History of EMS

The concept of an American ambulance can be traced back to the Civil War when Clara Barton, founder of the American Red Cross, used horse drawn wagons to transport wounded soldiers. Although the injured were called patients and the wagons ambulances, in general little care was provided while on the way to the hospital and many soldiers simply bled to death. By the 1950’s nearly a century had passed but not much had changed in ambulance care. Although the horse drawn wagon was replaced by a funeral home hearse (doubling as an ambulance), typically little or no patient care was provided while on the way to the hospital. Even in cities with an organized ambulance service, patient treatment was minimal and the value of pre-hospital care had yet to be recognized. Development of the emergency room would come later too. In the 1950’s and early 1960’s many rural hospitals lacked even basic emergency facilities and often closed at night requiring the doctor to be summoned from home.

 

It was not until the Korean Conflict and the Vietnam War that trauma care began to change. The Mobile Army Surgical Hospital (MASH) was used with tremendous success. These portable hospitals were set up close to the battlefield in an effort to minimize the time between injury and surgery. Furthermore, the importance of spinal stabilization and field treatment were recognized as vital to a trauma patient’s survival. As a direct result, during the 1960’s and 1970’s development of the civilian emergency medical service (EMS) system was proposed.

In 1966 Congress passed the National Highway Safety Act in an effort to reduce the number of car accident deaths that were steadily rising across the country. The Act directed the U.S. Department of Transportation to develop standards for ambulance crew training and patient care. Finally in 1973, the National Emergency Services System Act was passed by Congress to establish a formal EMS system. By the 1970’s nearly every hospital offered emergency services and the public started to view the ambulance not merely as transportation, but as an extension of the hospital to the accident scene. As ambulance training improved, survival rates for trauma patients increased dramatically and the title "ambulance attendant" was replaced by emergency medical technician (EMT).

Meanwhile fire departments in Seattle, Los Angeles, Miami, and elsewhere were experimenting with an electrical device called a defibrillator. Medical research suggested that delivering a shock to the heart during cardiac arrest could revive the patient long enough to survive an ambulance trip to the hospital. In Los Angeles the very first patient to be defibrillated on the scene was saved. This early success led to federal funding and to the creation of a new healthcare professional called paramedic. By the early 1980’s fire department paramedic care was available in most cities across the country. Eventually, training for trauma care and cardiac care were combined into a single educational program for ambulance personnel. Today, EMT’s and paramedics are trained to asses, treat, and transport any type of medical emergency. For more information about the role of the EMT and paramedic in our emergency medical service system, visit the U.S. Department of Labor.

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