Quick, Call 911

Call 911-The Emergence of EMS

Call 911. In minutes an ambulance staffed with trained Emergency Medical Technicians (EMTs) arrives at your door, checks your medical status, stabilizes you, puts you on a trolley, loads you into a well equipped ambulance and transports you to the nearest appropriate emergency room where emergency physicians and nurses attend your needs and possibly save your life, all the while communicating electronically as needed between the dispatcher, the ambulance and the hospital. Routine stuff now. But it was not always so. Here is a short history of how that happened through the eyes of one who was there.

In the 1950s and ‘60s, more often than not the ambulance that showed up at an accident scene was little more than a station wagon, owned by a funeral home, and staffed by untrained student athletes, like my brother who while in high school worked for the funeral home in my hometown. Or private enterprises who competed for clients, and at least in one case in the Washington D.C. area, staff of two responding outfits engaged in fisticuffs over who should pick up a client. Other services were provided by volunteer rescue services.

Then, in the late ‘60s, at the Federal level, serendipity entered the picture. The Department of Transportation received a large appropriation, some of which could be spent on activities to ensure safety for the travelling public. Someone in DOT gave money to the National Academy of Engineering to identify what equipment should be on an ideal ambulance. The NAE addressed the question, gave their report to DOT, and DOT promptly filed away the report.

Meanwhile, Over in the Public Health Service (PHS), through a reorganization, The Division of Health Mobilization, which figured prominently in readying the country’s health response to a nuclear attack through provision of Packaged Disaster Hospitals and inventories of medical supplies for use during disasters, inherited an organization called the Hospital and Ambulance Services Branch which literally consisted of only a handful of staff and no budget, with a murky mission of concerning themselves with hospitals and ambulances.

Health Mobilization management recognized that they had both a problem and an opportunity. They brought in a new Branch Chief, Stuart Nottingham, a PHS Physician, and added me, Cleve Taylor, a senior public health analyst to the staff who together brought new energy and ideas to the branch. Our efforts led to the discovery and dusting off of the equipment recommendations for ambulances, the development and successful promotion of Emergency Medical Services as a system including acceptance of recommended standards for EMT training; ambulance design, staffing, and equipment; and communications. The Office of Science and Technology while looking for benefits to the public adapted from the space program, accepted their suggestion that EMS systems planning was stimulated by space program systems planning models, and put their proposed EMS Demonstration grants program proposal into President Nixon’s State of the Nation address. This resulted in 8 fully funded EMS demonstration sites across the USA.

And remember DOT? To support the upgrade in the county’s EMS capability, they convinced the DOT, who could give communities the money to purchase ambulances, to only fund purchases of ambulances that complied with the PHS recommended standards of design and equipment, even though no such ambulances existed at the time! As they told attendees at a National EMS Conference they organized when attendees endorsed their recommended standards, the moment industry knew the requirements for an ambulance and knew there was money to buy them, someone would build them.

And so it happened. Industry immediately met the need, EMTs became a reality. EMS became more than the sum of its parts. Nine one one (not nine eleven because there was no eleven on the phone dial) became universal and reliable.

And of final note, a few years ago I got the benefit of all of this when I was shuttled off to the hospital in an ambulance in response to a failing heart.