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EMS is the extension of emergency medical care into the prehospital setting. The concept of bringing medical care to the sick or injured dates back to Roman times. However, EMS systems as we know them today have their roots in legislative and clinical developments of the 1960s and 1970s. The 1966 report, Accidental Death and Disability—The Neglected Disease of Modern Society, highlighted the deficiencies of prehospital care for trauma victims, which were attributable to inadequate equipment and provider training. Up until that time, more than half of ambulance services were run by funeral homes because hearses were among the few vehicles able to transport a stretcher. The National Highway Safety Act, passed the same year, established the U.S. Department of Transportation and made it the lead agency responsible for upgrading EMS systems nationwide.1

In 1967, J. F. Pantridge began using a physician-staffed mobile coronary care unit in Belfast, Northern Ireland, to extend cardiac care into the prehospital setting. By doing so he was able to reduce mortality among myocardial infarction patients.2 The concept of using physicians to staff ambulances never gained popularity in the U.S. However, in the late 1960s and 1970s, prehospital personnel in the U.S. began to learn advanced medical skills, including IV placement and administration of medications, cardiac rhythm interpretation, and defibrillation of cardiac arrest patients.3

The U.S. EMS Systems Act of 1973 set aside large federal grants to develop regional EMS systems across the country. Approximately 300 EMS regions were established and became eligible for federal funding. To receive funding, the Act required that EMS systems address 15 key elements (Table 1-1). These 15 elements form the foundation of many EMS systems in their present form.4

Table 1-1 Fifteen Key Elements of EMS Systems Defined by U.S. EMS Systems Act of 1973

The 1970s became something of a Golden Age for EMS in the U.S. The U.S. Department of Transportation developed curricula for EMTs, paramedics, and first responders. EMS communications systems were formalized. In 1972, the Federal Communications Commission recommended that 911 be implemented as the emergency telephone number nationwide. The concept of designated trauma centers within EMS systems was introduced, the idea being that EMS personnel would transport seriously injured patients preferentially to these facilities. Even the general public was caught up in the enthusiasm for EMS, demonstrated by the popularity of the long-running 1970s television series “Emergency,” which chronicled the lives of Los Angeles County firefighter/paramedics John Gage and Roy DeSoto.

The Omnibus Budget Reconciliation Act of 1981 eliminated direct federal ...

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