1. History of the EMS Dr. Miada Mahmoud Rady Ems - 472

2. Outline key historical events that influenced the development of emergency medical services (EMS) systems.

3. Topics of the lecture A.Introduction. B.Definition of the EMS system. C.EMS system development.

4. Introduction  EMS has made significant advances over the last 30 years.  The role of the paramedic has advanced accordingly.  Originally, the primary role of the paramedic was transportation.  Paramedics now are highly trained health care professionals.

5. EMS system  Definition :  Definition : A comprehensive network of personnel, equipment, and resources, established to deliver aid and emergency medical care to the community.

6. Simply, it is Planned configuration of Community Resources and Personnel necessary to provide immediate care to patients with Sudden/Unexpected Injury/Illness.”

8. EMS System Development 1 Ancient times 2 Military EMS 3 The 20 Th century 4 Civilian EMS

9. Ancient Times EMS System Development Ancient Times  EMS systems have developed from the traditional and scientific beliefs of many cultures:  Ancient Egyptians : used herbs and drugs as medicine,evidence of bandages and splints usage, performed surgeries and also referred to pulsation of heart and abnormal motor functions associated with brain injury.

10. Military EMS EMS System Development Military EMS  Military Used the First Organized Prehospital Care.  Covered cart was first ambulance.  Moved injured soldiers during Napoleonic wars.

11. Military EMS EMS System Development Military EMS  Napoleonic Wars : → First efforts of field care developed by one of Napoleon’s surgeons, which implements a Prehospital System designed to Triage and Transport the injured from the battlefield to aid stations.

12. EMS System Development The 20 Th century 1.Civil War. 2.WW I. 3.WW II. 4.Korean War. 5.Vietnam War. 6.Iraq War.

13. EMS System Development The 20 Th century  U.S. Civil War : 1.Triage and transport of wounded soldiers to improvised hospitals in houses, barns, and churches. 2.Saw the beginning of organized medical care with people like Clara Barton, who started to establish the American Red Cross. 3.Immediate care in field hospitals with transport to hospitals behind the lines by train was also started.

14. EMS System Development The 20 Th century  WW I : 1.Poor planning and excessive evacuation times caused high mortality rates mostly due to hemorrhagic shock. 2.No antibiotics. 3.Blood transfusions were introduced. 4.Thomas half ‐ ring femur splint considered best trauma care.

15.  WW II: 1.Evacuation time: 4–6 hours 2.Antibiotics developed. 3.Plasma/blood transfusions became common. 4.Hospitals were closer to front line. 5.Fixed ‐ wing air transport began. EMS System Development The 20 Th century

16.  Korean and Vietnam conflicts : 1.In the Korean War, Mobile Army Surgical Hospital (MASH) units were used. 2.In both Korea and Vietnam, Helicopter Transport was used for the wounded. 3.These wars also brought about the development of civilian hospitals specializing in the treatment of trauma. EMS System Development The 20 Th century

17.  Iraq War: 1.Tourniquets reintroduced. 2.Hemostatic agents were developed. 3.CAB concept developed. EMS System Development The 20 Th century

20. Civilian EMS  Non-military ambulance services began operating in early 1900s in U.S.  Often operated by hospitals, fire departments, or funeral homes.  No requirements or standards for equipment, crew training, or ambulance design.  Mouth-to-mouth resuscitation was developed by Drs. Élan and Safar.

21.  The Portable Defibrillator was also developed by Johns Hopkins Hospital.  Mobile intensive care units (MICUs) were developed, it were staffed by specially trained physicians, however shortage of physicians led to training of non physician. Civilian EMS

22. The white paper  Also called “Accidental Death and Disability: The Neglected Disease of Modern Society”.  It was released in 1965 by National Academy of Science and the National Research Council.  It dealt with the high number of deaths from traffic collisions due to inadequate emergency medical care.  Provided great impetus for attention to be turned to the development of EMS.

23.  Finding of the whitepaper included: 1.Lack of uniform laws and standards. 2.Poor-quality equipment. 3.Lack of communication between the hospital and EMS teams. 4.Lack of training. The white paper

24.  The White Paper finding outlined 10 critical points for EMS Systems and Led to national Highway Safety Act which created US Department of Transportation which provided authority and finances for the development of life support programs.  The paper made 29 recommendations for ultimately improving care for injured victims; which are related directly to out-of- facility EMS. The white paper

25. Dr. Eugene Nagel  1969, Dr. Eugene created the first true paramedic programs, he trained fire fighters with advanced emergency skills  He also developed a telemetry system through which fire fighters transmitted patients’ electrocardiograms to physicians and received medical instructions from physicians based on it  That why he was often called the Father of Paramedicine  Standards for ambulance design and equipment were published this year.

26. National Registry of Emergency Medical Technicians  1970s :  The NREMT was founded in 1970 as a result of the recommendations made by the Committee on Highway Traffic Safety.  It was established to standardize education, examinations and certifications.

27. 1970 's  1971: Emergency Care and Transportation of the Sick and Injured, First EMT textbook, was published by the American Academy of Orthopedic Surgeons (AAOS).  1973: Emergency Medical Services System Act was released, it defined 15 required components of an EMS system and provided additional federal guidelines and funding for the development of regional EMS systems.

28. 1970 's  1977: First National Standard Curriculum for Paramedics developed by US DOT based on Nancy Caroline’s work.

29. 1980 's and 1990 's  Number of trained personnel grew.  The National Highway Traffic Safety Administration (NHTSA) developed 10 system elements to help sustain EMS System.  Responsibility for EMS transferred to the states.  Major legislative initiatives e.g. EMS for Children (EMS- C) program.

30. Summary  EMS has made significant advances over the last 30 years.  Military used the first organized prehospital care.  EMS made major changes after WWII  Non-military ambulance services began operating in early 1900s in U.S.

31. HOME WORK AB Clara Barton Established to standardize education, examinations and certifications Dr. Eugene Nagel Also called “Accidental Death and Disability: The Neglected Disease of Modern Society Johns Hopkins HospitalDeveloped mouth to mouth resuscitation Drs. Élan and Safar. Established the american red cross NREMT The Portable Defibrillator The white paperCreated the first true paramedic programs

32. Home work should be sent in ward document to E-mail no later than next Monday.

33. ANY QUESTIONS ?