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EMS IN THE UNITED STATES
EMS Leaders, Educators, and Government Officials -
Throughout my more than thirty-year EMS career, I have come to appreciate the significance of having experienced mentors and dependable resources to navigate the intricacies of our complex EMS system. When I initially assumed leadership roles at both the state and national levels, I was struck by the scarcity of resources that could bridge the knowledge gap between local EMS leadership and the broader state or national leadership--understanding the history, grasping an overview of the organization, and possessing a guide to traverse the layers of influence. I was fortunate enough to have exceptional mentors, yet I witnessed many ambitious emerging leaders falter, in part, due to gaps in their knowledge and resources.
To help address this gap, I authored this book as a resource to provide a historical context for pivotal decisions that have shaped contemporary EMS systems. It is conceived as a desk reference, with each chapter functioning independently. You may notice some repeated information across different chapters, but this is intentional, serving to provide additional context in relation to the specific issue or historical event being discussed. Furthermore, I impart some insights drawn from my personal experience in leadership and management.
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From the birth of EMS in the United States to current challenges such as health equity and COVID-19, my objective is to offer you an overview of key historical decisions and demonstrate how they persistently influence the design and operations of EMS in our country.
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It is my hope that this book will not only act as a resource for budding EMS leaders, but also enable you to comprehend the historical underpinnings as the EMS system continues to modernize and evolve. By illuminating key facets of our history that are often neglected, we can delve deeper into understanding how EMS has developed, recognizing that our current state is inherently linked to past decisions. Each historical decision was made with purpose, and understanding this context will help guide us in shaping the future.
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I am eager for you to embark on this journey with me, exploring the rich history, complex present, and opportunity-laden future of EMS in the United States. The work you undertake is critical for the health and safety of our communities. I am optimistic that this guide will prove to be an asset to you as you work tirelessly to enhance emergency medical care in the United States.
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EMS History Photos
Historical Files
This book is enriched with over 100 references to Congressional records, hearings, reports, and historical events that were instrumental in shaping the modern Emergency Medical Services system in the United States. After years of research and document collection, a selection of these fascinating public domain documents and records are provided on this website. You are encouraged to read the book to uncover how these pieces of history intertwine and continue to influence the structure of today's EMS system.
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All links below will open up the document in a new tab!
In 1863, the Cincinnati Lancet & Observer published a call to action by leading Boston physicians urging Congress to investigate and reform the American system of army ambulances, advocating for a more uniform and effective approach to prehospital care.
Tourism has been a vital part of New York City since it was founded. This 1871 visitor's guide highlights the city's modern ambulance service (established 2 years prior, see page 43).
In 1963 the AMA designed and published the Universal Medical Identification Symbol. AMA gifted the symbol to the NREMT in 1970, where is became known as the Star of Life.
Read the original 1965 Medicare Act.
The NAS/NRC Committee on EMS publishes Guidelines and Recommendations for the Training of Ambulance Personnel.
The 1969 Training of Ambulance Personnel manual, published by The Ohio State University, and co-authored by Rocco Morando (prior to his appointment as Executive Director of the NREMT).
The first standardized EMT-Ambulance training course was published by NHTSA in 1970.
The Military Assistance to Safety and Traffic (MAST) program was established in 1970 to leverage military helicopters and personnel for civilian emergency medical transport, particularly in response to highway accidents.
The Dept of Health, Education & Welfare again researched EMS related statutes and published a summary in 1972.
In 1972 ACEP called for the Star of Life to be the standardized symbol for Emergency Medical Services and proper hospital emergency departments.
The statewide plan developed by Dr. Boyd presents the vision for a systems-approach to EMS & Trauma.
The comprehensive 1973 DHEW report includes EMS for the first time in the list of health occupations. This report shows the foundation EMS used to gain official recognition as a health profession. (The complete 500 page report is here.)
In 1973 the report America Burning spurred the creation of the US Fire Administration.
The Department of Health, Education & Welfare's EMS Program guide for States implementing EMS systems.
President Ford designated the 3rd week of May as EMS Week. Read the first ever EMS Week presidential proclamation.
Read President Ford's White House press release for EMS Week, 1975.
President Ford hosted EMS leaders for a Conference on EMS at the White House on Jan 6, 1976. Read President Ford's daily journal for details, and his remarks.
This 1976 report to Congress aptly titled, Progress, But Problems... highlights the challenges with implementing a national EMS system.
