This year marks 50 years since the National Academy of Sciences—National Research Council Committees on Trauma and Shock—released the white paper “Accidental Death and Disability: The Neglected Disease of Modern Society.” The paper, prepared by the National Academy of Sciences and the President's Commission on Highway Safety, highlighted that injuries were at epidemic levels as well as the lack of appropriate pre-hospital organized care systems to treat patients with serious injuries. It became known as “The White Paper.”
Looking back
In 1966, the authors of the 37-page White Paper probably never imagined what things would look like today. They just knew that people were dying unnecessarily due to improper treatment. To put things in perspective, at the time, your chance of surviving a bullet wound was better in Vietnam than it was on the streets of America. At least in Vietnam, medics would treat you immediately, start IVs, and a helicopter would usually transport you to a close MASH unit, where surgeons and nurses would begin immediate treatment.
The statistics were staggering and sobering. In 1965, there were 52 million accidental injuries leading to 107,000 deaths, 10 million people were temporarily disabled, and 400,000 people were permanently impaired at an estimated cost of $18 billion (1965 dollars). The White Paper stated that accidents were the leading cause of death for persons aged 1–37 and the fourth-leading cause of death for all ages. For people under 75, motor vehicle accidents constituted the leading cause of accidental death. In 1965, there were 47,089 traffic fatalities, and in 2014, there were 32,675 deaths. That is a reduction of 14,414 deaths during a time when the U.S. population actually increased approximately 124 million people.
Fifty years ago, there was no real EMS in the United States. It was a free-for-all of mostly funeral homes, hospitals, fire departments and some private ambulance companies. In south St. Louis where I grew up, I can remember seeing injured people being loaded onto a canvas stretcher and into the back of a police prisoner transport vehicle called a “paddy wagon.” There were no trauma centers, and many of the doctors in emergency rooms were residents moonlighting to make extra money. The people working on ambulances had no real training since EMTs and paramedics did not exist. If you had to be transported by ambulance, and you got lucky, your “ambulance driver” had advanced first-aid training from the American Red Cross. But there was also the chance that no one would be riding in the back with you.
It took seven years after the White Paper before Congress passed the EMS Systems Act of 1973, and put EMS under the National Highway Traffic Safety Administration (NHTSA). Although this pushed money out to the states through grants for improving care for those injured or ill outside the hospital, the NHTSA took a more centric role of standardizing EMT and paramedic curriculum, licensing and program development.
EMS evolution
EMS has been an evolutionary process. Each step along the way has been a step up the ladder to improve the system as a whole. Some milestones along the way included the Star of Life in 1977 and the Emergency Medical Service for Children Program in 1984. This program focused on research, training, system development and injury prevention for children.
Thirty years after the White Paper, the EMS Agenda for the Future was released to help guide what EMS systems should look like going forward. In 2000, the EMS Education Agenda for the Future focused on developing future EMS education standards and also defined the Scope of Practice to further clarify the roles of the EMT-B, EMT-I, EMT-IV, paramedic and other.
In 2001, the National EMS Information System (NEMSIS) was released, standardizing some data collection fields for sharing and storage purposes. Much like NFIRS, patient care records were uploaded to the state EMS office and then onto a central repository where all states dumped their information.
In 2010, the Culture of Safety research project was conducted to see what could be done to improve safety among EMS providers, and in 2014, the EMS Compass Project was started to begin looking at evidence-based performance measure outcomes so EMS systems of the future can examine ways to improve EMS care.
Bright future
There is no doubt that EMS looks vastly different than it did 50 years ago. I am curious what the next 50 years will bring. I would suspect driverless ambulances, new telecommunications systems, robotics treatments in the back of the ambulance, and newer and more powerful medicines for dealing with everything from gunshot wounds to cardiac arrests. The future looks bright!
