History of the EMS
Dr. Miada Mahmoud Rady
Ems - 472
Outline key historical
events that influenced
the development of
emergency
medical
services
(EMS)
systems.
Topics of the lecture
A. Introduction .
B. Definition of the EMS system.
C. EMS system development.
Introduction
 EMS has made significant advances over the last 30
years.
 The role of the paramedic has advanced accordingly.
 Originally, the primary role of the paramedic was
transportation.
 Paramedics now are highly trained health care
professionals.
EMS system
Definition :
A
comprehensive
network
of
personnel, equipment, and resources , established to
deliver aid and emergency medical care to the
community.
Simply ,
it is
Planned
configuration
Community
Resources
of
and
Personnel necessary to provide
immediate care to patients with
Sudden/Unexpected
Injury/Illness.”
EMS System Development
1
2
3
4
• Ancient times
• Military EMS
• The 20Th century
• Civilian EMS
EMS System Development
Ancient Times
֍ EMS systems have developed from the traditional
and scientific beliefs of many cultures:
֍Ancient Egyptians : used herbs and drugs as
medicine ,evidence of bandages and splints usage ,
performed surgeries and also referred to pulsation of
heart and abnormal motor functions associated with
brain injury.
EMS System Development
Military EMS
Military Used the First Organized Prehospital Care .
Covered cart was first ambulance.
Moved injured soldiers during Napoleonic wars.
EMS System Development
Military EMS
Napoleonic Wars :
→ First efforts of field care developed by one of
Napoleon’s surgeons , which implements a Prehospital
System designed to Triage and Transport the injured
from the battlefield to aid stations.
EMS System Development
The 20Th century
1. Civil War.
2. WW I.
3. WW II.
4. Korean War.
5. Vietnam War.
6. Iraq War.
EMS System Development
The 20Th century
 U.S. Civil War :
1. Triage and transport of wounded soldiers to improvised
hospitals in houses, barns, and churches .
2. Saw the beginning of organized medical care with people like
Clara Barton, who started to establish the American Red
Cross.
3. Immediate care in field hospitals with transport to hospitals
behind the lines by train was also started.
EMS System Development
The 20Th century
WW I :
1. Poor planning and excessive evacuation times caused high
mortality rates mostly due to hemorrhagic shock.
2. No antibiotics.
3. Blood transfusions were introduced.
4. Thomas half‐ring femur splint considered best trauma care.
EMS System Development
The 20Th century
 WW II:
1. Evacuation time: 4–6 hours
2. Antibiotics developed.
3. Plasma/blood transfusions became common.
4. Hospitals were closer to front line.
5. Fixed‐wing air transport began.
EMS System Development
The 20Th century
 Korean and Vietnam conflicts :
1. In the Korean War, Mobile Army Surgical Hospital
(MASH) units were used.
2. In both Korea and Vietnam, Helicopter Transport was used
for the wounded.
3. These wars also brought about the development of civilian
hospitals specializing in the treatment of trauma.
EMS System Development
The 20Th century
 Iraq War:
1. Tourniquets reintroduced.
2. Hemostatic agents were developed.
3. CAB concept developed.
Civilian EMS
 Non-military ambulance services began operating in
early 1900s in U.S.
 Often operated by hospitals, fire departments, or funeral
homes.
 No requirements or standards for equipment, crew
training, or ambulance design.
 Mouth-to-mouth resuscitation was developed by Drs.
Élan and Safar.
Civilian EMS
 The Portable Defibrillator was also developed by Johns
Hopkins Hospital .
 Mobile intensive care units (MICUs) were developed , it
were staffed by specially trained physicians , however
shortage of physicians led to training of non physician.
The white paper
 Also called “Accidental Death and Disability: The Neglected
Disease of Modern Society”.
 It was released in 1965 by National Academy of Science and
the National Research Council .
 It dealt with the high number of deaths from traffic collisions
due to inadequate emergency medical care.
 Provided great impetus for attention to be turned to the
development of EMS.
The white paper
Finding of the whitepaper included:
1. Lack of uniform laws and standards.
2. Poor-quality equipment.
3. Lack of communication between the hospital
and EMS teams.
4. Lack of training.
The white paper
 The White Paper finding outlined 10 critical points for
EMS Systems and Led to national Highway Safety Act
which created US Department of Transportation which
provided authority and finances for the development of life
support programs.
 The paper made 29 recommendations for ultimately improving
care for injured victims; which are related directly to out-offacility EMS.
Dr. Eugene Nagel
 1969 , Dr. Eugene created the first true paramedic programs
, he trained fire fighters with advanced emergency skills
 He also developed a telemetry system through which fire
fighters transmitted patients’ electrocardiograms to physicians
and received medical instructions from physicians based on it
 That why he was often called the Father of Paramedicine
 Standards for ambulance design and equipment were published
this year.
National Registry of Emergency
Medical Technicians
 1970s :
 The NREMT was founded in 1970 as a result of the
recommendations made by the Committee on
Highway Traffic Safety.
 It
was
established
to
standardize
examinations and certifications.
education,
1970 's
 1971: Emergency Care and Transportation of the Sick and
Injured ,
First EMT textbook , was
published by the
American Academy of Orthopedic Surgeons (AAOS).
 1973: Emergency Medical Services System Act was released ,
it defined 15 required components of an EMS system and
provided additional federal guidelines and funding for the
development of regional EMS systems.
1970 's
 1977: First National Standard Curriculum for Paramedics
developed by US DOT based on Nancy Caroline’s work.
1980 's and 1990 's
Number of trained personnel grew.
The National Highway Traffic Safety Administration
(NHTSA) developed 10 system elements to help sustain
EMS System.
Responsibility for EMS transferred to the states.
Major legislative initiatives e.g. EMS for Children (EMSC) program.
Summary
EMS has made significant advances over the last 30
years.
Military used the first organized prehospital care.
EMS made major changes after WWII
Non-military ambulance services began operating in
early 1900s in U.S.
HOME WORK
A
B
Clara Barton
Established to standardize
examinations and certifications
education,
Dr. Eugene Nagel
Also called “Accidental Death and
Disability: The Neglected Disease of
Modern Society
Johns Hopkins Hospital
Developed mouth to mouth
resuscitation
Drs. Élan and Safar.
Established the american red cross
NREMT
The Portable Defibrillator
The white paper
Created the first true paramedic programs
• Home work should be sent in ward document to E-mail no
later than next Monday .
ANY QUESTIONS ?