HISTORY OF EMS

The U.S. Army institutes America's first ambulance service. Civilian ambulance services begin in the United States within Cincinnati and New York City. Hospital interns rode in horse drawn carriages designed specifically for transporting sick and injured patients.

The first written record of the term "air ambulance" is in Jules Verne's Robur le Conquérant (1866), which describes the rescue of shipwrecked sailors by an airship (balloon) named the Albatross.

The first documented use of an air ambulance occurred during the Siege of Paris when balloons were used to evacuate more than 160 soldiers from the besieged city.

Signal boxes were used in World War I by injured soldiers to assist medical teams in locating them in the field of battle. Medical teams also used electric, steam, and gasoline powered carriages for transporting the injured. It was also the first war to utilize traction splints and other medical equipment.

During the First World War air ambulances were tested by various military organizations. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews.

The first recorded British ambulance flight took place in Turkey when a soldier in the Camel Corps, who had been shot in the ankle, was flown to a hospital in a de Havilland DHH within 45 minutes. The same journey by land would have taken 3 days to complete.

During the Great War, the first true Air Ambulance flight was made when a Serbian officer was flown from the battlefield to hospital by a plane of the French Air Service. Records kept by the French at the time indicated that, if casualties could be evacuated by air within six hours of injury, the mortality rate among the wounded would fall from 60 percent to less than 10 percent - a staggering reduction!

Volunteer rescue squads are organized in Virginia along with the coast of New Jersey. Phoenix Fire Department begins using inhalators (a device providing a mixture of oxygen and carbon dioxide for breathing that is used especially in conjunction with artificial respiration) on calls.

In Britain, sick passengers were ferried by air from the Western Isles of Scotland to the mainland in the early 1930s. The first such flight to be recorded was on May 14, 1933 when a fisherman suffering from a perforated stomach, with consequent risk of peritonitis, was flown from Islay to Glasgow's Western Infirmary in a DH Dragon owned by Midland and Scottish Air Ferries.

An organized military air ambulance service was evacuating wounded from the Spanish Civil War for medical treatment in Nazi Germany.

Prior to World War II, the hospitals provided ambulance services in many large cities. Due to the war effort, severe manpower shortages proved difficult to maintain services resulting in re-positioning the responsibility to the local police and fire departments. The care provided to patients was unregulated as no laws were in place to govern this service and no specialized training beyond first aid existed. In Switzerland, with the increasing interest in winter sports during the early post World War 2 years, the use of air ambulances evolved from the increasing difficulties experienced in mountain rescue work. Initially fixed-wing aircraft were used, landing medical teams with equipment as close as possible to the injured parties so that rapid first aid treatment could be applied prior to evacuation. To overcome a lack of suitable landing sites close to the incident in mountainous regions, it was even at one stage proposed to parachute medical personnel with equipment and sledges into the rescue area. Although training was undertaken, there is no documentary evidence to suggest that this technique was ever put into practice. The first documented medevac by helicopter occurred during the second World War.

AUS Army Air Forces aircraft with three wounded British soldiers on board, was forced down in the jungle behind Japanese lines near Mawlu in Burma.A new US Army Sikorsky YR-4B helicopter, flown by Lt. Carter Harman, could carry only one passenger but, over 25-26 April 1944, four return trips were made.

Following the end of the Second World War, the first civilian air ambulance in North America was established by the Saskatchewan government in Regina, Saskatchewan, Canada. Back in the United States, saw the creation of the Schaefer Air Service, the country's first air ambulance service. Founded by J. Walter Schaefer, of Schaefer Ambulance Service in Los Angeles, Schaefer Air Service was also the first FAA-certified air ambulance service in the United States. Para-medicine was still decades away, and unless the patient was accompanied by a physician or nurse, they operated primarily as medical transportation services.

Funeral home hearses which were being used to transport patients slowly begin to be replaced by fire department vehicles.

The first dedicated use of helicopters by U.S. forces occurred during the Korean War. While popularly depicted as simply removing casualties from the battlefield (which they did), helicopters also expanded their services to moving critical patients to more advanced hospital ships once initial emergency treatment in field hospitals had occurred. On August 4, 1950, just one month after the start of the Korean War, the first rotor wing medical evacuation was performed with a bubble-fronted Bell 47 (as seen in the TV series M*A*S*H). The wounded were transported on basket stretchers attached to the top of the landing gear on the outside of the small helicopter. They were covered with blankets in a nearly futile effort to maintain body heat and prevent wound contamination. It is estimated that more than 20,000 injured soldiers were evacuated by helicopter. The World War II casualty/death rate of 4.5 deaths per 100 casualties dropped to 2.5 per 100 casualties during the Korean War. While there were some technological advances in medicine during that period, the improvement is largely attributed to use of the helicopter to evacuate patients to definitive care more quickly. The external litter, however, did not allow for medical care during transport.

The first known civilian application of a medical helicopter was in Etna, California. Bill Mathews, a businessman, started a helicopter service to ferry patients for Dr. Granville Ashcraft, the town's only physician. The town druggist also used the helicopter to deliver drugs during emergencies.

The next major advance in air medical transport occurred during the Vietnam War, where the Bell UH-1 helicopter was placed into operation. Affectionately known as the Huey, this aircraft was large enough to hold patients inside, where medical personnel could begin treatment during the flight to a field hospital. The mass deployment of these aircraft as medevac units reduced the average delay until treatment to one hour. The ability to carry patients inside the aircraft was a key element in the reduction of mortality and morbidity. Military medics performed procedures previously done only by physicians: they started central lines, inserted chest tubes, and sutured bleeding wounds. This care, coupled with the initiation of specialty hospitals for the treatment of different types of injuries, resulted in a reduction in the mortality rate to 1 death per 100 casualties.

