called attention to the fact that at least 50 percent of ambulance services nationwide were being provided by morticians. The report contained a total of 29 recommendations, 11 of which applied directly to prehospital EMS (Delbridge et al., 1998). These included recommendations to (1) develop federal standards for ambulances (design, construction, equipment, supplies, personnel training and supervision); (2) adopt state ambulance regulations; (3) ensure provision of ambulance services applicable to the conditions of the local government; (4) initiate pilot programs to evaluate automotive and helicopter ambulance services in sparsely populated areas; (5) assign radio channels and equipment suitable for voice communications between ambulances and emergency departments (EDs) and other health-related agencies; and (6) develop a single nationwide telephone number for summoning an ambulance. The report also laid out a vision for the establishment of trauma systems as we know them today.

In addition to the momentum that had been provided by the President’s Commission, support for the NAS/NRC report was fueled by surgeons with military experience in Korea and World War II who recognized that the trauma care available to soldiers overseas was better than the care available in local communities. In 1966, Congress passed the Highway Safety Act, which led to the formation of the National Highway Traffic Safety Administration (NHTSA) within the Department of Transportation (DOT). NHTSA was given authority to fund improvements in EMS. Among those improvements, NHTSA developed a national EMS education curriculum and model state EMS legislation. NHTSA’s 70-hour basic EMT curriculum became the first standard EMT training in the United States. The department developed more extensive advanced life support (ALS) training several years later. Also as part of the 1966 act, DOT offered grant funding to states with the goal of improving the provision of EMS.

1970s: Rapid Expansion of Regional EMS Systems

In the early 1970s, additional research and policy planning focused on the unmet needs of EMS. In 1972, the NAS/NRC released another report on EMS entitled Roles and Resources of Federal Agencies in Support of Comprehensive Emergency Medical Services (NAS and NRC, 1972). The report expressed concern that the federal effort to upgrade EMS had not kept pace with what was needed. It urged integration of all federal EMS efforts into the Department of Health, Education and Welfare (DHEW, which later became the Department of Health and Human Services [DHHS]). The report also stated that the focal point for local EMS should be at the state rather than the federal level, and that all efforts should be coordinated through regional programs.

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