The original National Standard Curriculum for EMT-Paramedic
Following the blunt Congressional investigative report, the Department of Transportation and the Department of Health, Education & Welfare finally signed an MOU...albeit sho
With the looming repeal of the EMS Systems Act, ACEP and industry leaders attempted to persuade Congress to maintain funding for EMS. “With all that has been accomplished over the past five years in EMS (1975-1980), a setback of this dimension is unthinkable.”
-ACEP Testimony to Congress, April 22, 1980
1979, EMS Act
Review the full congressional record for the 1979 EMS Systems Act.
David Boyd, MD, & R Adams Cowley, MD, describe the 303 regional EMS and trauma system concept in this Journal publication.
NHTSA in collaboration with stakeholders published the EMS Agenda for the Future in 1996; setting a vision for the future of EMS.
The National Highway Traffic Safety Administration and
the Maternal Child Health Bureau's EMS Research Agenda.
The Rural and Frontier EMS Agenda for the Future established a vision for EMS in rural America.
Congress added EMS to PL92-498, a component of the US Fire Administration.
In 2014 a team of stakeholders published Model Legislation for the EMS Compact. Since then, 24 states have passed this Model Legislation into state law.
The National EMS Advisory Council published an advisory on the Recognition of EMS Personnel Licensure Interstate Compact.
The 2021 release of the National EMS Education Standards.
NASEMSO releases the Third edition of the National Model EMS Clinical Guidelines.
This 2023 Journal publication examines "A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies"
On May 15, 2024 Freedom House Ambulance was recognized for their service. View the book published by NASEMSO.
In 1865, Cincinnati city council records documented the first paid civilian ambulance driver at Cincinnati Commercial Hospital, marking the formal establishment of organized civilian EMS in the United States.
In 1885, the State of Louisiana established an ambulance service at Charity Hospital in New Orleans, LA.
The U.S. Navy trained it's first "Paramedics" in 1963.
This landmark publication, Accidental Death & Disability, is a foundational report for today's EMS system.
The NAS/NRC Committee on EMS publishes Medical Requirements for Ambulance Design and Equipment.
In 1969 the Dept of Health, Education & Welfare researched and collected a summary of all state regulations related to ambulances and Good Samaritan laws.
On the direction of President Johnson, the American Medical Association Committee on EMS created a task force to explore the creation of a new profession and a 'National Registry' for EMTs. Read the official meeting minutes!
The Office of Economic Opportunity highlights the Freedom House Ambulance Service in the 1971 magazi
NHTSA publication on the use of Helicopters in EMS.
Also in 1972, Gerald Looney, MD explores the question on the federal role in EMS.
Perhaps the most substantive Congressional action related to EMS was the 1973 EMS Systems Act.
In 1977, Dr. Farrington's Scudder Oration on Trauma was aptly titled, "The Seven Years' War"
The 1974 DOT Highway Safety Manual provides guidance to states on EMS system development (under the DOT model, not the DHEW model)
President Nixon appoints the first Interagency Committee on Emergency Medical Services, including Dr. Peter Safar. View the appointments in President Nixon's digest.
Recognizing EMS systems lacked sustainable financing, this 1975 report outlines the economic realities of providing rural EMS.
In 1975 NHTSA commissioned a report on Methodologies for the Evaluation and Improvement of EMS Systems.
The Department of Health, Education & Welfare collected over 200 abstracts to document EMS innovations around the nation. Read them here!
Recognizing conflicts between federal departments in implementing EMS systems, Congress called for this investigative report.
DOT publishes a guidance document describing the Star of Life as the official symbol for EMS.
The National Academy of Science report concludes, "EMS in the United States in midpassage, urgently in need of midcourse corrections, but uncertain as to the best direction and degree."
"All momentum will be lost if funds are not available with which to implement the planned systems. " Congressional testimony on behalf of the Massachusetts Department of Health
Read the summary of the 1979 Government Accountability Office's report to congress on the implementation of the EMS Systems Act.
This Act briefly led to the establishment of the Division of Trauma and Emergency Medical Systems within the Health Resources and Services Administration.
2000 Ed Agenda
In 2000 the EMS Education Agenda for the Future: A Systems Approach was released, charting a refined vision for EMS education.
An autobiographical account of the History of EMS written by Peter Safar, MD.
In 2007, the Government Accountability Office produced a congressional repot on the Costs and Expected Medicare Margins for Ambulance Providers.
