Chapter 1: Introduction to Emergency Medical Services
Topics
● The Emergency Medical Services System
● Components of the EMS System
● The EMS Role in Public Health
● Research
● Special Issues
The Emergency Medical Services System
How It Began
● 1790s
○ French began to transport wounded soldiers away from the scene and battle for
care by physicians
○ Earliest documented Emergency Medical Service
● Civil War
○ Clara Barton began emergency service for wounded and later helped establish
American Red Cross
● World War I
○ Volunteer ambulance corps
● Korea/Vietnam
○ Medical teams produced advances in field care
○ Battlefield advances led to civilian advances such as specialized emergency
medical centers devoted to the treatment of trauma
● Nonmilitary ambulance services began operating in early 1900s in U.S.
○ Transport services only with little or no emergency care
○ Did not develop in smaller communities until late 1940s
○ Operated by local undertaker or fire service
○ Need to organize systems for emergency prehospital care and train personnel
recognized
EMS Today
● 1966
○ Department of Transportation charged with developing EMS standards
● 1970
○ Founding of the National Registry of EMTs (NREMT)
● 1973
○ National Emergency Service Systems Act passed by Congress
NHTSA Standards of EMS Systems
1. Regulation and policy
● Each state establishes laws, a lead EMS agency, a funding mechanism, policies,
procedures, and regulations
2. Resource managements
● Centralized coordination of emergency treatment and training
, 3. Human resources and training
● Assure EMS personnel are trained and certified to minimum standards
4. Transportation
● Provide safe, reliable transportation
5. Facilities
● Transport to closest appropriate facility
6. Communications
● Universal system access number (911)
● Dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-hospital, and
hospital-to-hospital communications
7. Public information and education
● Educate public about their role in EMS, access to EMS, prevention of injury
8. Medical direction
● Medical Director is accountable for EMS personnel within system
9. Trauma systems
● Develop trauma triage, transport, and treatment protocols
10.Evaluation
● Establish program for evaluating and improving effectiveness (QI, QA, TQM)
Components of the EMS System
● Emergency medical dispatchers
○ Activation of EMS in response to patient
● EMS responders
○ Emergency medical responders and EMTs
● Emergency department/hospital
○ Doctors, nurses, allied health personnel
● Specialized care facilities
○ Trauma centers
○ Burn centers
○ Pediatric centers
○ Cardiac centers
○ Stroke centers
Accessing the EMS System
● 911 telephone access
○ Available in most communities
● Enhanced 911
○ Provides caller number and location for landline phones
● Emergency medical dispatchers
○ Can provide instructions to callers on how to provide emergency care until EMS
personnel arrive
○ Research has consistently pointed to the importance of early access and prompt
initiation of emergency care and CPR
Topics
● The Emergency Medical Services System
● Components of the EMS System
● The EMS Role in Public Health
● Research
● Special Issues
The Emergency Medical Services System
How It Began
● 1790s
○ French began to transport wounded soldiers away from the scene and battle for
care by physicians
○ Earliest documented Emergency Medical Service
● Civil War
○ Clara Barton began emergency service for wounded and later helped establish
American Red Cross
● World War I
○ Volunteer ambulance corps
● Korea/Vietnam
○ Medical teams produced advances in field care
○ Battlefield advances led to civilian advances such as specialized emergency
medical centers devoted to the treatment of trauma
● Nonmilitary ambulance services began operating in early 1900s in U.S.
○ Transport services only with little or no emergency care
○ Did not develop in smaller communities until late 1940s
○ Operated by local undertaker or fire service
○ Need to organize systems for emergency prehospital care and train personnel
recognized
EMS Today
● 1966
○ Department of Transportation charged with developing EMS standards
● 1970
○ Founding of the National Registry of EMTs (NREMT)
● 1973
○ National Emergency Service Systems Act passed by Congress
NHTSA Standards of EMS Systems
1. Regulation and policy
● Each state establishes laws, a lead EMS agency, a funding mechanism, policies,
procedures, and regulations
2. Resource managements
● Centralized coordination of emergency treatment and training
, 3. Human resources and training
● Assure EMS personnel are trained and certified to minimum standards
4. Transportation
● Provide safe, reliable transportation
5. Facilities
● Transport to closest appropriate facility
6. Communications
● Universal system access number (911)
● Dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-hospital, and
hospital-to-hospital communications
7. Public information and education
● Educate public about their role in EMS, access to EMS, prevention of injury
8. Medical direction
● Medical Director is accountable for EMS personnel within system
9. Trauma systems
● Develop trauma triage, transport, and treatment protocols
10.Evaluation
● Establish program for evaluating and improving effectiveness (QI, QA, TQM)
Components of the EMS System
● Emergency medical dispatchers
○ Activation of EMS in response to patient
● EMS responders
○ Emergency medical responders and EMTs
● Emergency department/hospital
○ Doctors, nurses, allied health personnel
● Specialized care facilities
○ Trauma centers
○ Burn centers
○ Pediatric centers
○ Cardiac centers
○ Stroke centers
Accessing the EMS System
● 911 telephone access
○ Available in most communities
● Enhanced 911
○ Provides caller number and location for landline phones
● Emergency medical dispatchers
○ Can provide instructions to callers on how to provide emergency care until EMS
personnel arrive
○ Research has consistently pointed to the importance of early access and prompt
initiation of emergency care and CPR
