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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 first hand 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
was 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 it's 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. |
