To honor National EMS Week I wrote a previous blog article looking at how early advances in caring for the wounded in war shaped the foundation of emergency medical care. Now, I’ll talk about the technological, political and social changes that led to the creation of EMS as we know it.

Retro ambulance

The “White Paper”: A Call for Better Emergency Care

In 1966, the National Academy of Sciences released the report Accidental Death and Disability: The Neglected Disease of Modern Society. The “White Paper,” as this report was known, marked a key turning point in the history of EMS. The White Paper found several serious problems in the state of emergency medical care during that time:

  • No standard protocols for treatment
  • Lack of training in emergency care
  • No uniform standards for ambulance design, equipment and use
  • Lack of communication
  • Lack of public awareness and political action to pass laws to regulate emergency care and also to allocate tax dollars to improve care
  • Lack of research in emergency medicine
  • Shortages of qualified medical emergency personnel

Statistics in this report revealed that more Americans were being killed in vehicle accidents every year than were killed during the entire Korean War (1950–1953). In fact, military personnel wounded in combat had better care and survival odds than civilians.

The White Paper also recommended changes to address these problems. Among these were increased research in emergency medicine, laws and regulations to set standards for quality in emergency care, and more intensive training for emergency personnel.

Legislation, Training, Technology and Even TV

The White Paper spurred action to improve emergency care. Here’s a look at some key changes that took place soon after the White Paper was released.

New Laws

Federal and state laws were passed to standardize care and provide resources to improve emergency care, including:

  • The EMS Systems Act of 1973, which laid the groundwork for the funding and organization of EMS
  • California’s Wedsworth-Townsend Act of 1970, one of the first state laws establishing paramedic certification and training, and allowing paramedics to provide treatments — such as IVs — that only doctors and nurses were previously allowed to administer

More Focus on Training and Research

Doctors, nurses and paramedics began to be better trained in providing emergency medical care, and programs for training were created and standardized. Research into improving emergency medicine also started to be conducted. Here are some of the biggest advances in training and research programs.

  • The University of Maryland established the nation’s first Shock Trauma Center in 1969.
  • During the early 1970s, the first Emergency Medical Technician-Paramedic (EMT-P) training was created in our home city of Pittsburgh by Nancy Caroline, MD and Dr. Walt Stoy, Ph.D., who trained the pioneering Freedom House Enterprises Ambulance Service, one of the first EMS programs in the country (see sidebar).
  • In 1972, the first residency program to train doctors specializing in emergency medicine was established at the University of Cincinnati.

Advances In Technology

The 1960s and 1970s also brought several technological advances in emergency care.

Emergency! Brings EMS to TV

Despite these advances, the general public was mostly unaware of the movement toward modern EMS. That changed in 1972 with the release of the hit TV show Emergency! Millions of Americans tuned in to see firefighters/paramedics Roy DeSoto and Johnny Gage of the Los Angeles County Fire Department’s Squad 51 helping in emergencies — from earthquakes, fires and heart attacks, to hands stuck in jars and swallowed quarters.

This show not only increased public awareness of EMS, it also incited public concern over the need for universal EMS care and encouraged people to pursue careers in EMS and emergency medicine.

Emergency! was one of my favorite TV shows as a kid. Like most young boys, I wanted to be a fireman when I grew up, but I wanted to be one like the crew of Squad 51. Many a day, I toted my Fisher-Price medical kit around our rec room on the way to rescue ill and injured stuffed animals, dolls and action figures, checking their vital signs, and starting imaginary IVs of Lactated Ringer’s.

I transported them to the couch that pretended to be Rampart General Hospital, to be cared for by my sister, cousins and neighborhood kids, who were pretending to be trauma surgeons. Although I didn’t end up becoming a firefighter or paramedic, I still enjoy watching Emergency! reruns. It was while watching the pilot episode on TV recently, as a matter of that, that I wrote my articles on EMS history.


EMS Today

Modern EMS focuses on six key areas of care as portrayed by the “Star of Life” symbol.

  1. Detection: The first rescuers on the scene, usually untrained civilians or those involved in the incident, observe the scene, understand the problem, identify the dangers to themselves and the others, and take appropriate measures to ensure their safety on the scene.
  2. Reporting: The call for professional help is made and dispatch is connected with the victims, providing emergency medical dispatch.
  3. Response: The first rescuers provide first aid and immediate care to the extent of their capabilities.
  4. On-scene care: The EMS personnel arrive and provide immediate care to the extent of their capabilities on the scene.
  5. Care in transit: The EMS personnel proceed to transfer the patient to a hospital by ambulance or helicopter and provide any needed medical care during the transportation.
  6. Transfer to definitive care: Appropriate specialized care is provided at the hospital.

I’d like to end by acknowledging all those who make this care possible: the first responders and EMTs who arrive at the scene of an emergency; the doctors, nurses and other experts at hospitals around town and around the country who care for the ill and injured; and all others who keep the ambulances rolling and the helicopters flying.

They’ve saved many lives, and there’s no higher calling than that.