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EMS SYSTEMS
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Topics
• History of EMS
• Components of an EMS System
• National Groups and
Associations
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Today we will look at the
History of EMS
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History
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History (cont’d)
• Where do we start when looking at the
history of EMS?
• 25 years ago?
• 50 years ago?
• Further back still?
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The History of EMS and EMS
systems have developed from the
traditional and scientific beliefs
of many cultures.
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Ancient Times
First “protocols” established in
Mesopotamia. Evidence of medications,
patient assessment techniques, and
bandages.
During the 15th century Crusades, special
tents for the wounded called
‘ambulancias’ were prepared by King
Ferdinand and Queen Isabelle of Spain.
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th
18
and
th
19
Centuries
First efforts of field care developed by one of
Napoleon’s surgeons, Barron Domenic-Jean
Larrey, during the Austrian/Prussian conflicts
in 1792.
Even the American Civil War forced changes
and advancements onto the medical system.
Triage, a method of sorting patients by severity,
was also developed during this time.
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th
20
Century
World Wars I and II and the Vietnam and
Korean conflicts resulted in great
advances in patient care delivery systems
including transportation and patient care
procedures.
Buses and taxies became ambulances and
the soldiers in Korea saw the first
Medevac.
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1966-US
• The National Highway Safety Act
established the Department of
Transportation which provided grants for
EMS.
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1969-US
• The EMT-Ambulance program was made
public. The first paramedic curriculum
followed in 1977.
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1971-US
• White House issues $9 million in EMS
grants.
• Alberta had first paramedic program.
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1972• The Department of Health, Education &
Welfare funded initiatives to develop
regional systems.
• Kingston Paramedic Course
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EMS Systems Act of
1973
• Provided funding for a series of trauma
projects.
• $300 million was allocated to study EMS
planning, operations, expansion, and
research.
• Continued funding for regional
systems until ’81.
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To be eligible for funding a
system must address:
COMMUNICATIO
NS
MANPOWER
TRAINING
CRITICAL CARE
UNITS
PUBLIC
SAFETY
AGENCIES
TRANSPORTATION
ACCESS TO CARE
DISASTER
PLANS
EMERGENCY
FACILITIES
PATIENT
TRANSFER
MUTUAL AID
STANDARDIZED
RECORDKEEPING
PUBLIC
INFORMATION &
EDUCATION
SYSTEM REVIEW
& EVALUATION
CONSUMER
PARTICIPATION
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Two Items the
Legislation Omitted
• System finance
• Medical direction
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1975
• Ontario had developed EMCA system
• Ambulance and Emergency Care college
course (AEC)- a one year program
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1977
• Air Ambulance System started
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“Star of Life”
“Just as pharmacists
have the mortar and
pestle and doctors
have the caduceus,
Paramedics and
Emergency Medical
Responders have a
symbol in the ‘Star of
Life.’”
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“Star of Life”
• Designed by Leo R. Schwartz, Chief of the
EMS Branch, National Highway Traffic
Safety Administration (NHTSA), the "Star of
Life" was created after the American
National Red Cross complained in 1973
that they objected to the common use of an
Omaha orange cross on a square
background of reflectorized white which
clearly imitated the Red Cross symbol.
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“Star of Life”
• The newly designed, six barred cross,
was adapted from the Medical
Identification Symbol of the American
Medical Association
– registered on February 1, 1977
• Each of the bars of the blue "Star of
Life" represents the six system
function of the EMS.
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“Star of Life”
• The snake and staff in the center of
the symbol portray the staff of
Asclepias, who, according to Greek
mythology, was the son of Apollo .
• Asclepias was usually shown in a
standing position, dressed in a long
clock, holding a staff with a serpent
coiled around it.
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“Star of Life”
• The Bars in the Star of life represent
the Six System Function of the EMS.
– Detection
– Reporting
– Response
– On Scene Care
– Care In Transit
– Transfer to Definitive Care
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1960/70s
• Dr Norman McNally
• Standardized system for ambulances and
attendants
• 1972 First Ambulance and Emergency
Care course starts at Humber College
with 25 students.
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1981
• …the passage of the Consolidated Omnibus
Budget Reconciliation Act (COBRA) wiped out
federal EMS funding.
• Canadian Provinces starting to look at
Paramedic Programs
• Ontario Pilot Program 1984 – For ACPS
• EMA’s (level I to III)
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1988-Components of an EMS
system
• Regulation
• Resources
Management
• Human
Resources/Training
• Transportation
• Facilities
•
•
•
•
•
Communications
Trauma Systems
Public Information
Medical Direction
Evaluation
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Modern Trends
• Within the last 10 years, moved from a
variety of “Ambulance Services”,
operated by:
– Privately Managed
– Hospitals
– Fire Services and Municipal Governments
• To more true EMS Systems
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1990’s
• OPALS-Ontario Advanced Life Support Study
(Dr. Steele)-Ottawa
•
Stiell IG, Wells GA, De Maio VJ, Nesbitt L et al. Advanced Cardiac Life Support in Out-of-Hospital Cardiac
.
Arrest. N Engl J Med 2004; 351:647-656
– Two separate streams
• Cardiac Arrest
• Critical Care
• SR/Defib
– PCP version of above
– Not a study
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2000’s
• 2000 – Colleges change to 2 year PCP program
• EMCA exam – changed to Advanced EMCA to account for
SR/Defib content
• Downloading of ambulance services to UTM’s from other source
(MOH, private or cities)
• Technology advances. Computers on board ambulances, advanced
airways, more meds, monitoring
• 2004 –Stroke bypass (various regions)
• 2007 + PTCA bypasses (Ottawa, York, TO, LDN)
• 2009 Revision of DNR, Combining of BH groups
• 2011 Change in ALS standards, BLS standards Deceased pt
standard,
• 2012 PTBO regional considering STEMI bypass for EMS