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Emergency medical service

Emergency medical service (EMS) is a branch of medicine that is performed in
the field (i.e., the streets, peoples' homes, etc.) by paramedics, emergency
medical technicians (EMTs), and certified first responders (CRFs).

Although not commonly understood, EMS systems nationwide provide emergency
care that is almost on par with that of an emergency room. Equipment and
procedures are obviously limited, due to the nature of the environment that
EMS personnel must work in. EMS providers work under the license and
indirect supervision of a medical director (a board-certified physician),
who oversees the policies and protocols of a particular EMS system or
organization.

EMS workers are trained to follow a formal and carefully designed decision
tree which has been created and approved by physicians. The emphasis in
emergency services is on following correct procedure quickly and accurately
rather than on making in-depth diagnosis which requires much professional
experience. The use of a decision tree allows EMS workers to be trained in a
much shorter time than physicians.

National EMS standards are drawn up by the U.S. Department of
Transportation, modified from state to state by the state's Department of
EMS (usually under its Department of Health), and further altered by
Regional Medical Advisory Comittees (usually in rural areas) or by other
comittees or even individual EMS providers. All alterations to U.S. DOT
protocols are made by qualified people and conform to all applicable rules
and regulations.

History

The origins of EMS date back to the days of Napoleon, when the French army
utilized horse drawn "ambulances" to transport the injured soldier from the
battlefield. Its more recent incarnation can be traced back to 1869, when
Dr. Edward L. Dalton at Bellevue Hospital, then known as the Free Hospital
of New York, in New York City started a basic transportation service for the
sick and injured. The component of care on scene began in 1928, when Julien
Stanley Wise started the Roanoke Life Saving Crew, the first rescue squad in
the nation. Over the years EMS continued to evolve into much more than a
"ride to the hospital."

In particular in the US state of California and in King County, Washington
state, projects began to include paramedics in the EMS responses in the late
1960s. Despite opposition from firefighters and doctors, the program
eventually gained acceptance as its effectiveness became obvious.
Furthermore, such programs became widely popularized around North America in
the 1970s with the television series, Emergency! which in part followed the
adventures of two Los Angeles County Fire Department paramedics as they
responded to various types of medical emergency. The popularity of this
series encouraged other communities to establish their own equivalent
services.

In a return to the military roots of EMS, the United States Army has
developed the combat lifesaver program to instruct soldiers in advanced
first aid and limited paramedic skills including intubation. The combat
lifesaver is intended to bridge the gap between self-aid / buddy-aid and the
platoon medic on the 21st century decentralized battlefield.

Levels of Care

Two levels of care are provided by EMS systems: BLS and ALS (Basic Life
Support and Advanced Life Support). BLS providers are CFRs and EMTs and
provide all care outlined in the EMS standard of care, except for invasive
procedures and (to a certain extent) giving medications. ALS providers are
principally paramedics and can perform invasive procedures and give a wide
variety of drugs.

In times of economic crisis and in poorer areas, much normal medical care is
provided through emergency services to patients who do not have regular
physicians or regular medical attention.

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