Emergency Medical Services in The United States - History

History

Civilian ambulance services in the United States began in Cincinnati and New York City in 1865 and 1869, respectively. Hospital interns rode in horse drawn carriages designed specifically for transporting the sick and injured.

The first volunteer rescue squads organized around 1920 in Roanoke, Virginia, Palmyra, New Jersey, and along the New Jersey coast. Gradually, especially during and after World War II, hospitals and physicians faded from prehospital practice, yielding in urban areas to centrally coordinated programs. These were often controlled by the municipal hospital or fire department. Sporadically, funeral home hearses, which had been the common mode of transport, were being replaced by fire department, rescue squad and private ambulances.

Prior to the 1970s, ambulance service was largely unregulated. While some areas ambulances were staffed by advanced first-aid-level responders, in other areas, it was common for the local undertaker, having the only transport in town in which a person could lie down, to operate both the local furniture store (where he would make coffins as a sideline) and the local ambulance service. However, after the release of the National Highway Traffic Safety Administration's study, "Accidental Death and Disability: The Neglected Disease of Modern Society", (known in the EMS trade as the White Paper) a concerted effort was undertaken to improve emergency medical care in the pre-hospital setting.

In the late 1960s, Dr. R Adams Cowley was instrumental in the creation of the country's first statewide EMS program, in Maryland. The system was called the Division of Emergency Medical Services (now known as the Maryland Institute for Emergency Medical Services and Systems). Also in 1969, Cowley obtained a military helicopter to assist in rapidly transporting patients to the Center for the Study of Trauma (now known as the R Adams Cowley Shock Trauma Center), a specialized hospital that he had started for the purpose of treating shock. This service was not only the first statewide EMS program, but also the beginning of modern emergency medical helicopter transport in the United States.

The first civilian hospital-based medical helicopter program in the U.S., Flight For Life Colorado, began in 1972 with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado.

National EMS standards for the US are determined by the U.S. Department of Transportation and modified by each state's Department of EMS (usually under its Department of Health), and further altered by Regional Medical Advisory Committees (usually in rural areas) or by other committees, or even individual EMS providers. In addition, the National Registry of Emergency Medical Technicians, an independent body, was created in 1970 at the recommendation of President Richard M. Nixon in an effort to provide a nationally accepted certification for providers and a nationwide consensus on protocols. Currently, National Registry certification is accepted in some parts of the U.S., while other areas still maintain their own, separate protocols and training curricula.

A significant event in the development of modern standards of care in the U.S. was a report published in 1966 by the National Academy of Sciences entitled "Accidental Death and Disability: The Neglected Disease of Modern Society", commonly referred to as "the White Paper." In this study, it became apparent that many of the deaths occurring every day were unnecessary, and could be prevented through a combination of community education, stricter safety standards, and better pre-hospital treatments.

In particular, in the US state of California, in Seattle, Washington state called Medic One, and in Miami, projects began to include paramedics in the EMS responses in the early 1970s. Groups in Pittsburgh, Pennsylvania, Charlottesville, Virginia and Portland, Oregon were also early pioneers in pre-hospital emergency medical training. Despite opposition from firefighters and doctors, the program eventually gained acceptance as its effectiveness became obvious. Furthermore, such programs became widely popularized around North America in the 1970s with the NBC television series, Emergency! which, in part, followed the adventures of two Los Angeles County Fire Department paramedics as they responded to various types of medical emergency. James O. Page served as the series technical adviser and went on to become integral in the development and EMS in the U.S. The popularity of this series encouraged other communities to establish their own equivalent services.