Our EMS community is Texas proud! Over the last 30 years, EMS has moved from a transportation service, to medical transportation, to out-of-hospital healthcare. That is a quantum leap in terms of the innovations in equipment, the education and knowledge that is needed to analyze situations and evaluate healthcare needs and the sophistication required to manage a service that responds immediately with appropriate equipment and staffing.
Pre-hospital emergency medical services (EMS) first came into public awareness during the 70s as the nation followed the weekly exploits of Johnny Gage and Roy DeSoto as they roared around Los Angeles County on Squad 51. More recently Rescue 911, resurrected public interest in EMS with weekly stories of courage and dedication. While both shows spawned interest, they did not tell the real story of EMS in America.
Although emergency care response can be traced back to early Roman and Napoleonic Wars, the first ambulance service was initiated by the U. S. Army in the 1860's to serve as transport for fallen soldiers during the Civil War. This service simply allowed transport of fallen individuals from battlefields to crudely-constructed field treatment stations. As late as the early 1960's, EMS was not viewed as a component of the healthcare system, but rather simply as a transport component as it had been during the Civil War 100 years earlier. In fact many of the first providers in the nation and Texas were funeral homes with a single, inadequately-trained crew member who responded to death and emergency calls alike. The first federal agency assigned responsibility to oversee emergency health services was the Department of Health, Education and Welfare. Their role in EMS was limited to disaster planning and information dissemination with no active effort directed toward treatment of the ill and injured, or development of educational tools related to their profession.
The mid-60's proved pivotal for EMS with the passing of the Highway Traffic Safety Act and the publication of Accidental Death and Disability: The Neglected Disease of Modern Society written by a commission representing the National Academy of Sciences; National Research Council, and Division of Medical Services in 1966. The Department of Transportation-National Highway Traffic Safety Administration (DOT-NHTSA) was assigned responsibility for and oversight of guideline development related to the provision of EMS. This included the first attempt at standardized curriculum development and designing standards for ambulances and communications systems, to name a few. The death and disability report was the first attempt at identifying problems within EMS and establishing standards for an EMS system, a multi-faceted concept that began to reshape the face of the emergency healthcare system across the nation. This report established a gold standard for EMS system design and while over 30 years old, it continues to provide a valid series of benchmarks for systems to reach for and address. More importantly, this report led EMS toward inclusion in the healthcare industry and established EMS as part of the continuum of patient care. During this time, the President's Commission on Highway Safety recommended that emergency care of the injured be made a "community action program," a process espoused today by The Texas Department of Health Bureau of Emergency Management (bureau). While the report and President's Commission provided a major boost to EMS, they were primarily concerned with injured patients and virtually ignored all other clinical areas with which EMS acts on a daily basis.
The prehospital transportation system received an additional boost in 1970 when the Department of Defense combined resources with DOT and Department of Health, Education and Welfare (DHEW) to create the MAST (Military Assistance to Safety and Traffic) program. Following lessons learned during Vietnam, it was decided that the use of air resources to extricate seriously injured patients from accident sites to appropriate medical facilities would allow the greatest opportunity for survival because of reduced transport times. This system, still active today, plays an integral role in rural responses, especially in West Texas in both the single patient response and local disaster level mutual aid responses. In his 1972 State of the Union address, President Nixon directed the DHEW to "provide new ways of organizing EMS and providing care to accident victims." One result of this call to action was the passage of the Emergency Medical Services Systems Act of 1973, and the allocation of $185 million dollars over several years, for EMS system development. A key component of this legislation and associated funding was the intent to foster the development of regionalized systems, a process TDH continues to support.
The 80s were a period of growth and standardization for EMS, especially regarding patient care techniques and training. There were no major advances made relative to the 1966 report and trauma, so many of the previously designed standards remained intact. However, new advances in the treatment of the cardiac patient hit the scene, and EMS was thrust into new standards of care for cardiac victims. CPR as we know it today became the focus of a new public education drive, and the American Heart Association (AHA) came out with an Advanced Cardiac Life Support (ACLS) course which increased the impact that prehospital personnel could have on a cardiac patient.
The last part of the decade saw the advent of Prehospital Trauma Life Support (PHTLS) and Basic Trauma Life Support (BTLS) courses, and these too have become an integral part of EMS training.
The 90's era echoed the 80's a great deal, although debate was sparked as to the true role of EMS across the nation and centered around the question of whether its role is public safety or healthcare. It was recognized that some advances made in the profession were the result of EMS-initiated research and study. As a result, a greater emphasis has been placed on the profession generating its own research-based decisions and designs. There still exists a dearth of data, but strides have been made toward heightening awareness that data is necessary.
The white paper report published in 1966, and followed up by Injury in America (1985) focused on accidental death in the United States and went far as to label trauma as an American epidemic. As with any other epidemic, a strategic plan was formulated designed to address and reduce the impact, both financial and physical, of this disease process. the plan was important in numerous ways, but specifically because it identified EMS as an integral part of the healthcare industry and made a call for members of local government and the medical profession to take steps necessary to lay the groundwork for a standardized, unified prehospital system which would provide care across the nation.