Emergency Medical Services

Emergency Medical Services (EMS) has a mission to save lives of sick or injured people in emergency situations. The development of EMS has been based on tradition and, to some extent, on scientific knowledge. Its roots are deep in history. For example, the Good Samaritan bound the injured traveler's wounds with oil and wine at the side of the road, and evidence of treatment protocols exists as early as 1500 B.C.

Civilian ambulance services in the United States began in Cincinnati and New York City in 1865 and 1869. Hospital interns rode in horse drawn carriages designed specifically for transporting the sick and injured. The first volunteer rescue squads organized around 1920 in Roanoke, Virginia, and along the New Jersey coast. Gradually, especially during and after World War II, hospitals and physicians faded from pre-hospital practice, yielding in urban areas to centrally coordinated programs.

By 1960, new advances to care for the sickest patients were being made. The first recorded use of mouth-to-mouth ventilation had been in 1732, involving a coal miner in Dublin, and the first major publication describing the resuscitation of near drowning victims was in 1896. However, it was not until 1958 that Dr. Peter Safar demonstrated mouth-to-mouth ventilation to be superior to other methods of manual ventilation. In 1960, cardiopulmonary resuscitation (CPR) was shown to be extremely beneficial.

Demonstration of the effectiveness of mouth-to- mouth ventilation in 1958 and closed cardiac massage in 1960 led to the realization that rapid response of trained community members to cardiac emergencies could help improve outcomes. The introduction of CPR provided the foundation on which the concepts of advanced cardiac life support (ACLS), and subsequently EMS systems, could be built. The result has been EMS systems designed to enhance the "chain of survival."

The first nationally recognized EMT curriculum was published in 1969. Shortly thereafter paramedic education began, but training focused heavily on cardiac care and cardiac arrest resuscitation, almost to the exclusion of other problems. Training standards and certification requirements have continued to vary significantly in communities throughout the nation.

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