Due to an astonishing increase in motor vehicle traffic accidents, (more people were killed in traffic accidents in 1965 than in the Vietnam War). This created the National Highway Safety Act which started the National Highway Safety Administration. An article is published stating that nearly 25,000 Americans are left crippled or paralyzed due to insufficient or poorly trained ambulance personnel.

Medicare is created by an act of Congress. Ambulance transportation is recognized as a covered beneficiary service allowing a long term funding mechanism for EMS and medical transportation.

American Telephone and Telegraph starts to reserve the digits 9-1-1 for emergency use. The first 911 system begins in Haleyville, Alabama. Seattle Fire Department partners with Harbor View Medical Center to create "Medic 1", a Winnebago dispatched only to cardiac related calls.

The nation's first Paramedic program is started in Miami, FL. Shortly after it's induction, it provided the very first out-of-hospital defibrillation in which the patient walked out of the hospital neurologically intact. In Vietnam, the use of specially trained medical corpsmen and helicopters as ambulances led U.S. researchers to conclude that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This conclusion inspired the first experiments with the use of civilian paramedics in the world. Two programs were implemented in the U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi. Three helicopters were purchased through a federal grant and located strategically in the north, central, and southern areas of the state. Upon termination of the grant, the program was considered a success and each of the three communities was given the opportunity to continue the helicopter operation. Only the one located in Hattiesburg did so, and it was therefore established as the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services. Also, the state of Maryland received a grant to purchase Bell Jet Ranger helicopters and started one of the nation's first medevac programs. The four helicopters, manned by paramedics, were strategically based throughout the state for quick response to emergency situations. When they were not carrying patients, the helicopters were used for law enforcement and traffic control.

the first permanent civil air ambulance helicopter, Christoph 1, entered service at the Hospital of Harlaching, Munich, Germany.

The television show Emergency! is debuted and is contributed to changing public views on fire and emergency medical services.

The first civilian, hospital-based medical helicopter program in the United States began operations. Flight For Life Colorado began with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado.

The Star of Life is published by the Department of Transportation and The EMS Systems Act is passed by Congress which funded 300 regional EMS systems. A national curriculum is established by the Department of Transportation for first responder, EMT, and Paramedic.

The National Association of EMT's is formed.

In Ontario, Canada, the air ambulance program began, and featured a paramedic-based system of care. The system, operated by the Ontario Ministry of Health, began with a single rotor-wing aircraft based in Toronto. An important difference in the Ontario program involved the emphasis of service. 'On scene' calls were taken, although less commonly, and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients.

Computer-aided dispatch (CAD) is developed.

Paramedics being staffed on-board engine companies in Phoenix, AZ.

The National Registry of EMT's publishes it's first national standard exam for EMT-Intermediate.

75% of all fire departments are involved in some level of EMS service. The Emergency Medical Dispatcher program is established.

Funding under the EMS Systems Act ended with the Comprehensive Omnibus Budget Reconciliation Act (COBRA) which consolidated EMS funding into state preventative health and health services block grants, reduced compliance with federal guidelines and abolished the federal lead agency.

Automated Vehicle Locators (AVL) are developed.

The Trauma Care System & Planning Development Act is passed by Congress in an effort to reduce the number of patients resulting with accidental death and disability. Local EMS authorities assumed responsibility for establishing trauma systems and designating trauma centers in an effort to improve care and outcomes of patients suffering from traumatic injuries.

Paramedics are identified to assume further roles of pre-hospital care and practices for non-emergent patients by learning expanded skills.

Health Insurance Portability and Accountability Act is enacted by Congress. New York City EMS is absorbed by FDNY.

San Francisco and Chicago institute Paramedic engine companies.

9/11 Terrorist attacks occur at WTC, the Pentagon and United Flight 93. The largest and deadliest terrorist attack in world history and most devastating attack on American soil since Pearl Harbor, resulting in the injuries of over 6,000 and death of 2,996 people including 343 FDNY firefighters and 71 law enforcement officers. In this incident it was found that first responders had communication issues, different policies and protocols within the same area and different capabilities. From this began a revolutionary change to EMS in standardizing practices, communications, procedures and operations throughout the country. EMS has come a long ways from its infancy in the days of horse and buggy. As it grows alongside emergency medicine, there are opportunities for physicians to become involved at every level. While EMTs are not independent practitioners and require operating under a medical director's scope and license, the situations they face require considerable problem solving, judgment, and clinical decision making skills. Physicians are needed at every step to help develop treatment protocols, provide quality improvement, hold regular training sessions and ensure all personnel have the tools they need to perform high quality pre-hospital care. In addition, physicians may be called upon for situations that require their presence on scene in the field including mass casualty incidents, high acuity and high risk scenarios, tactical situations, or patients that require advanced skills such as surgical airways, pericardiocentesis, chest tubes and others. Large scale operations including concerts, conventions, and city events also benefit form physician input. EMS will continue to be the front line of emergency medicine as the field expands in the coming future. Physicians involved with pre-hospital care will be paramount to providing the support and knowledge required to help EMS systems grow, as evidenced by the recent recognition of EMS as an official clinical sub specialty.