San Francisco Paramedic Association
In This Section
History of the Profession
What is Emergency Medical Services?
The transportation of injured persons has its earliest recorded roots during Napoleon’s time, when his chief surgeon saw the value of taking wounded soldiers off the battlefield. In the United States, the Civil War saw the rise of organized emergency transportation by trained personnel. By the late 1800s several major cities across the United States such as New York City, Cincinnati, Atlanta, San Francisco and Boston had horse-drawn ambulances that transported patients, often using physicians.
By the mid 1900s many areas across the country had some type of ambulance transportation available. While rescue squads in Virginia and New Jersey were considered “state of the art” at the time, many of these pre-EMS services were run by well-meaning but poorly equipped and poorly trained persons. Funeral homes were often the ambulance provider in their community.
By the time the Korean War ended, and the Vietnam conflict was underway, it was becoming evident that death by trauma in this country was climbing at an alarming rate. Automobile crashes in particular were claiming many lives. The National Academy of Science (NAS) published a seminal position paper in 1966, “Accidental Death and Disability, The Neglected Disease of Modern Society”. For the first time, trauma was noted to be a “disease”, and as such efforts could be applied to reduce the effects of the disease. The NAS included a multitude of recommendations to combat the problem, including safer vehicles, safer roads, and a systematic method of emergency transport of injured passengers by trained emergency medical personnel to appropriate receiving hospitals. The modern era of EMS had begun.
Today, EMS can be found in virtually across the United States. Estimates vary, but approximately 800,000 to 1 million trained emergency medical personnel provide prehospital care and transport of ill and inured patients around the clock. EMS system design varies tremendously, and there is no truer statement than “when you have seen one EMS system, you have seen one system.” In northern California, most prehospital care is provided by a fire department, private company, or hospital-based organization. EMS providers can be found on first response vehicles such as fire engines, ambulances, and aircraft such as helicopters and fixed wing. The emphasis is that it is an EMS system, where there is an organized, systematic approach to the delivery of the service. Most EMS systems in northern California are organized at the county level, with a local EMS agency (LEMSA) providing regulatory oversight of the system, as required by law. In turn, the LEMSAs are authorized to provide this oversight by the state EMS Authority, located in Sacramento.