Emergency medical services (EMS) constitute the
extension of emergency medical care into the community. Strong
emergency physician leadership is essential to a safe and effective
EMS system.
The current EMS system in the United States started with the
1966 National Highway Safety Act, which authorized the U.S.
Department of Transportation (DOT) to fund ambulances,
communications, and training programs for prehospital medical
services. Coincidentally, in 1967, J. F. Pantridge began using a
mobile coronary care unit in Belfast, Northern Ireland, to extend
coronary care into the prehospital setting.
In 1973, Public Law 93-154 defined a goal of improving emergency
medical care and EMS on a national scale. Although much
has changed in EMS since passage of that initial act, the original
definition of an EMS system is useful for understanding its
functions. This law identified 15 elements of an EMS
system: (1) personnel, (2) training, (3) communications, (4)
transportation, (5) facilities, (6) critical care units, (7) public
safety agencies, (8) consumer participation, (9) access to care, (10)
transfer of care, (11) standardization of patients' records, (12)
public information and education, (13) indepen-dent review and
evaluation, (14) disaster linkage, and (15) mutual aid agreements.
Thus an EMS system is the entire system in place to provide care
to emergency patients from the initial call to definitive care.
In the United States, individual state EMS laws and regulations
typically define levels of ambulance service capability, training requirements,
equipment requirements, and requirements for
physician leadership and accountability. In addition, the state health
department may be the lead agency in promoting and funding
EMS activity.