Chapter 1-1

Evolution of EMS Systems

• EMS systems have evolved from basic transportation to advanced care capabilities.
• Early EMS development was spurred by awareness and research, especially in rural areas.
• Public perception of EMS is influenced by media and personal experiences.
• Treating all people with dignity and respect and continuing education are important factors

Historical Figures

• Dr. Nancy Caroline and Dr. Peter Safar made significant contributions to prehospital emergency care.
• Dr. Safar is credited as the inventor of modern CPR.

Early EMS History

• 1487: First recorded use of ambulances during the siege of Malaga.
• 1800s: Napoleon's army developed a prehospital system for triage and transport.
• 1865: First civilian ambulance used in the United States in Cincinnati, Ohio.
• Late 1800s: First ambulance service started at Bellevue Hospital in New York City.
• Late 1800s: First automobile-type ambulance used at Michael Reese Hospital in Chicago.

20th Century Developments

• World War I and World War II: Hospital-based EMS services declined.
• 1920s: Phoenix Fire Department started a service similar to modern EMS.
• Late 1920s: Julian Stanley Wise launched the first Rescue Squad in Roanoke, Virginia.
• 1940s: EMS was turned over to fire and police due to lack of personnel and training standards.
• World Wars: Continuous evolution of field treatment and transport systems occurred.
• 1950s-1960s: Military medical researchers recognized that bringing hospital-type services closer to the field improved patient survival.
• 1950s: Helicopters were used during the Korean War and MASH units were implemented.
• Mouth-to-mouth resuscitation was developed by Drs. Alan and Safar.
• 1959: Portable defibrillator was developed by Frank Pantridge.
• Late 1950s-Early 1960s: Focus shifted to bringing the hospital to the patient.
• Development of mobile intensive care units.

The White Paper (1965)

• Instrumental paper also known as "Accidental Death and Disability: The Neglected Disease of Modern Society"
• Findings: Lack of uniform laws and standards, poor quality or non-existent ambulances and equipment, lack of communication between EMS and hospitals, lack of personnel training, high motor vehicle crash mortality.
• Outlined 10 critical points to establish a functioning system.
• Led to the National Highway Safety Act.

National Highway Traffic Safety Act (1968)

• A task force of the Committee of EMS was created.
• Created basic training standards and principles of a 911 system.

1969 Key Developments

• Dr. Nagel in Miami, Florida created the first true paramedic program and telemetry system.
• Referred to as the father of paramedicine
• Standards for ambulance design and equipment were published.

1970s Developments

• Helicopters for medical transport became available.
• National Registry of Emergency Medical Technicians was established.
• Emergency Care and Transportation of the Sick and Injured was published, the basis for many EMT training programs
• AAOS began training EMTs through a national workshop using the Nancy Caroline textbook.
• TV show "Emergency" focused on EMS.
• 1973: EMS Systems Act defined 15 required components of an EMS system, emphasizing regional development and trauma care.
• 1974: A federal report disclosed that fewer than half of ambulance personnel completed sufficient training.
• 1975: AMA recognized emergency medicine as its own branch.
• 1977: First National Standard curriculum for paramedics was developed by the US Department of Transportation.

1980s - 1990s

• Number of trained personnel grew significantly.
• NHTSA developed a 10 system element to help sustain an EMS system.
• Federal funding and staff for EMS were reduced.
• Responsibility for EMS was transferred to the states, leading to funding challenges.
• EMS for Children (EMSC) program was implemented in 1985.
• 1986: Amendment to the Public Safety Officers Benefit Program.
• Trauma systems development.

21st Century EMS Initiatives

• National EMS Quality Alliance (formerly EMS Compass) is measuring performance for EMS and healthcare partners.
• EMS training is being used in many other areas of healthcare.
• Community Paramedicine: Experienced paramedics receive advanced training to provide additional services.
• Additional capabilities aim to supplement, not replace, current healthcare modalities.
• Focus is on applying paramedic capabilities in underserved areas.