setting to definitive, hospital-based care.


Public law 93-154: Emergency Medical Services System Act of 1973 identified the following essential components of an EMS system:

  1. Communications

  2. Training

  3. Manpower

  4. Mutual aid

  5. Transportation

  6. Accessibility

  7. Facilities

  8. Critical care units

  9. Transfer of care

  10. Consumer participation

  11. Public education

  12. Public safety agencies

  13. Standard medical records

  14. Independent review and evaluation

  15. Disaster linkage

Unfortunately, this neglected two other essential components that are critical in the provision of EMS care today: physician-led medical direction and system financing.

Multiple changes have occurred over the years; each component of the EMS system has gone through many stages of development. The Consolidated Omnibus Budget Reconciliation Act, which has shifted the burden to state and local agencies, has virtually abolished federal financing. In 1988, the Statewide EMS Technical Assessment Program was established by NHTSA and defined elements necessary to all EMS systems. However, the Technical Assessment Program did not provide funding or other mechanisms to support state and local agencies that needed to change to meet these new requirements. Today, ...

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