Chapter 2. Prehospital Emergency Services

Development of modern prehospital emergency medical services (EMS) stems 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 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.

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 essentials: medical direction and system financing.

Multiple changes have occurred over the ensuing years, and each component of the EMS system has gone through many stages of development. Federal financing has virtually been abolished by the Consolidated Omnibus Budget Reconciliation Act, which has shifted the burden on state and local agencies. In 1988, the Statewide EMS Technical Assessment Program was established by NHTSA and defined elements necessary to all EMS systems.

Communications

Communications are a critical part of prehospital emergency care. From universal access for the public to the EMS system, to adequate radio space for providers to communicate with each other in spite of disaster, communications are the lifeblood of EMS.

The 911 universal access system provides entry into the emergency system. The Wireless Communications and Public Safety Act of 1999 was enacted with the goal of implementing 911 as the universal access to emergency services. Enhanced 911 allows automatic reporting of ...