History of emergency medical services
Over the past four decades, prehospital care and emergency medical services (EMS) in the US have evolved rapidly from near nonexistence into key links in the chain of survival for patients with acute injury or illness. Beginning in the mid-1960s, after a landmark report titled Accidental Death and Disability: The Neglected Disease of Modern Society detailed serious deficiencies in out-of-hospital trauma management, state and federal lawmakers began to enact new standards for training, equipment, and oversight in EMS systems. The resulting translation into the field of formerly hospital-limited therapies for life threats, such as the unstable airway, respiratory failure, hemodynamic collapse, and dysrhythmias, in addition to traumatic injuries, has resulted in countless numbers of lives saved. With further advances in research, technology, and education, today's prehospital care providers are continually becoming more sophisticated in the diagnosis and treatment of acute injury and illness. Understanding the structure and capabilities of EMS is a critical component of emergency medicine, as the collaboration between prehospital and hospital-based providers determines the quality of emergency medical care delivered to the community.
Each municipality or rural area has several options with regard to the administration of their EMS. When government-run, EMS can be administered either as a stand-alone agency or under the command of the fire department. Alternatively, prehospital care can be provided by a local hospital or private ambulance company under contract to the city or county.