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Alyssa Zima
April 27, 2015
U.S. History C
Mrs. Mike
Development of the Emergency Medical System
Our modern society depends on many different systems, such as political systems and
environment systems. Among these systems are the medical systems, which have evolved greatly
in the past hundred years. We all know it rarely happens that a person becomes sick or injured in
a hospital with the hospital staff right there to help the patient immediately. This is why out-ofhospital care or pre-hospital care is needed. The development of the emergency medical system
has greatly improved organization and quality since the start of the emergency medical system.
The original use for the emergency medical system was for the wounded in the war.
Before the emergency medical system was in wars, the soldiers were left on the battlefield when
they died. In the civil war, dead soldiers could lay on the fields for days. The emergency medical
system was first seen when "... the French began to transport wounded soldiers away from the
scene of battle so they could be cared for by physicians."1 With this early emergency medical
system there was only the transportation and no pre-hospital care. After the French many other
different wars started to transport wounded soldiers. During World War I, many volunteers
joined the battlefield ambulance corporations.2 This is the time period where they provided the
soldiers with some pre-hospital care on the battlefield and then having the ambulance pick them
up. During this time there were many new ideas arising for the system and some of them remain
in function to this very day. During the Civil War, Clara Barton would help severely wounded
soldiers, which could vary from extreme hunger to life-threatening injuries.3 To collect the
materials to help the soldiers, She collected some relief articles herself, appealed to the public
1 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
2 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
3 Founder Clara Barton. Clara Barton. Accessed April 23, 2015. doi: American Red Cross

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for others, and learned how to store and distribute them.4Although she did a lot with helping the
soldiers with physical damages, she helped them with emotional damages. Barton was known to
read to them, write letters for them, listen to their hardships and pray with them.5 ... Clara
Barton began such a service for the wounded and later helped establish the American Red
Cross.6 The emergency medical system in the wars helped save so many lives that they moved
the system to also cover cities and communities emergency medical needs.
Since the emergency medical system for the wounded soldiers in war worked well, it
began to move into cities and other communities. Nonmilitary ambulances began in some major
American cities in the early 1900s- again as transport services only, offering little or no
emergency care.7 Even though no emergency care was given on scene; the system evolved in a
short time to where the whole purpose for this system was to save time for the patient. All
traumatically injured patients have a time frame referred to as a golden hour, this is a hour of
time starting after the traumatic injury. If the patient is delivered to the hospital in the golden
hour than the medical treatment, such as surgery, will be most effective with a lower chance of
abnormal occurrences and permanent damage. After 1 hour there is a 10% chance of morality,
while after 4 hours the chance of morality is 33%.8 The use of an ambulance and pre-hospital
care minor and major injuries can be dealt with faster, eliminating chances of permanent damage.
The patient is put into an ambulance to save time on the drive to the hospital because in the back
of an ambulance medical treatment can still be given while in an car medical treatment cannot be
given. The ambulance can call into the hospital before arriving so the hospital knows that
patients information and can prepare for that specific patient. In the smaller communities the
4 Founder Clara Barton. Clara Barton. Accessed April 23,2015. doi: American Red Cross
5 Founder Clara Barton. Clara Barton. Accessed April 23, 2015. doi: American Red Cross
6 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
7 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
8 TRAUMA.ORG: History of Trauma: Trauma Resuscitation. TRAUMA.ORG: Hisotry of Trauma: Trauma Resuscitation. Accessed May 03, 2015.

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ambulances services did not start until the late 1940s, after World War II9 The first motorized
ambulance was manufactured in the end of the 19th century.10 Often times a hearse would be
used for ambulance transport if it was provided by the local undertaker.11 The emergency medical
system was not as organized there as it is today. Ambulance services now, have more than one
ambulance. This is so if there is more than one emergency call at the same time, another crew
can take out another ambulance. With the later years to come all areas of the system will become
more complex to ensure the safety of the emergency medical care provider and the patient
receiving the medical care.
The emergency medical system continued to develop and change into the modern
emergency medical system that started in 1960. There are different levels of care in the modern
medical system, the two levels are basic life support and advanced life support that make up the
emergency medical system. Under these two levels of care are sublevels, in basic life support the
lowest level is the ambulance driver. This responder does not have to have any medical
qualification because they are transporting the patient and not helping with the medical
treatment. The next level is a first responder, which can be known as an emergency medical
responder. These responders can provide very basic medical help such as CPR or administering
oxygen. After this is the emergency medical technicians, these technicians can provide a wide
variety of medical problems. They can administer some medications, provide cervical spinal
care, aline extremities, apply traction splints, automated defibrillation and many other medical
treatments. An emergency medical technicians are the highest level in the basic life support.
There is only one main level of advanced life support and that is a paramedic. A paramedic can
provide pre-hospital care that a technician cannot do such as; a cannulation, tracheal intubation
9 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
10 Katherine Barkley (1978). The ambulance: the story of emergency transportation of sick and wounded through the centuries. New York: Exposition Press.
11 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)

