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HISTORY OF THE EMS SYSTEM

Category: EMS Operations

Topic: EMS Systems

Level: EMT

18 minute read

The first use of ambulances occurred during the American Civil War. The first civilian ambulance service was established in 1865 in Cincinnati, Ohio. Initially, they were only for transporting and not emergency care. Funeral homes operated some, and any ambulances that did any sort of medical care were typically run by the fire department.

President Lyndon B. Johnson and the President's Commission on Highway Safety of the National Academy of Sciences published a report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society"  (also known as the EMS White Paper), and this document, along with the National Highway Traffic Safety Act, provided a federal standard for creating EMS systems.

In 1996, the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA) published the highly regarded consensus document titled the EMS Agenda for the Future, commonly referred to as "the Agenda." This document describes the vision for EMS of the future and outlines the methods by which the plan should be executed.

The Technical Assistance Program of the NHTSA has developed a set of Assessment Standards which set standards in certain categories, as outlined below, for EMS agencies nationwide. Each state must have regulations that create funding for EMS, designate a lead EMS agency, and means of establishing and maintaining provider and agency certifications.

Resources should be centrally managed so that well trained and equipped providers can give care to everyone needing it and provide timely transport to appropriate facilities: 

  • Anyone actually providing care on an ambulance should be at least the EMT provider level.
  • Safe and reliable means of transportation, whether ambulances, fixed-wing aircraft, or helicopters.
  • Acutely ill or injured patients should be transported to the NEAREST appropriate facility.

 

EMS Prior to World War I

1485 – Siege of Malaga, first recorded use of ambulance by military, no medical care provided

1800s – Napoleon designated vehicle and attendant to head to battlefield

1860 – first recorded use of medic and ambulance use in the United States

1865 – The first use of ambulances occurred during the American Civil War.

The first civilian ambulance service was established in 1865 in Cincinnati, Ohio. Initially, they were only for transporting and not emergency care. Funeral homes operated some, and any ambulances that did any sort of medical care were typically run by the fire department.

1869 – First ambulance service, Bellevue Hospital in New York, NY.

1899 – Michael Reese Hospital in Chicago operates automobile ambulance EMS Between World War I and II.

1900s – Hospitals place interns on ambulances; first real attempt at quality scene and transport care.

1926 – Phoenix Fire Department enters EMS.

1928 – First rescue squad launched in Roanoke, VA.

Squad implemented by Julien Stanley Wise and named Roanoke Life Saving Crew.

 

World War II

1940s Many hospital-based ambulance services shut down due to lack of manpower resulting from WW II.

City governments turn service over to police and fire departments.

No laws on minimum training.

Ambulance attendance became a form of punishment in many fire depts.

 

Post-WW II

1951 – Helicopters used during the Korean War.

1956 – Mouth-to-mouth resuscitation developed by Dr. Elan and Dr. Safar.

1959 – First portable defibrillator developed at Johns Hopkins Hospital.

1960 – LAFD puts medical personnel on every engine, ladder, and rescue company.

1966 – EMS Guidelines – Highway Safety Act, Standard 11.

1966 – Delivery of pre-hospital care using ambulances by Dr. Frank Pantridge in Belfast, Northern Ireland.

1966 – President Lyndon B. Johnson and the President's Commission on Highway Safety of the National Academy of Sciences published a report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society" also known as the EMS White Paper.

This document, along with the National Highway Traffic Safety Act, provided a federal standard for creating EMS systems. It addressed:

  • Lack of uniform laws and standards.
  • Ambulances and equipment of poor quality.
  • Communication lacking between EMS and hospital.
  • Training of personnel lacking.
  • Hospitals used part-time staff in ED.
  • More people died in auto accidents than in Vietnam War 1967 – AAOS creates “Emergency Care and Transportation of the Sick and Injured.”
  • First textbook for EMS personnel.

1968 – Task Force of the Committee of EMS drafts basic training standards, results in “Training of Ambulance Personnel and Others Responsible for Emergency Care of the Sick and Injured at the Scene and During Transport” by Dunlop and Associates.

1968 American Telephone and Telegraph reserves 9-1-1 for emergency use.

1969 – Dr. Eugene Nagel launches Nation’s first Paramedic program in Miami.

1969 – The Committee on Ambulance Design Criteria published “Medical Requirements for Ambulance Design and Equipment.”

1970 - Use of Helicopters in EMS was explored with Project CARESOM (Coordinated Accident Rescue Endeavor-State of Mississippi) through a federal grant providing 3 civilian helicopter ambulances at 3 different locations in Mississippi. After the 15 month project, the Hattiesburg base remained in place as it was a successful exploration in better patient outcomes.

1970 – National Registry of Emergency Medical Technicians established.

1971 – The Committee on Injuries of the AAOS hosts national workshop on training for EMTs.

1972 – Department of Health, Education and Welfare directed by President Nixon to develop new ways to organize EMS.

1972 – Departments of Defense and Transportation from helicopter evacuation service.

1972 – TV show “Emergency!” begins 8-year run 1973 – EMS Systems Act of 1973 passed.

1973 – Star of Life developed by DOT.

1973 – St. Anthony’s Hospital in Denver starts Nation’s first civilian aeromedical transport service.

1974 – Department of Health, Education and Welfare published guidelines for developing and implementing EMS Systems.

1974 – Federal report discloses that less than half of ambulance personnel completed DOT 81-hour course.

1975 – American Medical Association recognizes Emergency Medicine.

1975 – University of Pittsburgh and Nancy Caroline, M.D. awarded contract for first EMT-Paramedic National Standard Curriculum.

1975 – National Association of EMTs is formed.

1983 – The EMS for Children Act passed 1985 – National Association of EMS Physicians formed.

1990 – The Trauma Care System Planning and Development Act is passed.

1991 – The Commission on Accreditation of Ambulance Services sets standards and benchmarks for ambulances services.

1996 – the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA) published the highly regarded consensus document titled the EMS Agenda for the Future, commonly referred to as the Agenda.

This document describes the vision for EMS of the future and outlines the methods by which the plan should be executed.