Monday, July 30, 2007

From the Civil War to Star Wars: A Brief History of EMS in the United States

I've been writing about EMTs (emergency medical technicians) for a while, and, by extension, fire fighters (who are increasingly required to have some level of EMT training) . All of this medical training falls under prehospital care - emergency medical services (EMS) provided before a patient enters the hospital, either at the site of the illness or injury or during transport to a hospital. EMTs range from first responders to paramedics, who have the most medical training (measured in hours of classroom and clinical training and equipment/techniques used).

Prehospital care is a structured and fairly militaristic culture, with both the camaraderie and tensions of long shifts, and sudden exposure to trauma. EMTs never know exactly what they will encounter each day when they go out on calls, from a simple transport that didn't even require an ambulance to a wrenching pediatric emergency.

Modern EMS, in fact, has military origins, since it arose as a way to manage injured soldiers. During the Civil War, wounded soldiers often languished for days on the battlefield before they were treated, according to a fascinating Elsevier publication on the history of EMS. In 1862, General Jonathan Letterman, a Union surgeon for the Army, implemented a formal system to treat wounded soldiers and transport them quickly to field hospitals. His ideas for improved medical treatment were based on those of a Baron who grappled with the same problems during the French Revolution. In many ways, Letterman is the father EMS in the United States.

Fast-forward about 100 years to the Highway Safety Act and the creation of the U.S. Department of Transportation (DOT) in 1966. The DOT standardized EMT training, and in 1970 Ronald Reagan, then the governor of California, signed an influential law giving paramedics more legal rights to provide advanced treatments to patients.

And then there was Hollywood. Many EMTs were influenced by, or are interested in, the TV series Emergency!, an NBC drama about Los Angeles paramedics that ran from 1972 to 1977. Emergency! was not only extremely popular, but it also helped lead to landmark legislation, the EMS Act of 1973 (Public Law 93-154). Spearheaded by Senator Alan Cranston (D-CA), the law improved funding for paramedic training in the United States (federal support for EMS has decreased since the 1980s, however).

And Star Wars? The Army founded a hospital in San Francisco's Presidio in the 1890s to treat the great numbers of soldiers going the Philippines (and often treating returning soldiers who had contracted complicated tropical diseases there). This hospital was renamed the [Jonathan] Letterman Army Medical Center in 1911. In 1994, the Army turned over the Presidio to the Golden Gate National Recreation Area. The hospital was eventually torn down and George Lucas, of Star Wars fame, of course, built the new Letterman Digital Arts Center there.

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