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What caused EMS to be what it is today?

Call 911, it’s an emergency!” Those are the words that no one cares to say or even hear for that matter. However, as we all know, for as long as there have been people, there have been emergencies. Surprisingly, emergency medical services (also known as EMS) have only been standardized and efficiently orchestrated in the United States within the last fifty years. That is good news for our generation, however, it has been a lengthy process to get this far.

Ambulance
Ambulance photographed at Fort Knox Historic Site, Maine

During the Civil War era, ambulance carts were invented out of necessity to assist battle men in saving their fellow soldiers from demise. Never was there a promise that a professionally-trained technician would be on board to assist in stabilizing the patient until they could reach appropriate medical care. As you can imagine, both World Wars provided excellent opportunities for medical teams to develop an efficient plan to assess and assist injuries in the field.  Surprisingly, this emergency service did not transfer over to include civilians until decades after and it wasn’t until 1966 that a US government-structured, public service format was presented by the National Academy of Sciences on Accidental Death and Disability. The document entitled, The Neglected Disease of Modern Society was reviewed by President Lyndon B. Johnson and was the first official document to purpose the use of “ambulance services, voice communication systems, emergency departments and intensive care units of hospitals”[i].  It stated that a concerning 52 million accidental injuries had killed, disabled, and permanently impaired hundreds of thousands of Americans and had cost citizens an aggressive $18 billion. The report declared succinctly, “Public apathy to the mounting toll from accidents must be transformed into an action program under strong leadership.”[ii] Car wrecks, work-related accidents, and incidents at home had gotten to such a staggeringly high number that people could no longer turn a blind eye and leave emergency health care in the hands of local or state government oversight. Furthermore, the report, colloquially known as the “White Paper,” referred to expert consultants who, after returning from wartime conditions in Korea and Vietnam, had asserted that “if seriously wounded, an injured person in civilian America had better chances of survival in the zone of combat than on the average city street.”[iii]

One of the major problems with emergency medical services was the personnel working on the ambulances. At that point, no standardized test or training program existed for emergency medical technicians. Even today, there are only two systems of delivering emergency health care that provide the basis for worldwide response teams: the Franco-German model and the Anglo-American model. The Franco-German model has medical doctors treating patients on the scene, bringing the hospital to the patient. Once the patient has been stabilized, he or she is taken directly to the hospital wards, not to an emergency room. The overarching organization emergency medical services fall under in this model is public health. On the other hand, the Anglo-American model involves paramedics transporting patients to emergency departments. These services fall under public safety organizations, similar to fire and police departments.[iv]

Image compliments of ems.gov.

Whether patients in need of emergency care were treated by doctors, assisted by paramedics, or the paramedics themselves with medical oversight, it was clear in the early days of emergency services that standardization for emergency medical technicians (EMTs) be put in place. The first nationally recognized curriculum, the EMT-A, was published in 1969 and paramedic programs today are accountable to higher authorities and often connected to colleges or universities.[v]

Even though medical personnel have been dealing with trauma and emergency medical situations for hundreds of years, the last fifty years have proved instrumental in the organization and standardization of emergency practices in America and worldwide. The fact is that EMTs and Paramedics save lives daily despite the grueling tasks of understaffed programs, ill-equipped ambulances and unoptimal conditions. There is so much left to conquer on the quest for perfect healthcare. To read more about the evolution of the US Emergency Medical Service and the evolution of the EMT, visit MMEMed.com.


[i] “Accidental Death and Disability: The Neglected Disease of Modern Society”. National Academy of Sciences. September 1966. https://www.ems.gov/pdf/1997-Reproduction-AccidentalDeathDissability.pdf

[ii] “Accidental Death and Disability”

[iii] “Accidental Death and Disability”

[iv] “Models of International Emergency Medical Services (EMS) Systems”. Sultan Al-Shaqsi. October 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191661/

[iv]  “Birth of EMS: The History of the Paramedic”. Dennis Edgerly. October 2013. http://www.jems.com/articles/print/volume-38/issue-10/features/birth-ems-history-paramedic.html?c=1