Chapter 1: Emergency Medical Services

INTRODUCTION

EMS is the extension of emergency medical care into the prehospital setting. 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 of trauma victims, attributable to inadequate equipment and training. 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 provide prehospital cardiac care.² Physician staffing of ambulances never gained popularity in the United States. However, in the late 1960s and 1970s, nonphysician personnel began learning advanced skills, including IV administration of medications, cardiac rhythm interpretation, and defibrillation.³

The U.S. EMS Systems Act of 1973 made available federal grants to develop regional EMS systems. Approximately 300 EMS regions were established. 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 a Golden Age for EMS. 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 9-1-1 be adopted as the emergency telephone number nationwide. In addition, the concept of designated trauma centers was introduced, with the idea being that EMS personnel would transport injured patients preferentially to these facilities.

The Omnibus Budget Reconciliation Act of 1981 eliminated direct federal funding for EMS. Instead, federal funds were distributed as block grants. The result was a decrease in both EMS funding and coordination. EMS systems took on a decidedly local flavor, with great variation between systems. This trend has had long-term consequences for the field.¹

In 2011, the American Board of Emergency Medicine recognized EMS as its seventh subspecialty. The certification examination is based on the Core Content of EMS Medicine with four major content areas: Clinical Aspects of EMS Medicine, Medical Oversight of EMS, Quality Management and Research, and Special Operations.⁵

EMS SYSTEM OVERVIEW

A review ...