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or needle decompression.12 These levels are what are on the personnels tag on the ambulance.
With the development of the modern EMS system, the concept of ambulance service as a means
for transporting the sick and injured passed into oblivion. No longer could ambulance personnel
be viewed as people with little more than the strength to lift a patient into and out of an
ambulance13 That was a short overview of the modern emergency medical system roles. To keep
the emergency medical system improving acts and standards were passed to endure national
regularities. In 1966 the National Highway Safety Act charged the Unites States Department of
Transportation with developing EMS standards and assisting the states to upgrade the quality of
their prehospital emergency care. Most EMT courses today are based on models developed by
the DOT.14 This was only six years after the emergency medical system was claimed to the
modern emergency medical system. The difference between those two were the standards, now
that emergency medical systems were everywhere, the United States of America could now work
on making these systems that are everywhere regulated. In 1970, the National Registry of
Emergency Medical Technicians was founded to establish professional standards. In 1973,
Congress passed the National Emergency Medical Services Systems Act as the cornerstone of a
federal effort to implement and improve EMS systems across the United States15 Along with
these standards where standards of providing care such as the rules of splinting; which are
immobilize above and below and injury and circulatory motor sensory (CMS) before and after
applying the splint. The rules of suctioning were also created and changed throughout the years.
The rules used to be suction only as far as you can see, only suctioning on the way out and for no
longer than fifteen seconds. These rules changed to suction only as far as you can see, only
12 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
13 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
14 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
15 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)

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suctioning on the way out and for no longer than ten seconds.16 It is the little changes and
improvements that keep improving the emergency medical system.
All certificated EMS are highly educated but all education has limits. As it was discussed
earlier, there are different levels of the EMS program. Some of the certifications only take a few
weeks while others can take years. In EMS, there are always changes and improvements and the
certified workers need to continue to be active in learning even after they have their certification.
An EMT must also maintain up-to-date knowledge and skills. Since ongoing research in
emergency care occasional changes in procedure, some of the information you receive while you
are studying to become an EMT will become outdated during your career.17 For most
certifications there is a short refresher course that you have to take every two years to continue
their certification. Not only is there limits on what types of care that can be provided; there are
limits on the information that we have. When the attacks on the World Trade Center, the Office
of Emergency Management ceased to exist because it was located in the World Trade Center.
The OEM was to serve as the command-and-control center during large-scale emergencies. Its
offices were on the 23rd floor in Seven World Trade Center, a 47-story building on the north side
of the complex. This post had been made bomb-resistant and bulletproof and had been reinforced
to withstand hurricanes. It also had a reserve of 30 days' worth of food and water. The OEM
operated on a 24-hour schedule and was responsible for coordinating the 68 city, state, and
federal agencies, as well as the city's fire and police departments. Personnel monitored all
emergency radio frequencies, and the center had a state-of-the-art communication system.
Occurrences like this is what test the OEM and after these occurrences is what change the OEM.

16 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)
17 Daniel Limmer and Michael F. OKeefe. Emergency Care. 12th ed. (Upper Saddle River: Pearson.)

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Sometimes no one can really can be prepared enough for these occurrences, so education of the
EMS needs limitations.
The emergency medical system has developed into a more organized system that can
provide many different areas of emergency care. It will continue to develop to keep up with the
way of the world. If the emergency medical system did not develop as it has, simple injuries
could turn into life threatening much faster and easier. The EMS is a critical component in the
medical system. Without the emergency medical system, the whole medical system would be
changed and would not be as helpful as it is now. Thankfully, we have had people and
organizations that devote their time for the betterment of the emergency medical system. The
development of the emergency medical system has greatly improved organization and quality
since the start of the emergency medical system.

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Works Cited
Atkins, Stephen E. "Office of Emergency Management." In American History. ABC-CLIO,
2000-. Accessed May 3, 2015. http://americanhistory.abc-clio.com/.
Barkley, Katherine (1978). The ambulance: the story of emergency transportation of sick and
wounded through the centuries. New York: Exposition Press.
"Founder Clara Barton." Clara Barton. Accessed April 23, 2015. doi:American Red Cross.
Limmer, Daniel, and Michael F. O'Keefe. Emergency Care. 12th ed. Upper Saddle River:
Pearson.
"TRAUMA.ORG: History of Trauma: Trauma Resuscitation." TRAUMA.ORG: History of
Trauma: Trauma Resuscitation. Accessed May 03, 2015.
http://www.trauma.org/archive/history/resuscitation.html.