A Brief History of Emergency Medical Services


          EMS in America can be traced back to the Civil War era. All military personnel had to be examined by medical officers to qualify for duty. Also, ambulances were assigned based on the size of the regiment. Each ambulance team was trained in patient care to better take care of the soldiers. In 1865 Cincinnati incorporated the first civilian ambulance. Then, in 1869, New York City advertised a 30 second response time and provided an Ambulance Surgeon and a quart of brandy for their patients!


          During World War I, signal boxes were used by injured soldiers to assist medical teams in locating them in the field of battle. Medical teams also used electric, steam, and gasoline powered carriages for transporting the injured. It was also the first war to utilize traction splints and other medical equipment.  After the war, civilian ambulances carrying surgeons were equipped with radio dispatchers to better serve the community.

          The transition to what we know as the modern day EMS started during the 1950's as an off shoot of 5 different types of businesses; towing operators, medical equipment companies, funeral homes, hospitals, and police/ fire departments. After many years of being unregulated, funeral homes began patient care and provided nearly half of the country's ambulances.

          In 1960 John F. Kennedy declared that "Traffic accidents constitute one of the greatest, perhaps the greatest, of the nation's public health problems". Then in 1966 Lyndon B. Johnson and President's Commission on Highway Safety/National Academy of Sciences declares the carnage "the neglected disease of modern society." Soon after, the National Highway Traffic Safety Act was adopted which standardized EMS training, promoted state involvement, encouraged community oversight, recommended radio communication, and stressed a single emergency number.

          Other federal initiatives were put into action that further helped define the EMS program. In 1972 the Heath Services and Mental Heath Administration under the Dept of Health, Education, and Welfare became the lead agency for EMS.  Also the Physician Responder Program was implemented, which later morphed into paramedic programs and lead to close physician supervision.

          1973 brought about the EMS Systems Act. The DHEW established 300 EMS systems throughout the country. The Department of Transportation adapted training curricula for EMT, EMT P, and first responder. Public Law 93-154 established new rules for EMS radio communications. General Services Administration also introduced ambulance specifications. The next step came in 1981 with the Consolidated Omnibus Budget Reconciliation Act which consolidated funding into state preventive health block grants, eliminated funding under EMSS Act, reduced compliance with federal guidelines, and lastly, abolished the federal lead agency.

          In 1996 the EMS Agenda for the Future was drafted, which further connected the EMS with the other medical professions. That same year the EMS Education Agenda for the Future was drafted, which provided recommendations for Core content, Scope of practice and Certification of EMS professionals.



EMS Today


          It has been nearly four decades since President Lyndon Johnson's Committee on Highway Traffic Safety recommended the creation of a national certification agency to establish uniform standards for training and examination of personnel active in the delivery of emergency ambulance service. The result of this recommendation was the inception of the National Registry of Emergency Medical Technicians (NREMT) in 1970.

            Since that time, pre-hospital emergency medical care has continually evolved and improved. The EMT has been acknowledged as a bonafide member of the health care team. Excellent training programs have been developed and a vital focus has been placed on continuing education. National standards have been established. Ambulance equipment essentials have been set. National accreditation of paramedic programs has been achieved, and professional associations for the EMT have been organized.

           The NREMT, among others, has helped to establish, implement and maintain uniform requirements for the certification and recertification of emergency medical technicians. The NREMT has also been involved in numerous national projects and its staff participates on major national committees, playing an active part in the ever-continuing process of improving standards of emergency medical services.



EMS/Health Careers


An EMT-Intermediate is the level of training between Basic (EMT-B) and Paramedic. There are actually two intermediate levels, the EMT-I/85 and the EMT-I/99 curriculum, with the 1999 level being the higher of the two. The standard curriculum for EMT-I from 1998 is defined by the U.S. Department of Transportation, but each state may not have implemented or approved this program. (Note: This level of EMT is not currently recognized in WV .)



EMT-I/85 is a level of training that will typically allow several more invasive procedures than are allowed at the basic level, including IV therapy, the use of multi-lumen airway devices (even endotracheal intubation in some states), and provides for enhanced assessment skills. The EMT-I/85 is typically allowed only the same medications an EMT-B is allowed to use (these being oxygen administration, oral glucose, activated charcoal, epinephrine auto-injectors (Epi-Pens), nitroglycerine, and Metered-Dose Inhalers (MDIs).  Protocols for medications vary by state. For example, in New Hampshire, an EMT-I is allowed to administer Narcan, Atropine, Thiamine, and nebulized Albuterol in addition to the above listed medications.  (Note: This level of EMT is not currently recognized in WV.)



The EMT-I/99 level is the closest level of certification to Paramedic, and allows many techniques not available to the EMT-I/85. Some of these techniques include needle-decompression of tension pneumothorax, endotracheal intubation, nasogastric tubes, use of cardiac event monitors/ECGs, and medication administration to control certain cardiac arrhythmias.  (Note: This level of EMT is not currently recognized in WV)


Paramedics are employed by various public and private emergency service providers. These include private ambulance services, fire departments, the 9-1-1 system, hospitals, law enforcement agencies, the military, various EMS-specific, public safety agencies. Paramedics may respond to medical incidents in an ambulance, rescue vehicle, helicopter, fixed-wing aircraft, motorcycle, or fire suppression apparatus.

Paramedics may also be employed in medical fields that do not involve transportation of patients. Such positions include offshore drilling platforms, phlebotomy, blood banks, research labs, educational fields, law enforcement and hospitals.

Critical care transporters move patients by ground ambulance or aircraft to a medical treatment facility. A nurse credentialed in critical care medicine may accompany the patient. Other critical care units use paramedics who have received critical care medical training, or continuing education courses in the Critical Care Emergency Medical Transport Program (CCEMTP).

Tactical paramedics work on law enforcement teams. These medics, usually from the EMS agency in the area, are commissioned and trained to be tactical operators in law enforcement, in addition to paramedic duties.  Advanced medical personnel perform dual roles as operator and medic on the teams. Such an officer is immediately available to deliver advanced emergency care to other injured officers, suspects, victims and bystanders.

In-Hospital paramedics are increasingly employed in the emergency departments and intensive care units due to the nursing shortage. Often, paramedics operate with greater latitude and autonomy than many nurses.

Paramedic salaries can range from zero for unpaid volunteer positions, to as much as $90,000 a year depending on location, experience, and supervisory responsibilities.  (In WV, paramedics are trained by hospitals, usually in conjunction with higher education.)