First Responders Day 2019

First Responders Day: History of the EMS

This year is the first official year that America will be remembering First Responders Day on October 28.

The making of First Responders Day into a national holiday isn’t a super long story, but it really started with remembering 9/11.

The fateful day in 2001 led to America really recognizing the power and importance of first responders. Then in 2013, the Boston Strong movement started in response to the Boston Marathon bombing. Andrew Collier started  a day of recognition after his brother, Sean Collier, was killed in the horrific bombing.

On May 18, 2017 Congress decided to start getting in on the action. Senator Elizabeth Warren (who is currently running for president on a very socialist platform) and Senator Tom Cotton started the ball rolling with representatives Mark Meadows, Michael Capuano, and Elija Cummings to introduce a resolution to establish National First Responders Day.

Colorado made it official on September 27, 2017 when the state approved a bill honoring every single first responder.

Then, the nation backed the Colorado bill and on February 21, 2019 the bill passed both the House and Senate in bill HJ646 making First Responders Day official. The observance day is October 28 every year from now on. 

Why EMS and Not EMT?

A couple of Houston EMS unloading a gurney

I started researching for this article thinking I was going to just learn the history of EMTs. My brother is a paramedic and I just assumed that was a different way to say EMT. I was under the impression they were one and the same. 

So, naturally, I asked my brother, Ryan Whitworth, if there was any difference between the two and he said yes. I pressed him for specifics because my mind was blown and he told me, “To become a paramedic you must first obtain your EMT-B. Typically, most EMT programs require anywhere between 120 and 150 hours of training for EMT basic. Paramedics require upwards of 1200 hours training, depending on the state, school, etc. On the ambulance an EMT can only give a few medications and render first aid depending on company protocol and medical direction. Paramedics can analyze and interpret 4 lead and 12 lead EKGs; place advanced airways, including tracheal intubation and surgical cricothyroidotomy; start IV lines, and give many IV medications.”

Basically, an EMT can perform absolutely basic life saving techniques. A paramedic has more schooling and training that allows them to get a little more down and dirty on someone in need. 

Naturally, this sparked my curiosity and led me to do an overarching research session for all Emergency Medical Services or EMS.

History of EMS

A vintage first responders vehicle

Just like everyone wondering where something began, I was curious about the EMS simply because it has existed literally my whole life. I went to the number 1 source for all things EMS related the Journal of Emergency Medical Services website:

It all started in 1966 when President Lyndon B. Johnson gets a report called the Accidental Death and Disability:The Neglected Disease of Modern Society. This report shows that the “leading cause of death in the first half of life’s span.”

Basically, younger people were dying because of accidental deaths. It was not the accidents necessarily that killed the people, but the injuries sustained after the accidents.

This report is commonly referred to as “The White Paper.”

The White Paper had a few ideas to help solve the issue. The one that really stuck out and got working was the suggestion for the standardization of training for what was to be lumped in as the EMS. It included EMTs, paramedics (though these names weren’t created yet), policemen, firemen, and other response squads. 

LBJ took action with this information and allowed the the first national curriculum for EMS to be published in 1969. This original document is believed to be the founding document of the modern EMS.

Beginning of the Paramedic

Some first responders on the scene of an incident

When the EMS curriculum was first created, it didn’t allow for a difference between an EMT and a paramedic. 

Walt Stay, PhD, Nancy Caroline, MD, and a few others in the Pittsburgh area got together and realized that more could be done to help save lives besides the current level of care provided by ambulance personnel at the time. The group then decided to do something about this issue and created the first Emergency Medical Technician – Paramedic (EMT-P) curriculum. This was to build on the current EMT curriculum, which later became the EMT-B or EMT – Basic program. 

The main differences between the EMT-B and EMT-P was in the training hours required. The EMT-P now required 400 hours of lab work and clinical rotations along with a 100 hour field internship. 

This helped reinforce the general public’s trust in Emergency Personnel. This trust was also backed by a 1972 TV show called Emergency! The show was originally supposed to be kind of a comedy, but they brought on a former EMS as a show writer who helped turn it into a demonstration of the skills and medical prowess of emergency response personnel.

Improvement of EMS

EMS saving a man's life

In 1972, along with the new TV show, the first emergency physician residency was created by the University of Cincinnati. 

Of course, this was only the first and many more have been created since then. The field is always growing and colleges and medical professionals alike are working nonstop to help grow the field and help more people.

One such example is that advanced cardiac life support (ACLS) wasn’t even invented until 1979. It didn’t become a standard in all paramedic training until the mid 1980s. Until then, the level of care an injured individual would receive varied between care providers. 

The Development of the Accreditation Process

A checked off list for accreditation

There was no true accreditation process when the regulation of training began in 1969. So in 1970, the National Registry of EMTs (NREMT) was created. They met and created the first ever nationwide certification program. This helped establish consistent care that would be carried out all across the U.S.

In 1971, another important moment came when Rocco V. Morando was selected to be to founding executive director of the NREMT. This year also marked a huge milestone in having 1,520 people took the NREMT regulated ambulance exam.

When 1978 rolled around, the NREMT had finally established a paramedic exam. The first one was given in Minneapolis. It was a pivotal year for the NREMT because it became an official member of the National Commission for Health Certifying Agencies. Then the EMT-P became an approved health occupation through the Council of Allied Health Education and Accreditation (CAHEA) and the Joint Review Committee. 

1980 proved to be a very powerful time for the accreditation process because UCLA and Eastern Kentucky University became the first 2 reviewed programs in history. 

There are now 2 reviewing entities: the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).

Lastly, this showed how wordy the medical field can get because they have yet another acronym due to their inability to come up with a shorter name. 

Who am I kidding, no matter how long the name was it would get shortened. The NFL is a perfect example of this.

The Development of Practice Standards

A checklist

Just like with everything in the medical field, the practice standards are always updating to give the greatest possible care. 

This is shown with the updates of the EMT-B and the EMT-P exam updates. The first EMT-P exam update came in 1985. Then again in 1998, 2000, and 2009. 

Each update brings with it the newest developments in scientific help for those in need. It also became more intense. As noted with Ryan Whitworth’s statement about how many hours are required for acceptable accreditation, each update to the EMT-P program brought more and more necessary hours for completion. This also brought closer alignment to college programs. 

In an effort to establish a more consistent level of care, the NREMT will only accept students that have completed a CoAEMSP accredited program to take the NREMT-P exam.

The latest update also required that paramedic program directors must have a minimum of a bachelor’s degree, as well as having active EMS experience. This makes the directors better educated and have the wisdom of working in real world scenarios. Most program directors are dedicated to providing the best service and often pursue further education in a master’s program or doctoral program.

The Latest

A side view of a New York Fire Department Ambulance

EMS is always looking for improvement. Modern medicine is always advancing, so EMS programs have to do whatever it takes to keep up. This has drastically reduced the number of deaths related to lack of care after an accident. 

Recently, UCLA, HealthONE EMS, the University of Texas Southwest, Creighton University, Inver Hills Community College, Chemeketa Community College, Oklahoma Community College, and Gwinnette Technical College have all teamed up with the NREMT to replace the standard psychomotor exam with a more scenario based exam.

Every skill and practice is always being examined to find any possible improvements. When people’s safety and health is on the line, no stone is left unturned. Constant improvements are always being made by the NREMT for exams and standardization to become as good as possible.

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