General Information: Overview
There was a time when there were no consistent standards for training and testing for Emergency Medical Service (EMS) professionals. When patients were injured or ill, they didn’t know what level of medical attention they would receive. The education and ability of those providing emergency care or first aid varied. As a result, many patients may have been permanently disabled due to poorly trained personnel.
During the 1970's, improved care of the sick and injured in the pre-hospital 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 the injury or illness and once by failing to receive competent emergency medical care.
MAJOR ACCOMPLISHMENTS IN EMERGENCY MEDICAL CARE
An enormous amount of activity has taken place in a brief period of time (almost 40 years). Since the 1970’s the emergency medical technician (EMT) has been acknowledged as a 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 EMS professionals have been organized, and the public has been jogged into awareness of emergency medical services including its own self-help role.
THE BIRTH OF THE NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS
President Lyndon Johnson's Committee on Highway Traffic Safety recommended the creation of a national certification agency to establish uniform standards for training and examination of personnel active in the delivery of emergency ambulance service. The result of this recommendation was the inception of the National Registry of Emergency Medical Technicians (NREMT) in 1970.
GRANT MONEY IS AWARDED FOR EMERGENCY MEDICAL SERVICES
In the 70's the scramble for Federal grant money for emergency medical services 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 (DOT) gave over $140,000,000 in matching 402 grants to the ten Department Of Transportation regions. Approximately $182,000,000 was awarded by Department of Health, Education and Welfare (DHEW) to 543 grantees between fiscal year 1974 and fiscal year 1979.
EMS GAINS RESPECT AS MORE LIVES ARE SAVED
The fiction of TV's "Emergency" paled before the action of real-life EMS professionals as they lived the spontaneous script of the streets. With every run made, EMS professionals 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. EMS was a figurative shot in the arm for Americans.
ATTAINING STANDARDS - A DIFFICULT CHALLENGE
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: the patients. "National" direction began to diminish and state by state needs sprang up with local jurisdictions demanding more from the new funder-- the State. Standardization became difficult to attain; universal agreement on issues were 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. 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.
PROGRESS MADE TOWARDS A UNIFIED EMS VOICE
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. The EMS Alliance was founded (the pre-cursor for today's EMS Advocates) and more cooperation of organizations nationally based upon the perceived need for information sharing and a "unified EMS voice." These developments caused the National Highway Traffic Safety Administration (NHTSA) to contract with the The National Association of State EMS Officials (NASEMSO) and The National Association of EMS Physicians (NAEMSP) to develop a comprehensive review of EMS and to prioritize what came to officially be known as the “EMS Agenda for the Future.” The "Agenda" serves as a cornerstone for development of ideas, legislation, goals and objectives for organizations well into the next millennium.
EMS EDUCATION AGENDA FOR THE FUTURE IS UNVEILED
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 highly positive public image. New curricula for EMT-Basics, Intermediates and Paramedics were developed. The debate over the definition of licensure and certification of EMS providers continued. The National Registry analyzed the practice of EMTs in 1994 and repeated the study in 1999. NHTSA convened a group of experts to review the process for future curricula projects which evolved into a document entitled the “EMS Education Agenda for the Future”, which continues to serve as the standard for development of EMS educational curriculum. After 30 years of evolving EMS, the NREMT committed to study the EMS profession and commissioned a Longitudinal EMT Attribute Demographic Study (LEADS) project.