Advertisement

International EMS Systems: The United States: past, present, and future

      Abstract

      Emergency medical services (EMS) is an organised system designed to transport sick or injured patients to the hospital. Though EMS system configurations can be quite varied in design depending on locale, we provide an overview of EMS as it has evolved and is currently modelled in the US. We outline the history of EMS in the US, including the major events and legislation that shaped the current models that are in existence. We provide an overview of provider training, system design, system funding, and dispatch issues. The concepts of medical direction for physician surrogates, as well as EMS as it relates to specialty care are also elucidated.

      Sumàrio

      Os Serviços de Emergência Médica (EMS) são um sistema organizado desenhado para transportar doentes para o hospital. Embora a configuração do EMS possa variar no que se refere ao desenho da sua logı́stica de local para local, é possı́vel fornecer uma visão global dos EMS, da sua evolução e do estado actual nos EUA. Descreve-se a história dos EMS nos EUA, os acontecimentos mais importantes e a legislação que condicionaram os modelos de organização actualmente existentes. Fornecemos uma visão global do treino, organização dos sistemas, financiamento e modelos de activação. Elucidam-se conceitos de direcção médica e médicos de referência, bem como e relação dos EMS com as especialidades.

      Resumen

      Un servicio de emergencias médicas (EMS) es un sistema diseñado para el transporte de pacientes enfermos o lesionados al hospital. Aunque las configuraciones del sistema EMS pueden ser de diseños bastante variados según las condiciones locales, proporcionamos una visión de los EMS, como han evolucionado y como están actualmente modelados en los EEUU. Destacamos la historia de EMS en los EEUU, incluyendo los eventos mayores y la legislación que le ha dado forma a los actuales modelos en existencia. Proporcionamos una visión del entrenamiento de los proveedores de servicios, diseño de sistema, financiamiento del sistema, y temas en relación al despacho. También se aclaran los conceptos de dirección médica para subrogantes médicos, al igual que EMS en su relación con cuidados de especialidad.

      Keywords

      Palavras Chave

      Palabras Clave

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Traverse B, Locker-Freeman F. Medical discoveries: medical breakthroughs and the people who develop them. UXL, Detroit, Michigan; 1997.

      2. Sebastian A. A dictionary of the history of medicine. New York: Parthenon Publishing Group; 1999.

      3. Blackwell T. Principles of emergency medical services systems. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen’s emergency medicine concepts and clinical practice. 5th ed. St. Louis, Missouri: Mosby Inc.; 2002.

      4. Boyd DR. The conceptual development of EMS systems in the United States. Part I. Emergency medical services. January/February; 1982 p. 19.

        • Haller J.S
        The beginning of urban ambulance service in the United States and England.
        J. Emerg. Med. 1990; 8: 743-755
      5. Bledsoe BE, Cherry RA, Porter RS. Brady intermediate emergency care. 2nd ed. Upper Saddle River, New Jersey: Prentice Hall Inc.; 1998.

        • Blackwell T.H
        Pre-hospital care.
        Emerg. Med. Clin. N. Am. 1993; 11: 1-14
      6. Cone DC. Emergency Medical Services. In: Plantz SH, Adler JN, editor. Emergency medicine. Williams and Wilkins: Baltimore, Maryland; 1998.

      7. Lilja GP, Robert AS. Emergency Medical Services. In: Tintinalli JE, Klein GD, Stapcynski JS, editors. Emergency medicine: a comprehensive study guide. 5th ed. New York: McGraw-Hill; 2000.

        • Key C.B
        Operational issues in EMS.
        Emerg. Med. Clin. N. Am. 2002; 20: 913-927
        • Pantridge J.F
        • Geddes J.S
        A mobile intensive care unit in the management of myocardial infarction.
        Lancet. 1967; 2: 271-273
      8. Division of Medical Science. National Academy of Sciences—National Research Council: accidental death and disability: the neglected disease of modern society, Washington, DC: US Government Printing Office; 1966.

      9. California Health and Safety Code, Sections 1480–1485; 1970.

      10. Emergency Medical Services Systems Act of 1973, Public Law 93–154, Washington, DC: 93 US Congress; 1973.

        • Hoffer E.P
        Emergency medical services.
        N. Eng. J. Med. 1979; 301: 1118-1121
        • Sayre M.R
        • Sakles J.C
        • Mistler A.F
        • Evans J.C
        • Kramer A.T
        • Pancioli A.M
        Field trial of endotracheal intubation by basic EMTs.
        Ann. Emerg. Med. 1998; 31: 228-233
        • Haynes B.E
        • Pritting J
        A rural emergency medical technician with selected advanced skills.
        Prehosp. Emerg. Care. 1999; 3: 343-346
      11. Rhode Island Department of Public Health 1.10.3. Rules and regulations relating to emergency medical services(R23-4.1-EMS) Rev.;2002.

      12. US Department of Transportation—National Highway Traffic Safety Administration: Emergency medical technician-paramedic: national standard curriculum; 1998.

        • Brice J.H
        • Garrison H.G
        • Evans A.T
        Study design and outcomes in out-of-hospital emergency medicine research: a 10-year analysis.
        Prehosp. Emerg. Care. 2000; 4: 144-150
        • Culley L.L
        • Henwood D.K
        • Clark J.J
        • Eisenberg M.S
        • Horton C
        Increasing the efficiency of emergency medical services by using criteria based dispatch.
        Ann. Emerg. Med. 1994; 24: 567-572
      13. Emergency Medical Services Agenda for the Future. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration (DOT HS 808 441); 1996.

      14. Stout JL. System financing. In: Roush WR, editor. Principles of EMS systems. ACEP: Dallas, Texas; 1994.

        • Delbridge T.R
        EMS … agenda for the future.
        Emerg. Med. Clin. N. Am. 2002; 20: 739-757
      15. Sanders MJ. Mosby’s paramedic textbook. St. Louis, Missouri: Mosby Year-Book Inc.; 1994.

      16. Bledsoe BE, Cherry RA, Porter RS. Brady intermediate emergency care. Upper Saddle River, New Jersey: Prentice Hall Inc.; 1995.

        • Dunford J.V
        Emergency medical dispatch.
        Emerg. Med. Clin. N. Am. 2002; 20: 859-875
      17. National Emergency Number Association Website http://www.nena911.gov 2003.

      18. History of 911. http://www.911dispatch.com: 2003.

        • Champion H.R
        • Sacco W.J
        • Copes W.S
        • Gann D.S
        • Gannarelli T.A
        • Flanagan M.E
        A revision of the trauma score.
        J. Trauma. 1989; 29: 623-629
      19. Bledsoe BE, Porter RS, Shade BR. Brady paramedic emergency care. 3rd ed. Upper Saddle River, New Jersey: Prentice Hall Inc.; 1997.

      20. Blumen IJ, Rodenberg H. Air medical transport. In: Marx JA, Hockenberg RS, Walls RM, editors. Rosen’s emergency medicine. Concepts and clinical practice. 5th ed. St. Louis, Missouri: Mosby Inc.; 2002.

        • Urban M.J
        • Edmondson D.A
        • Aufderheide T.P
        Pre-hospital 12-lead ECG diagnostic programs.
        Emerg. Med. Clin. N. Am. 2002; 20: 825-841