creation? so i always love to come back to these seven themes when i'm thinking public health and final thoughts or questions, you all were absolutely fantastic. thank you so much. have a great weekendstarting ag,

adding on from the last class is lecture right. so last time we talked a little our public health so we said today we're going a little bit about now the build of ems. now today's lecture i will say a little bit a hodgepodge of different things coming at you. right. so we're going to talk not only about obviously the upbringing and start of, but we're going to really talk about also advances in medicine a little bit. and of talk about some of those other things to really kind of set the picture in regards to what that public health issue right because we said the public health issue essentially last class was what when it came to ems creation, remember what we said. yeah, i that's okay. so we get like accidents on the road and stuff like that. exactly right. so again, we're going to build on that, talk a little bit more about, you know, essentially how all that stuff started. and so a few things i want to talk about today, right? so obviously going to define ems. what is actual emergency medical? right. what do we do in basic terms?

and then also summarize some of the history of ems. we're talk a brief history, just because obviously that could be a whole semester class if we wanted it to be right. we're identifying the significant events, specific people that helped shape of the core foundations of vms and of the big things that we even still do today. right. and that also kind of finish of class talking about some of t 15 components essential to ems that again, that they laid out saying, you know, what are probably some of the minimal things needed to even really get into some started in the first place. okay. so what is ems? so ems a few things, right? so what do we really do? so emergency medical services, what obviously ems stands for all right. but really, at the core function of it, right. at the end of thda we're people, right place, right time, right. and doing the right thing. and we ems fills the gaps. what does that gap do we think? right. because what is the gap between

initial care and the hospital? exactly right. so we're filling that gap and that's where we tried to do good things with is filling that gap between where the actual incident, injury or illness, whatever it may be occurs and then filling that gap to the hospital. so providing care from start of injury to definitive care, which obviously is then the hospital. right. and again, we do through a multiple of different ways. we'll talk again the advances that kind of came through. but initially we didn't start with all this stuff. right. and we have fancy helicopters, fancy ambulances, way more fancier equipment than what it used to be. but i talk about some of those things. so we're going to go way back in history. and i say way back in history, i say pre-industrial era, but want to talk about what existed then and what existed back then. compared to now, simply put, not a whole lot, right? really nothing compared to what we have now, right? so back in the day, what did exist were the fact that there was really no general hospital,

right? there were no general practitioners, there were no ers, emergency medicine physicians. right. but what there was were things like arms, houses and city dispensaries where there was naturally a collection of sick people happening. and in those communities. right. so it wasn't advertised say, hey, if you're sick or whatever, if you need help, come here. it was more so that that's where a lot of them were already populated. right. so naturally that's where of those initial kind of what we would explain is today is that prehospital care happening. so again outside of hospital. now in zero formal sense, was that really happening but it was at least some kind of starting point, right? if we had to compare it to something, right, that we talk about resuscitative efforts and always love talking about this slide because what's going on remember one in the world is going on in these pictur right. so i'ell you, these wer resuscitative efforts back in th15, 1773, 1812, all tha

stuff. what do we think that's going? what do we think's going on here comparatively? and some of the techniques we use today. yeah, it's stimulation. okay. what kind to get the heart and through okay to get the heart pumping so maybe something resembling cpr or something like that, right. chest compressions maybe giving breaths and stuff like that. anyone know what's happening? this first photo here, anyone would anyone know what this medical device is? 's not medieval by any means, but that's used to cool down like weapons or anything like used in blacksmith shop. so yes, like a way back of the day. so i'll say i have one in my house, i have a fireplace. it was that thing that again, it's a below, right? so the thing that pushes air into fires, stuff like that to try make it a little bit hotter. now, what's, what's that being used here for? what do we think. what i even put air right now.

