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  • In the United States, the Emergency Medical Services (EMS) Systems Act of 1973 (PL 93-154) resulted in federal funding for the establishment of emergency medical systems.

  • The four levels of prehospital care providers described in the National EMS Education Standards of 2009 are emergency medical responder (formerly, first responder), emergency medical technician (EMT; formerly, EMT-Basic), advanced EMT (replaces both prior versions of the EMT-Intermediate), and paramedic.

  • The Stop the Bleed campaign developed under the direction of Lenworth M. Jacobs, Jr., MD, at Hartford Hospital trains laypersons to evaluate for life-threatening bleeding, compress bleeding, and apply tourniquets effectively.

  • Basic life support (BLS) in the field includes basic airway management, supplemental oxygen and rescue breathing, cardiopulmonary resuscitation, control of external hemorrhage, splinting, spinal immobilization, and uncomplicated childbirth.

  • Advanced life support (ALS) in the field includes advanced airway management, cardiac monitoring, cardioversion and defibrillation, insertion of intravenous lines, and administration of numerous medications.

  • In areas primarily covered by BLS units, a tiered response arrangement should be in place so that ALS backup is available when needed.

  • By 2015, 96% of the US population lived in an area covered by an enhanced 911 phone system, but this only represents about 50% of the counties in the country.

  • When caring for a critically injured patient, EMS personnel should limit on-scene time to 10 minutes or less.


Critically injured patients must receive high-quality care from the earliest postinjury moment to have the best chance of survival. Most trauma victims first receive health care from the emergency medical services (EMS) system, which is responsible for rendering aid and transporting the trauma patient to an appropriate facility.

The practice of medicine in the prehospital setting presents numerous challenges not encountered in the hospital. Hazardous materials along with environmental and climatic conditions may pose dangers to rescuers as well as to patients. If the patient is entrapped in a mangled vehicle or a collapsed building, there must be meticulous coordination of medical and rescue teams. Communication with police may be required in the setting of an active shooter or when concerns exist regarding potential explosive devices. Providers of prehospital care are expected to deliver high-quality medical care in situations that are dynamic, dangerous, austere, and unforgiving, and, often, for prolonged periods.

The role of the EMS system is far more complex than simply transporting the trauma victim to a medical facility. In most EMS systems in the developed world, specially trained health care professionals are responsible for the initial assessment and management of the injured patient. Experience from the past several decades has shown that these paraprofessionals can safely perform many of the interventions that were previously performed only by physicians or nurses in the emergency department.

Prehospital research has helped direct best practices, influence policies, and improve outcomes. As EMS systems mature and additional prehospital care research is ...

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