Chapter 1 - Introduction

Hx of EMS

1800: Chief physician in napoleons army created first prehospital system for triage and transport of pts.

1860-1970: Civilian ambulance services began in Cincinnati, OH (1865) and New York, NY (1869).

1928: First rescue squad formed in Roanoke, VA and more formed along east-coast, mainly NJ.

1940s: Shortage of medical personnel; work turned over to FD and PD with varying degrees of standards and feelings.

*WW1 and WW2 battlefield corps evolved as new techniques were learned and improved field care.

1950s: During Korean War, researchers determined bringing hospital-type services closer to the battle field would improve survival. Helicopters (1951) were used to bring pts to Mobile Army Surgical Hospitals (MASH) units.

1956: Dr. James Elan and Dr. Peter Safar developed mouth-to-mouth resuscitation.

1965: “The white paper” aka “Accidental Death and Disability: The neglected disease of Modern Medicine” was written and published 1966 by National Academy of Sciences and National Research Council. It outlined issues such as poor quality or non-existent ambulance equipment, varying standards of education and care, lack of EMS communication with hospitals, and poor hospital staffing.

1966: US Congress passed National Highway Safety Act and in turn created US DOT who acts as authority and financial support to create BLS and ALS programs.

1967: American Freedom House Ambulance was founded. First black paramedics. This program helped lay the groundwork for modern EMS, aided in setting the national standards, and revolutionized pre-hospital care.

1968: Task Force of the Committee of EMS drafted basic training standards and principles of 911 system

1969: Dr. Eugene Nigel, aka “Father of paramedicine”, created the first true paramedic program. Standards for ambulance design and equipment are published.

1975: American Medical Association recognized Emergency Medicine as it’s own medical specialty.

1988: National Highway Traffic Safety Administration (NHTSA) defined EMS essential elements.

Licensure: How states control who is allowed to practice as a medical professional.

Certification: A process in which a person, institution, or program is evaluated and recognized as meeting certain predetermined standards.

Registration: A recognized board of registration holds records of your education, state or local licensure, and recertification.

Credentialing: Occurs at a local level, typically by medical director; Medical director determines which skills health-care providers are allowed preform. Skills cannot supersede rules and guidelines set by the state.

Reciprocity: Granting certification to a provider from another state or agency. This is usually done through the NREMT.

Most EMS-providers who are integrated into the FD are paid and operated by the municipal government. Think Florrisant Valley FD.
Some areas are staffed by unpaid volunteers and others are staffed by volunteers who are paid per call.
EMS may have a separate management system from the fire-side that is operated independently of the FD.
Fire and EMS personnel may respond together to major incidents if additional staffing is needed.
Increased trend of fire-based EMS roles due to less incidence of fire and increased medical calls.

Some municipalities may establish and operate an ambulance that is separate of other first responder agencies. Think SCCAD.
A independent ambulance agency may offer their services under contract to a municipality that is unable to provide their own agency.
Typically operate separately from FD. Fire services may be requested as FD may not be dispatched automatically and vice versa applys for EMS in regards to the FD.

Operate similarly to municipal EMS.
May offer contract services to municipalities and hospitals.
Some follow 24-hour shifts and other practice status systems management. Status Systems Management allows EMS personnel to report to a single location, grab an ambulance, and stage in a designated location. Think AMR.

Hospital based services typically offer IFTs and airmedical services.
Some also offer 911 response and paramedic intercept services.
Paramedics working under this system may be required to staff different areas in the area. In down time, typically staff ED. Think Macon Co.

There are various roles and expectations that may be offered as pre-hospital care continues to grow.
May companies, such as oil companies, may staff their own medical response teams and medical facilities.
Companies may offer positions staffing specific locations such as national parks, events, and amusement parks. Think Acucare.

The EMS system is a complex network of coordinated services that provide varying levels of care throughout the community.
Publics expectation of EMS may be skewed due to inaccurate media representations. It is apart of our role to educate the public.
Factors that play a role in the outcome and chance of PT survival include the following: Bystander care, Dispatch + prearrival instructions, response mode + distance, Prehospital assessment + level of care provided, transportation, ED care, Definitive Care, and Rehab.
First contact in an emergency is typically a dispatcher.
Being active in the community increases awareness of local resources and capabilities.

Licensure of EMS personnel is usually a state function and subject to laws and regulations of aforementioned state.
Scope of practice, education, and relicensure requirements may vary state-to-state.