Emergency medical services in the United States
[4] In these cases, the volunteer squad may receive some funding from municipal taxes, but is generally heavily reliant on voluntary donations to cover operating expenses.
[5] In a variant of this model, the EMS system may be recognized as a legitimate third emergency service, but provided under a contractual agreement with another organization, such as a private company or a hospital, instead of direct operation.
[7] In the case of full integration, the EMS staff may be fully cross-trained to perform the entry-level function of the other emergency service, whether firefighting or policing.
There were no national standards for ambulance services and staff generally had little, if any, medical training or equipment, leading to a high pre-hospital mortality rate.
Such contracts usually result in a fee-for-service operation which is funded by the municipality on a supplementary basis, in exchange for formal guarantees of adequate performance on such issues as staffing, skill sets, resources available, and response times.
Apart from a handful of doctors who work on Medevac aircraft or perform training or medical quality assurance, it is extremely uncommon to see a physician deliberately responding to the scene of an emergency.
The vast distances covered by the U.S. mean that while helicopters may be the preferred form of service delivery for "on-scene" emergencies, fixed wing aircraft, including small jets, are often used for transfers from rural hospitals to tertiary care sites.
Gradually, especially during and after World War II, hospitals and physicians faded from prehospital practice, yielding in urban areas to centrally coordinated programs.
Sporadically, funeral home hearses, which had been the common mode of transport, were being replaced by fire department, rescue squad, and private ambulances.
The 1966 release of the National Academy of Sciences' study, "Accidental Death and Disability: The Neglected Disease of Modern Society", (known in the EMS trade as the White Paper)[23] prompted a concerted effort was undertaken to improve emergency medical care in the pre-hospital setting.
The study found many unnecessary deaths could be prevented through a combination of community education, stricter safety standards, and better pre-hospital treatments.
This service was not only the first statewide EMS program, but also the beginning of modern emergency medical helicopter transport in the United States.
Currently, National Registry certification is accepted in some parts of the U.S., while other areas still maintain their own, separate protocols and training curricula.
Groups in Pittsburgh, Pennsylvania, Charlottesville, Virginia and Portland, Oregon were also early pioneers in pre-hospital emergency medical training.
which, in part, followed the adventures of two Los Angeles County Fire Department paramedics as they responded to various types of medical emergency.
From 2005 to mid-2019, 160 rural hospitals closed, many in states that did not expand Medicare as part of the Affordable Care Act, leading to longer drive times for EMS.
[28] Compounding the problem was a temporary shutdown of training, recruitment by hospitals for nursing staff, and increased pay in other occupations experiencing a labor shortage and not subject to government reimbursement limits.
[28] Emergency Medical Service workers face numerous occupational hazards due to frequent activity and setting changes throughout their work day.
The stressors that emergency medical staff face, like watching human suffering/death and the job's unpredictable nature, can cause long-term consequences for their mental health as well.
[35] The COVID-19 Pandemic exacerbated these mental health issues in EMS workers due to increased field stress and limited resources.
A division of the Federal Emergency Management Agency (FEMA), The US Fire Administration, has published guidelines targeted toward reducing occupational hazards in EMS.
This creates significant challenges for the career mobility of many EMS providers, as they must often re-sit certification examinations each time they move from one state to another.
If patient condition warrants, an ALS provider may be summoned to assist and meet the ambulance en route to the hospital.
As of 2004, the largest "Private Enterprise" provider of contract EMS services in North America was American Medical Response,[47] based in Greenwood Village, Colorado.
On October 28, 2015, AMR announced that it had finalized the acquisition of Rural/Metro, forming the largest EMS organization in the United States and employing nearly 25,000 individuals.
Equipment and procedures are necessarily limited in the pre-hospital environment, and EMS professionals are trained to follow a formal and carefully designed decision tree (more commonly referred to as a "protocol") which has been approved by Medical Control.
Advanced technologies in use may include electronic mapping, Global Positioning System (GPS) or its first cousin Automatic vehicle location (AVL).
As a result, many dispatchers are trained to a high level in their own right, triaging incoming calls by severity, and providing advice or medical guidance by telephone prior to the arrival of the ambulance or rescue squad on the scene.
[59] As call volumes increase and resources and funding fail to keep pace, even large EMS systems such as Pittsburgh, Pennsylvania[60] struggle to meet these standards.
Individuals who live in rural areas far from emergency services also may expect a longer wait due to the distance involved.
