states. In 1991, two national resource centers were funded to provide technical assistance to states and to manage the dissemination of information and EMSC products. In 1995, the EMSC National Resource Center in Washington, DC was designated the single such center for the nation. Additionally, with the recognition of the dire need for research and the lack of qualified individuals in each state to perform it, a new center was funded, the National EMSC Data Analysis Resource Center (NEDARC) located at the University of Utah School of Medicine. Created through a cooperative agreement with the Maternal and Child Health Bureau, the NEDARC was established to “help states accelerate adoption of common EMS data definitions, and to enhance data collection and analysis throughout the country” [62].
As the 1980s ended, members of Congress requested information that justified continued funding of the EMSC program. The Institute of Medicine (IOM) of the National Academy of Sciences was commissioned in 1991 to conduct a study of the status of pediatric emergency medicine in the nation. A panel of experts was convened to review existing data and model systems of care, and to make recommendations as appropriate. The findings from this national study revealed continuing deficiencies in pediatric emergency care for many areas of the country and listed 22 recommendations for the improvement of pediatric emergency care nationwide [63]. These recommendations fell into the following categories: education and training, equipment and supplies, categorization and regionalization of hospital resources, communication and 9‐1‐1 systems, data collection, research, federal and state agencies and advisory groups, and federal funding. These findings convinced Congress to raise funding for the EMSC program.
In response to the IOM report, the EMSC program developed a strategic plan. With the assistance of multiple professionals, including physicians, nurses, and prehospital clinicians, major goals and objectives were identified. The EMSC 5‐year plan for 1995–2000 served as a guideline for further development of the program [64]. The plan had 13 goals and 48 objectives. Each objective had a specific plan that identified national needs, suggested activities and mechanisms to achieve the objective, and listed potential partners. In 1998, the plan was updated with baseline data, refined objectives, and progress in completing activities [65].
EMS Physicians 1982‐1996
Throughout the 1970s, emergency physicians and the fledgling ACEP supported regional EMS programs. By 1983, emergency physicians and the embryonic state chapters of ACEP were primarily focused on developing their new specialty and care in emergency departments. During this period, medical directors for EMS systems around the country increasingly began to publish articles in scientific journals on prehospital research and on their experiences with prehospital care. Gradually, they began to meet and, in the process, found many areas of common interest. After a series of organizational meetings that began in Hilton Head, South Carolina, in 1984, the National Association of EMS Physicians (NAEMSP) was created in 1985, with Dr Ron Stewart as its first president. By the late 1980s, emergency physician specialty groups such as ACEP and the Society for Academic Emergency Medicine also placed more emphasis on EMS and began to encourage EMS‐related activities among their members.
Training 1982‐1996
In the early 1980s, NHTSA developed an EMT‐I curriculum and by 1992 developed the EMT‐B curriculum (EMT‐basic, formerly the EMT‐A level), which was a success and adopted by most states. The EMT‐B curriculum included the use of automated external defibrillators as recommended by the AHA [42] and assisting patients with their medications. The National EMS Training Blueprint Project Task Force, sponsored by the NREMT, began a process in 1993 to define more clearly the scope of practice of EMS personnel [66].
Transportation 1982‐1996
Encouraging the use of voluntary ambulance standards was common from 1983 to 1990. By 1990, issues of ambulance operations, safety, and optimal mode of response were starting to be a risk‐management concern and more services began to use medical priority dispatch systems. The number and availability of medical helicopters increased, but with as many as 44 air ambulance crashes in one year, safety concerns began to increase as well.
1996‐2008: The Role of the Federal Government Matures, the United States Faces Terrorism, and EMS is at the Breaking Point
EMS Agenda for the Future
In 1996, NHTSA and HRSA published the EMS Agenda for the Future [67]. This document was the culmination of a year‐long process to develop a common vision for the future of EMS. The federally funded project was coordinated by NAEMSP and NASEMSO with involvement of hundreds of other organizations and EMS‐interested individuals who provided input to the spirit and content of the agenda. In addition to describing a vision for the future of EMS, the document discusses 14 attributes of the EMS system and outlines steps that will enable progress toward realizing that vision (Box 1.3). Shortly after its initial publication, thousands of copies of the EMS Agenda for the Future had been distributed to guide EMS system‐related planning, policy creation, and decision‐making.
Box 1.3 EMS Agenda for the Future attributes of the EMS system.
Integration of health services
EMS research
Legislation and regulation
System finance
Human resources
Medical direction
Education systems
Public education
Prevention
Public access
Communication systems
Clinical care
Information systems
Evaluation
Source: Modified from [67].
EMS Education for the Future: A Systems Approach
In December 1996, NHTSA held a conference to address the EMS education recommendations of the EMS Agenda for the Future report published earlier in the year. Over the next two years, an EMS Education Task Force was established. The goals were expanded to include defining the essential elements of a national EMS education system, as well as the education organizational and disciplinary interrelationships necessary to achieve the recommendations in the Agenda.
The outcome of the Task Force was the document entitled the EMS Education for the Future: A Systems Approach [68]. It called for development of five components of an overall EMS education system following the model of medical education: a national EMS core content, a national EMS scope of practice model, national EMS education standards, national EMS education program accreditation, and national EMS certification. General responsibility for each of the components was assigned to specific disciplines of the EMS community: EMS core content – physicians; scope of practice – state regulators; education standards – EMS educators; national program accreditation – educational programs; and certification – assumed by NREMT. Subsequent projects and documents for each of these areas were developed to fill those needs:
EMS Core Content publication – 2005; updated 2012 and 2019
EMS Scope of Practice publication – 2005; updated 2019
EMS Education Standards publication – 2009; planned update 2021
National Ambulance Fee Schedule
Complaints about Medicare reimbursement for ambulance services based primarily on transportation of the patient increasingly became an issue during the