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The National Association of State EMS Officials passed this resolution in 2010 reaffirming the role of a single paramedic accreditation board.
NHTSA publishes An Analysis of Prehospital Emergency Medical Services as an Essential Service And as a Public Good in Economic Theory
In 2019, EMS Visionaries published the EMS Agenda 2050.
Read the 2021 NEMSIS annual report.
Read the December 2022 report from the "Blue Ribbon Commission To Study Emergency Medical Services in the State (of Maine)"
This is the Phase 1 Report of Colorado's EMS System Sustainability Task Force.
Published June 2025, this report by the Wyoming Department of Health provides a comprehensive review of Ground Emergency Medical Services in Wyoming,
Review the meeting minutes from 1869 when NYC formally established an organized ambulance service under the direction of Dr. Edward Dalton. (Search the file for 'ambulance')
At the request of the White House, the American Medical Association publishes this Summary Report on National Emergency Medical Care, and establishes the AMA Task Force on EMS. This report calls for the establishment of a new type of training for Emergency Medical Services.
The American Journal of Public Health publishes a visionary article on Ambulances and EMS.
The 1966 instructor guide of Emergency Victim Care was published by The Ohio State University and Rocco Morando.
Perhaps one of the most impactful conferences to impacted the future of EMS in the United States was this 1969 conference held at the Airlie House in Virginia. Read the conference
New York City used computers to simulate a cost-effective model for ambulance placement.
The Committee on EMS, including EMS system founders Dr. Farrington, Dr. Safar, Rocco Morando, Roddy Brandes, and others, collaborated on the first patient and provider centric ambulance design specifications.
Dr. Peter Safar calls upon the medical community to recognize EMS personnel as Allied Health Professionals in this 1972 paper published in the Journal of Anesthesia and Analgesia.
The question was: What Is the Role of Federal Government in EMS? This was explored by the National Academy of Sciences and the Nain 1972.
Roles and Resources of Federal Agencies in Support of Comprehensive Emergency Medical Services.
Dr. Benson publishes his article "Elements of a Comprehensive Emergency Medical Services System" calling for a Systems Approach to EMS.
Transporting Lazarus: Physicians, the State, and the Creation of the Modern Paramedic
and Ambulance, 1955–73 is one of the most eye-opening and comprehensive historic texts available. The full text is available here.
This 1974 newsletter highlights the role of volunteers in Wisconsin and Wyoming during the early days of EMS system development.
This 1974 document outlines the origins, purposes, and history of programatic accreditation.
Letter from the NREMT to the American Medical Association requesting official approval of EMT-Paramedic as a new allied health profession.
Dr. J.D. 'Deke' Farrington and colleagues published this account of the History of EMS in the United States in 1976.
Recognizing the need for EMS personnel to collaborate across state lines, an Interstate EMS Consortium was established between Pennsylvania, Maryland, and West Virginia.
DHEW's publication explaining the regionalization approach, and economy of scale, for Regional EMS Systems.
In 1978 the Department of Transportation provided states with this model EMS Act.
The Department of Health, Education & Welfare publishes guidance for states seeking to implement the 1973 EMS Systems Act.
In 1980 the NAEMT and ACEP joined to standardized the definition and nomenclature of an EMT-Paramedic.
In 1981 NHTSA published a comprehensive report looking at the role and impact of Mobile Coronary Care.
With the future of any federal funding for EMS at risk, the National Association of State EMS Directors passed a resolution and the president testified in front of Congress.
At the direction of Congress, the Government Accounting Office, concluding "...local emergency medical services have reported substantial needs for improving the emergency care they provide."
In 2005, Rocco Morando wrote a brief history, in his own words, of the history of the NAEMT.
The 2007 National EMS Scope of Practice Model was a recommitment to national standards.
The National EMS Advisory Council published a Position Paper on the Role of a Lead Federal Agency for Emergency Medical Services
The National EMS Advisory Council published a comprehensive advisory on EMS Funding and Reimbursement in 2016.
Read the fact sheet explaining the CMS authorized Treatment in Place waiver for EMS due to the COVID-19 pandemic.
Author Kevin Hazard, in his book American Sirens, masterfully tells the story of the Freedom House Ambulance
2023 EMS Week
Nearly 50 years after the first EMS Week was celebrated, Colorado (and other states) reaffirmed their commitment to EMS. View the proclamation.
A comprehensive report on the financial realities of ambulance operations in Minnesota.
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