Timeline of Modern American EMS

1966—Release of the “white paper,” Accidental Death and Disability: The Neglected Disease of Modern Society. In Belfast, Northern Ireland, Dr. Frank Pantridge begins delivery of prehospital coronary care using ambulances. 

1967—The American Medical Association hosts the National Conference on Emergency Medical Services, which produces recommendations for training ambulance personnel. The Freedom House program begins in Pittsburgh.

1968—St. Vincent’s Hospital in New York City launches America’s first mobile coronary care unit using physicians, then later paramedics. AT&T designates the number 9-1-1 for emergency use. 

1969—The Miami Fire Department starts the nation’s first paramedic program under Dr. Eugene Nagel. Seattle quickly follows with Medic 1. The first nationally recognized EMT-A curriculum is published. 

1970—The National Registry of EMTs is created. California’s Wedworth Townsend Act is the first legislation to define paramedics under state law.

1971—The first EMT-A curriculum is published and exam administered.

1972—The Department of Health, Education and Welfare allocates $16 million to EMS demonstration programs in five states. The first residency program to train emergency medicine physicians is established at the University of Cincinnati. The TV show Emergency! premieres.

1973—Congress passes the EMS Systems Act, funding 300 regional EMS systems. The DOT creates the Star of Life. The Robert Wood Johnson Foundation appropriates $15 million to fund 44 EMS projects in 32 states and Puerto Rico.

1974—Dr. David Boyd is chosen to lead the first federal EMS lead office in the Department of Health, Education and Welfare. The American Heart Association issues its first resuscitation guidelines. The federal Star of Life ambulance purchasing specification (KKK-A-1822) takes effect. 

1975—The American Medical Association recognizes the specialty of emergency medicine. The National Association of EMTs is formed. The University of Pittsburgh and Nancy Caroline, MD, begin work on the first nationwide paramedic training course. The AHA creates ACLS. The AMA recognizes paramedic as an allied health occupation.

1977—NHTSA produces the first EMT-P National Standard Curriculum.

1978—Dr. Jeff Clawson’s initial system for triaging emergency calls and prioritizing responses is implemented in Salt Lake City.

1979—The American Ambulance Association is formed. NHTSA’s Crash Injury Management for the Law Enforcement Officer program is refashioned into a National Standard Curriculum for first responders.

1980—The National Association of State EMS Directors (later Officials) is created. The NREMT publishes its first national standard exam for EMT-Intermediates. In King County, Wash., the first EMTs are formally trained to provide defibrillation.

1981—The Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants. This gives states greater discretion in funding EMS systems and activities, and leads to the dissolution of many original regional EMS management entities established by initial federal funding. AIDS is first reported by the CDC; its spread throughout the 1980s gives rise to the practice of isolating body substances and the routine use of personal protective equipment by healthcare providers.

1983—Systems status management begins in Denver.

1984—The Emergency Medical Services for Children program is established. The National Association of EMS Physicians is created.

1985—The National Research Council publication Injury in America: A Continuing Public Health Problem describes deficiencies in addressing the problem of accidental death and disability. The DOT publishes national standard curricula for EMT-Intermediates and -Paramedics.

1988—NHTSA implements a statewide EMS technical assessment program that evaluates systems based on 10 components:

• Communications
• Evaluation
• Facilities
• Human resources and training 
• Medical direction
• Public information and education
• Regulation and policy
• Resource management
• Transportation
• Trauma systems

1990—The Trauma Care Systems Planning and Development Act is passed, and the HRSA Division of Trauma and EMS is created (the latter was disbanded in 1995). The Commission on Accreditation of Ambulance Services is formed to set standards for ambulance services.

1991—The Utstein style for uniform reporting of cardiac arrest data is introduced.

1993—The Institute of Medicine’s Emergency Medical Services for Children report spotlights the U.S. healthcare system’s weaknesses in addressing the emergency needs of pediatrics.

1994—The DOT’s EMT-A curriculum is revamped into a new curriculum for EMT-Basics. NHTSA’s Uniform Prehospital EMS Data Set is published.

1995—The bombing of the Murrah Federal Building in Oklahoma City kills 168—at the time the worst act of terrorism committed on American soil. Project 25 digital radio standards are formally established at the Association of Public-Safety Communications Officials (APCO) International conference in Detroit.

1996—FDNY absorbs New York City EMS. NHTSA publishes the vaunted EMS Agenda for the Future. An implementation guide follows, as do other similarly modeled Agenda documents.

1997—Congress awards a much-needed extra 24 MHz of broadcast spectrum space to public safety, but it takes additional action and almost 12 years for it to become available for use.

