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Key Points

  • Emergency medical services (EMS) is the extension of emergency medical care into the prehospital setting.

  • The U.S. EMS Systems Act of 1973 established key elements for EMS systems to receive funding.

  • In 2012, the American Board of Medical Specialties approved EMS as a subspecialty.


Emergency medical services (EMS) is the medical specialty that involves the delivery of prehospital care. The use of the term “EMS” may refer solely to the prehospital element of care or be part of an integrated system, including the main care provider, such as a hospital.

Federal funding for emergency medical services came with the U.S. EMS Systems Act of 1973, which established 15 key elements that must be addressed by systems to receive funding. The elements are used here as an outline for discussion.


The workforce providing prehospital care varies largely based on population density. Urban areas typically have paid providers serving through government agencies or as public safety officers in large public venues (airports, amusement parks, etc). Volunteers are more commonly found in suburban, rural, and wilderness areas.


The U.S. Department of Transportation (DOT) National Highway Traffic Safety Administration (NHTSA) National Standard Curriculum for prehospital care providers historically outlined 4 levels of training: first responder, EMT-basic, EMT-intermediate, and EMT-paramedic. Currently, these levels are being transitioned to 4 nationally standardized levels of certification: emergency medical responder (EMR), emergency medical technician (EMT), advanced EMT (AEMT), and paramedic. Each level of training infers a specific role, skill set, and knowledge base (Table 9-1). EMS provider training at all levels emphasizes airway, breathing, and circulation (ABCs) and provider scene safety as priorities in patient care. Although significant efforts have been made to standardize education and certification throughout the United States, variability exists from state to state in scope of practice and specific medication usage by each level of prehospital provider.

Table 9-1.

Prehospital care providers.

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