The history of the EMS System

While emergency medical care in one form or another has been around for perhaps hundreds of years, it was not until the early 1970s that EMS, in the form that we know it today, began to take shape. Prior to that time, EMS was provided by nearly anyone who would take on the task regardless of their training or experience. Funeral homes often provided patient transport with little or no medical care being administered. Sometimes it was the local police department that provided medical care.

Often, the local fire department would "rescue" a patient from a car accident or other trauma and then convey them to the hospital. Medical doctors made house calls for many of the same situations that EMS commonly responds to today. While providers did the best that they could with what little training and support they had, in most cases, ambulances were inappropriately designed, ill-equipped, and staffed with inadequately trained personnel. One report found that at least 50% of the nation’s ambulance services were being provided by 12,000 morticians. It was not until 1965 that the direction of EMS throughout the United States had the potential to improve. A publication of the National Academy of Sciences (NAS) titled “Accidental Death and Disability: the Neglected Diseases of Modern Society.” was released and began to receive attention. That paper reported that in 1965, 52 million accidental injuries killed 107,000 Americans, temporarily disabled more than 10 million and permanently impaired 400,000 more at a cost of approximately $18 billion.

Accidental injury is “the neglected epidemic of modern society” and “the nation’s most important environmental health problem,” the paper concluded. The NAS recommended several solutions, including the establishment of standards for ambulance design and construction, emergency medical equipment and supplies, and training and supervision of ambulance personnel. Congress responded to the NAS paper by enacting the National Highway Safety Act of 1966, which mandated the newly formed Department of Transportation (DOT) to establish minimum standards for the provision of care for accident victims. It also empowered DOT to penalize states up to 10% of their federal highway funds if they did not comply with the standards.

With the requirement to create an EMS system, and with Federal funding to help meet this goal, Wisconsin, like many states, began working towards implementation of ambulance services. This included drafting legislation, creating and adopting training curriculums, and the creation of a state EMS office. In 1969, the first nationally recognized training course for EMTs was held in Wausau, Wisconsin as a test site for the new DOT curriculum. The physician coordinator, Joseph D. ‘Deke’ Farrington was an EMS pioneer from Minocqua. Among his accomplishments, he promoted the use of extrication, invented the spine board and was responsible for the original 81 hour curriculum that Wisconsin and other states used. He also encouraged many other physicians to become involved in EMS.

Before Wisconsin and the nation could unveil EMS programs of their own, in 1971, the television program “Emergency!” appeared, catching the attention of the country. The program suggested to the public that paramedics existed everywhere. In reality, they did not. Additionally, it portrayed paramedics as frequent lifesavers when they were part of an integrated EMS system. In reality, they did save lives, though not as often as the television show led views to believe. Still "Johnny Gage and Roy DeSoto" came into America's living rooms every Saturday night to provide a firsthand look at what EMS was all about. The television show is credited with helping many areas of the country create new EMS programs in their local communities.

While the training was now available, there were still no state requirements for anyone to receive it. Many fire departments and newly formed ambulance services began voluntarily taking the training on their own. However it took nearly five more years until 1974 before Wisconsin mandated training and required state approval to provide ambulance transport and EMS care. Requirements also went into place mandating that EMS care and ambulance transport be available in every Wisconsin township. By this time, Wisconsin had licensed approximately 4,500 EMTs. While most EMTs and ambulance services were trained and authorized to provide Basic Life Support (BLS) care, several large cities began working toward creating paramedic programs that would include the administration of medications and the delivery of advanced procedures. Within a short time, communities including Janesville, West Allis, Milwaukee and Madison were providing paramedic Advanced Life Support (ALS).

Throughout the remainder of the 1970's more ambulance services were created and additional EMTs were trained. During this time, over $500 million in funding was provided throughout the United States. Many of Wisconsin's EMS services were created using this funding. Funding under the EMS Systems Act essentially ended with the Omnibus Budget Reconciliation Act of 1981 which consolidated EMS funding into state preventive health and health services block grants. It was at this time, in the early 1980s that states gained greater discretion in funding statewide EMS activities and regional EMS systems, and many of the regional EMS management entities established by federal funding quickly dissolved.

As EMS continued to progress, local and regional EMS services began working on their own to make improvements in their level of care. State and national publications, conventions and organizations were solidly in place and helping to push EMS along as a component of the healthcare team. In 1985, the National Research Council’s report entitled Injury in America: A Continuing Public Health Problem described deficiencies in the progress of addressing the problem of accidental death and disability. Development of trauma care systems became a renewed focus of attention with passage of the Trauma Care Systems Planning and Development Act of 1990.

The concept of a trauma system is to address the needs of all injured patients and match them to the available resources. The act encouraged the establishment of inclusive trauma systems and called for the development of a model trauma care system plan, which was completed nationally in 1992. In 1999, Wisconsin passed its own trauma legislation, a work in progress that continues through today.

The National Highway Traffic Safety Administration (NHTSA) implemented a statewide EMS technical assessment program in 1988. During assessments, statewide EMS systems are evaluated based on 10 essential components including: Regulation and policy; Resource management; Human resources and training; Transportation; Facilities; Communications; Public information and education; Medical direction; Trauma systems and; Evaluation. In 1992, NHTSA came to Wisconsin to complete an evaluation.

The resulting poor scores in many of the areas resulted in legislation being passed during the Wisconsin 1993-1994 legislative session in an effort to address these concerns. The legislation created a governor-appointed statewide EMS Advisory Board, a Physician Advisory Committee and the creation of a state EMS Medical Director. It also required that multiple reports be created in an effort to address the NHTSA elements that had found to be lacking. The appointed groups also worked on various improvements to the EMS system including additions and innovations that had not been tried in other states.

During this time, additional skills, new medications, added training, quality assurance and data collection were all added for use throughout Wisconsin. It has been these elements and many others that have placed Wisconsin EMS beyond many other states in the country. In 2001, NHTSA returned to conduct another assessment similar to the one completed nearly 10 years earlier. While they found vast improvement in many areas, they also found that many of the same problems that existed in 1992 were still in place in 2001.

Very little has changed since that time. As a relative new-comer when compared to other emergency services such as fire or police, EMS has traveled a long way in a relatively short period of time. EMS today is still very much a work in progress. Changes continue to be made on almost a yearly basis, designed to improve the care that is provided and the quality of EMS delivered throughout Wisconsin. At any given time, there are multiple projects underway that may serve to improve and enhance Wisconsin EMS.

While many of those first EMS providers in the early 1970's are no longer involved, there are others who still continue to provide emergency medical services through this day. Indeed, EMS history can still often be provided directly by those same individuals who were there when it all began.

Information above quoted from the Wisconsin EMS Association.