What is EMS?
From the American College of Emergency Physicians (ACEP)
EMS is a vital public service, as important to the community as the police or fire department. But surprisingly, few Americans understand how EMS works or what role it plays. A public opinion survey conducted by the American College of Emergency Physicians (ACEP) in 1992 found that nearly half of adult Americans could not identify 9-1-1 as the emergency number, or confused it with 4-1-1, the directory assistance number. Fewer still -- just one in five -- had talked to their doctor about what to do in a medical emergency.
Emergency Medical Services is a system of care for victims of sudden and serious illness or injury. This system depends on the availability and coordination of many different elements, ranging from an informed public capable of recognizing medical emergencies to a network of trauma centers capable of providing highly specialized care to the most seriously ill or injured. The 9-1-1 emergency number, search and rescue teams, and pre-hospital and emergency department personnel are some of the critical elements necessary for the EMS system to work.
In 1966, a National Academy Sciences (NAS) report, Accidental Death and Disability: The Neglected Disease of Modern Society, documented widespread deficiencies in emergency care. At the time, it was common for emergency patients to be transported to the hospital in vehicles operated by mortuary services, and few hospitals had emergency wards staffed by doctors.
The NAS report, which revealed that the average American had a greater chance of survival in the combat zones of Korea or Vietnam than on the nation’s highways, catalyzed public support for the creation of the EMS system as we know it today.
Also in 1966, Congress passed legislation enabling the creation of the National Highway Traffic Safety Administration (NHTSA), setting the stage for the first federal standards in EMS. In the 40+ years since, the efforts of EMS providers at all levels have helped make our EMS system the most advanced in the world. But despite its remarkable progress, the EMS system still faces the challenge of declining support for state and federal EMS programs.
History of EMS in South Carolina
Prior to 1974, pre-hospital emergency care in many areas of South Carolina meant a quick ride to the closest hospital in a funeral home hearse or other readily available vehicle and medical care by volunteers with varying degrees of training. In the heavier populated cities, however, there were a few designated ambulance services capable of providing basic levels of emergency care as early as the late 1960s. At that time, most personnel were trained by the military medical services corps -- many of whom continued their training and still work in Emergency Medical Services today.
From the early 1970s to the late 1990s pre-hospital emergency care has grown to become a sophisticated system of emergency medical care. Today's system includes three levels of state certification for professional emergency medical technicians, licensed ambulances stocked with the newest technical medical equipment, paid county and private pre-hospital emergency care providers and core groups of dedicated volunteers. An organized system of medical control and a system of designated trauma centers are also in place.
This tremendous change was launched with the passing of the federal Emergency Medical Services Act in 1973 and the federal funding initiatives that followed. As a result, South Carolina passed its own Emergency Medical Services Act in 1974, creating standards and regulations for the improvement of emergency medical services and forming a state EMS Advisory Council and its membership.
The History of the Ambulance
From the American College of Emergency Physicians (ACEP)
From earliest times, people have required a means of transporting their wounded and sick. The first wounded were probably carried in a hammock strung between two poles. Other unique conveyances included human dhooleys which were used in India; wicker cradles called mule panniers; and Egyptian camel litters. The Mojave Indians devised a litter comprised of a sheet of canvas between two poles carried on the shoulders of two men.
A more formalized ambulance surfaced in the late 15th century, when Ferdinand and Isabella of Spain took an unprecedented interest in the welfare of their troops during their crusade against the Moors. Surgical and medical supplies were brought together in special tents for the wounded called ambulancias.
The concept of the ambulance was developed further by a man named Dominique-Jean Larrey who had been appalled by the neglected wounded and poor medical conditions he had witnessed during France’s war with the Austrians and Prussians in 1792. Larrey came up with the idea of mobile ambulances -- light-weight, two wheeled vehicles which stayed with the troops and allowed surgeons to work on the battlefield, an idea he later refined for Napoleon during the General’s Italian campaign.
The evolution of the ambulance took yet another turn during the American Civil War when ambulances were too few, often late, and driven by civilian drunkards and thieves. A physician named Jonathan Letterman reorganized the field medical service to provide an effective ambulance service for the evacuation of battle casualties.
In 1864, an act was passed in Congress entitled “An Act to Establish a Uniform System of Ambulances in the Armies of the United States,” which spelled out who was responsible for each phase of the ambulance system.
During the 1864 Convention in Geneva, an agreement was made by several European countries to recognize the neutrality of hospitals, of the sick and wounded, of all persons connected with relief service, and the adoption of a protective sign or badge. In America, a similar organization had been functioning during the Civil War. The Sanitary Commission, which 20 years later became the American Red Cross, was brought into being in large part due to the efforts of Clara Barton.
Most ambulance innovations took place during wartime, which were then adapted to civilian life. American hospitals initiated their own ambulance services during the late 1860s. Horsedrawn, these ambulances had a moveable floor that could be drawn out to receive the patient. Beneath the driver’s seat was a container with: a quart of brandy, two tourniquets, six bandages, six small sponges, splint material, blankets and a two-ounce vial of persulphate of iron.
With the arrival of the automobile came a different type of ambulance, the first appearing in 1899. During World War I, many ambulances were adapted from buses and taxis. The world’s oldest builder of ambulances is the Hess and Eisenhardt company in Cincinnati, Ohio. In 1937, they sold the first air-conditioned ambulance built in America. Developed with the idea that the ambulance should be a pre-hospital emergency room, these pre-cursors of the modern ambulance were filled with medicine cabinets, roof lights, and two-way radios.
Ambulance service has not been confined to ground units. During the Civil War, train ambulances and steam boat hospitals were used, and street car/trolley ambulances were popular in some cities in the late 1800s. More recently, the Star of Life, a water cruiser, began to operate under the direction of the Coast Guard and Marine Police in 1976.
And the “medicopter” is commonplace now, first coming into service as a means of evacuating combat patients in Korea and Vietnam, and now invaluable during natural disasters, such as the Johnstown Flood, when medical supplies required refrigeration and patients needed to be airlifted to hospitals.
Today's ambulances come equipped with some amazing new technology, from defibrillators and monitors that can transmit a complete 12-lead ECG directly to the emergency department to the latest in handheld computers.
Information obtained from "The Ambulance," by Katherine Traver Barkley, ©1978, Load N Go Press, Kiamesha Lake, New York. Copies can be obtained by calling (800) 798-1822.
For additional information, call (803) 545-4204