Before 1970, EMS in the United States, wasn’t much to talk about. There was virtually no significant training of providers beyond basic first aid, ambulances were designed without standards—for speed, not patient care—and there were no real systems to coordinate the care and transport of the sick and injured. As a country, we were just functioning with a more contemporary model of what had been around since the Civil War. To use a computer software analogy, you might say we were operating Version 1.0 of EMS.
Modern EMS began in 1966 with the publication of the landmark white paper “Accidental Death and Disability: The neglected disease of modern society” from the National Research Council of the National Academy of Sciences. That same year, the Highway Safety Act (Public Law 89-564) was passed to reduce the number of fatalities and injuries that occur on U.S. roads and highways. This is when our current notion of EMS really began: we started to use the term “EMS,” established standards of training for EMTs and paramedics, created design criteria for ambulances and talked about “systems” for delivering our service rapidly and ubiquitously.
In 1996, the National Highway Traffic Safety Administration (NHTSA) published the “EMS Agenda for the Future,” which included guidance for EMS training, educational standards and the National Scope of Practice Model. These provided further enhancements to previous training curricula and standards, and described a more advanced world for EMS practitioners.
Over the last 50 years, this Version 2.0 of EMS saw us broadening the limits of what EMS could do and substantially refined the expectation of what an EMS system should be, boadened our scope of patient care, and laid down a path for the future we should strive to attain.
A Fundamental Upgrade
Now, we’re on the cusp of the next fundamental upgrade in the history of EMS. An initiative spearheaded by the National EMS Management Association (NEMSMA), National Association of EMTs (NAEMT), National Association of State EMS Officials (NASEMSO), National Association of EMS Physicians (NAEMSP) and National Association of EMS Educators (NAEMSE) will unveil EMS 3.0 this year.
The document will define and describe the evolution now necessary for EMS to coincide with the broader U.S. healthcare system reform currently underway. It recognizes that as American healthcare changes into a value-driven, outcomes-based model, so must EMS. The document focuses on the need for our profession to fall in line with the Institute of Healthcare Improvement’s Triple Aim:
- Improving the patient experience of care, including quality and satisfaction;
- Improving the health of populations; and
- Reducing the per-capita cost of healthcare.
EMS 3.0 highlights the way healthcare is funded, financed, and is measured. The document underscores that how we structure our systems and deliver care needs to change in order to be successful, both for our patients and for our agencies’ fiscal health.
Performance standards will be tied to patient outcomes, including patient satisfaction.
Efficient, effective clinical care and service delivery will be essential, with success rewarded and failure punished through reimbursement methodologies implemented by the Centers for Medicare and Medicare Services (CMS) and adopted by the health insurance industry.
Our value as a profession will depend on factors both new and old. Rapid response, quality clinical care on scene and safe transport to a hospital will only be part of the picture. How we contribute to improving a patient’s health and their recovery from illness or injury will be scrutinized as never before.
The ultimate outcome of the patient will be measured and our performance judged by both those who pay the bill and our partners in care. Our incentives will change from reacting to acute emergencies to preventing future episodes.
EMS agencies can demonstrate their value to other stakeholders in the healthcare system by expanding their services to include: community health screenings, injury prevention initiatives, mitigation strategies for chronic repetitive patients, assistance programs to improve patient compliance with healthcare plans, well-being checks, mechanisms to route patients to the appropriate segment of the healthcare system, expanded on-scene care to eliminate the need for transport, and strengthening bonds between patients and primary care physicians.