1998—Revision of the NSC for EMT-Is and EMT-Ps. The National Defense Authorization Act for fiscal 1999 creates the Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, aka the Gilmore Commission. The first Gathering of Eagles (State of the Sciences) meeting is held in Pittsburgh. 

1999—A student attack at Columbine High School in Littleton, Colo., kills 12 students and a teacher. The American Red Cross incorporates defibrillator training into its CPR course.

2001—Attackers fly hijacked jets into the World Trade Center and Pentagon in the worst terror attack in U.S. history. A total of 2,996 are killed. This gives rise to the concept of homeland security, along with the federal department of the same name; launches America’s ongoing war on terror; and spotlights chronic emergency-services problems, including communications interoperability. Work begins on the National EMS Information System (NEMSIS). 

2002—Publication of Medicare’s revised national ambulance fee schedule results in reduced payments for many services. In the wake of September 11, Advocates for EMS is founded to represent the needs of EMS providers in Washington, DC.

2004—Prominent EMS authority James O. Page dies. The FDA approves Philips’ HeartStart AED for over-the-counter sales without prescriptions. Release of the National EMS Core Content.

2005—Hurricane Katrina strikes New Orleans and surrounding areas, killing 1,836 people. The city’s public-safety and healthcare response capabilities are shattered, and the state and federal governments are slow to assist. NHTSA releases the National EMS Scope of Practice Model, an effort to standardize provider competencies and nomenclature across the U.S. 

2006—Publication of the IOM’s Emergency Medical Services: At the Crossroads report, which details the major problems facing EMS as it enters the 21st century. Congress establishes the Federal Interagency Committee on EMS (FICEMS). The Pandemic and All Hazards Preparedness Act (PAHPA) becomes law, creating the Office of the Assistant Secretary for Preparedness and Response (ASPR) within the Department of Health and Human Services. 

2007—Virginia Tech senior Seung-Hui Cho kills 32 in what was then the deadliest mass shooting by a single gunman in U.S. history. The NREMT begins offering computer-based testing. 

2008—The National EMS Advisory Council (NEMSAC) first meets. DHS unveils the first National Response Framework. An AHA advisory statement formally embraces compression-only CPR. 

2009—Release of the National EMS Education Standards. Early community paramedic pilot and prototype programs begin. Pandemic influenza caused by a new strain of H1N1 kills an estimated 150,000 people worldwide. The NTSB issues 19 new recommendations for HEMS safety. EMS World and the NAEMT establish the National EMS Awards of Excellence. 

2010—The Affordable Care Act is signed into law. The AHA’s new CPR/ECC guidelines reorder the traditional ABCs to start compressions first. NAEMT initiates EMS On the Hill Day. The National Volunteer Fire Council establishes an EMS section. NASEMSO votes to require national accreditation for paramedic education programs. 

2011—U.S. forces kill top terrorist Osama bin Laden, whose al Qaeda organization carried out the 9/11 attacks. NAEMT debuts its EMS Safety course. 

2012—Congress allocates the key D Block segment of the broadcast spectrum to public safety, clearing the way for FirstNet. Superstorm Sandy hits the Northeast, causing flooding in New York City. The first community paramedic program graduates are certified in Minnesota. Rough beginning of the current opioid epidemic. 

2013—The mobile integrated healthcare concept leaps forward as CMS Innovation grants help fund proof-of-concept programs in Reno and elsewhere; state-sanctioned pilot projects begin in Maine; and pioneering Texas service MedStar EMS changes its name to MedStar Mobile Healthcare. The Strategy for a National EMS Culture of Safety is published, culminating a three-year effort. The NFPA 1917 ambulance standard is released. 

2014—An outbreak of Ebola virus disease in West Africa becomes history’s deadliest, officially killing 11,310 (thought by WHO to be an underestimate), and eventually spreads to the United States, infecting three healthcare workers. The EMS Compass performance measures project begins. The U.S.’ first mobile stroke unit debuts in Houston. 

2016—EMS Agenda 2050 development begins. A mass shooting at Orlando’s Pulse nightclub kills 49, becoming (for a year) the deadliest in U.S. history. The Commission on Accreditation of Ambulance Services releases its ground vehicle standard, GVS 1. The EMS 3.0 effort gets underway. 

2017—A gunman firing from a hotel at Las Vegas’ Route 91 Harvest Festival kills 58, surpassing the toll of last year’s Pulse shooting. Anthem BlueCross BlueShield announces it will reimburse ambulance care without transport.