During the 1970's, improved care of the sick and injured in the prehospital phase became a crusade
led by concerned physicians, nurses, ambulance service providers, health care administrators,
elected officials, and private citizens. The movement was supported by statistics reflecting an
abysmal state of affairs. In 1972, a spokesman for the Ambulance Association of America stated,
"Possibly as many as 25,000 persons a year may be permanently disabled due to mishandling by poorly
trained ambulance personnel." The patient was being twice victimized, once by fate and once by
failure to receive quality emergency medical care.
The history of the National Registry of Emergency Medical Technicians, America's National EMT
certifying agency, spans the years 1970 to the present. It encompasses the nation's leap from the
mortician driven hearse/ambulance to today's standardized vehicles manned by well-trained EMTs and
Paramedics.
An enormous amount of activity has taken place in a brief period of time. The EMT has been
acknowledged as a bonafide member of the health care team. Excellent training programs have been
developed and a vital focus has been placed on continuing education. National standards have been
established and ambulance equipment essentials have been set. Recognition has been given to the
vital area of medical control. National accreditation of paramedic programs has been achieved.
Professional associations for the EMT have been organized, and the public has been jogged into
awareness of emergency medical services including its own self-help role.
Improvement of prehospital services affected in-hospital activities. The training of physicians and
nurses turned to the up-to-date skills of the emergency medical technician. Interaction of
emergency department personnel and the EMT was not without its "emery board" moments. However, with
improved patient care and enthusiastic public acceptance, a redefinition of turf has occurred. The
continuing growth of mutual respect between the professions presents an integrated team approach to
the care of the emergency victim.
In the 70's the scramble for Federal grant money resulted in the processing of mountains of paper.
The fine art of grantsmanship was in great demand and the hopes of communities across the land rose
and fell with the awarding of a 402, 1202, or seed moneys from the Robert Wood Johnson Foundation.
Between 1968 and 1979, the U.S. Department of Transportation gave over $140,000,000 in matching 402
grants to the ten DOT regions. Approximately $182,000,000 was awarded by DHEW to 543 grantees
between FY 1974 and FY 1979.
In the 70's, EMS meetings drew more attendees throughout the country than the circus, and the
atmosphere was decidedly three ring-electric, eclectic, and hectic. Registrants were bombarded with
terms like "medico legal", "traumatology", and "circular categorization". Ambulance personnel from
Jugville, Michigan, met their counterparts from Antlers, Oklahoma, and the community of EMS grew in
the common knowledge that what it was about was very important.
The fiction of TV's "Emergency" paled before the action of real-life EMTs as they lived the
spontaneous script of the streets. With every run made, EMTs added to their reputation as respected
members of the medical community. Death and disability statistics felt the impact, and the
gratitude of those served by quality care was boundless. The genesis of Emergency Medical Services
evolved from the "You call, we haul" or "Snatch'em and patch 'em" approach to today's systematic
response. Prehospital EMS was a shot in the arm to Americans...often administered through an IV
line.
As EMS evolved into the 1980's, the huge federal deficit began to take its toll on EMS funding.
State and local jurisdictions began to accept some funding responsibilities and ultimately so did
the consumers; our patients. "National" direction began to diminish and up sprang state by state
needs with local jurisdictions demanding more from the new funder; the "state". Standardization
became difficult to attain, universal agreement on issues only resolved when the lowest common
denominator could be agreed upon by every entity. The final product often looked like Swiss cheese
with no one accepting the final standard even though all took part in its development. The
consensus process for national standards failed to achieve its goals. EMS experienced its teenage
years; rapid growth, trendy ways of dress and makeup, a full size body without the maturity to
direct it. All of this evolved while the public, via the next EMS television event, "Rescue 911",
became more aware of the possible success of EMS when all goes well.
The 90's started off with a new federal approach to managing the health care industry. Suddenly
words like "managed-care", "capitation," consolidation of services, ambulance buy-outs, and a
national health plan began to be discussed predicated upon the need to control the cost of health
care. Up sprang the EMS Alliance and more cooperation of organizations nationally based upon the
perceived need for information sharing and a "unified EMS voice." These developments caused NHTSA
to contract with NASEMSD and NAEMSP to develop a comprehensive review of EMS and to prioritize an
EMS Agenda for the Future. The "Agenda" will serve as a cornerstone for development of ideas,
legislation, goals and objectives for organizations well into the next millennium.
By the mid-90’s EMS continued to be influenced by television. ER became one of the highest rated
TV shows. Along with “Paramedics”, Third Watch, Trauma and other shows, EMS enjoyed a very high
positive public image. New curricula for EMT-Basics, Intermediates and Paramedics were printed and
“rolled-out”. The debate over the definition of licensure and certification of EMS providers
continued. The Registry analyzed the practice of EMTs in 1994 and repeated the study in 1999.
The NHTSA gathered a group to review the process for future curricula projects which evolved into a
document entitled the EMS Education Agenda for the Future. Information sharing became more
accessible and soon every EMS agency had a “Website” and “e-mails” were loading down managers.
Strategic planning replaced business plans and organizations were compiling their plans. Finally,
after 30 years of modern EMS, the NREMT committed to study the EMS profession and commissioned a
Longitudinal EMT Attribute Demographic Study (LEADS) project.
As the vocation of the EMT evolves, his professional needs became evident. Early recognition of the
importance of a certification agency for the EMT resulted in the birth of the National Registry of
Emergency Medical Technicians. This web site provides the history of the Registry and a
comprehensive picture of its policies and procedures.