how effective do you think this is right now? it's essentially putting a fan up someone's face and saying, hey, here, hopefully this will help you breathe right? not super effective. that being, though, we do something very similar now. right, which are, again, manual ventilations where okay, maybe you need to have a good seal, maybe a little bit better equipment, maybe can hook up some oxygen. right. so it's lot obviously much more advanced and what this is. right. what about the second picture here? what do we think. any guesses? no, wrong answers. yeah, yeah, it is some of barrel for sure. what kind of we think. i will say the second picture always kind of is the interesting one, because i truly. i really don't know. right i had to look it up and

apparently it has something to do with they thought back in the day that by rolling someone on a barrel, they were pressing the chest. so with pressures, all that stuff, it waing the heart, i don't know, or sucking air into the lungs, so on and such. what about that last one kind of a two parter here. yeah, i like that guy's like walking over there for like quite while, but it's over his, like, kind of chest area. okay. so two parts of first of all, what's the benefit this move my patient moved my person who's sick or whatever maybe from point a to point b without me carrying them right. the other thing they were trying to do here is apparently, again, a horse is kind of trotting, right? the body was going up and down and that was providing apparently some type of chest compression action. again, looking at all this stuff. right. this stuff is very ridiculous compared to what we have now. but again, as a starting point. right, it was something now i

will say and we'll see if that's video plays. we've advanced significantly right. not only in regards to having protocols specifically in place on what medications give what when to give those medications. and also the equipment has gone obviously a lot better than using pillows to try to provide manual ventilation for people right to the point where we actually even have devices where. we have mechanical devices that actually provide chest compressions for you in the hospital and stuff like that. also in the pre-hospital setting. right. so even again, when i first started, we didn't have stuff like this. we were doing manual compressions the entire time. has anyone ever done cpr before? right. how exhausting is this? pretty exhausting. and very, very small person like me. i can't last that long when doing cpr. right. but guess what? again, this because i'm tired. does that mean i can stop? absolutely not. right. so again, stuff like this. so, lucas came out with a device

or called the lucas three. this is the third iteration of this device from physio right. something like this is great because as as the battery is still there, that thing's just pumping away right at the right rate, right. so, again, super effective, especially in things like medicine or emergency medicine, where yeah, we might have to be doing other things and not use someone to do cpr, right. also while you're moving around and stuff like that, how effective. is this not super effective? right. this again worth making sure that we continuous pause not positive effective right cpr throughout the entirety of that or movement or whatever it may be. right. so advances in medicine, right. so again, some big ones here. right. things like the development general, general anesthesia. right. or things like the gm theory. righ so in 1846, i ballston general hospital, right.

dr. morton was one of the first ones to actually utilize a form of anesthesia. right. and back in the day, was it the fancy stuff we have now? absolutely not. it was essentially just ether gas that they use to knock someone out and that was their form anesthesia. right. but super effective and also a huge advancement because what could they now theoretically do? they could do, again, a very their form of surgery was. but they could do surgery. right, which was a huge advance of medicine. and also the fact that you could now so things up or cut things or whatever it may be without someone screaming they're all theoretically right. so super, super effective and. also a huge advancement for surgery. and then also the germ theory, 1860s, we discovered that, oh, yeah, germs are actual thing, right? because before tn what we dog concepts like gloves, right? washing your hands after dealing with patients seeere again they're performing surgery. no one's got gloves, right?

we're just doing it right. and obviously then we found out that yeah, that's probably not the best thing to do. right. and it was causing like infections, which was back in the day, one of the biggest killer people. right. things like, infection. that's why people were dying early. right. so, again, 1865, antiseptic surgical techniques start to get introduced. things like penicillin your antibiotics start to get introduced. also in 1940s, right? so all those things obviously only help life expectancy within our patients, which again, we're going to talk about causes some other issues as well. right. right. so obviously, ems, not about orient emergency medicine, only about treating people, but how do we move people? how do we categorize people? and i'll tell you right now there's going to be a theme that you throughout this lecture, that theme, a lot of war theaters, right. or war settings. it's like right now a lot of advances in trauma, emergency medicine and pre-hospital really stem from the war setting.

anyone of a thought on why. they're deprioritized like if a person has been shot, then it would be safe for us to compare to a person who just got like a shrapnel. okay, so we'll say types of patients. obviously there's more readily a type of patient that we could potentially try these treatments on. absolutely anything else that i saw him. yeah a lot more appointments. yeah. unfortunately, there's a lot more abundance. so it truly is one of those natural experience that we're doing. and i hate to call it an experiment, it's a natural way of seeing. and what are some of these clinical practices? do they work? do they not work? right. because it'd be super me to obviously go around and create patients myself. right. so again, the war settings obviously was a great place for a lot of these things to get introduced. and even today, lot of technologies that we still use today like train tickets right, specific protocols that we use

in trauma medicine, a lot of those things developed and really kind of refined a lot of these war theaters. right. which is pretty so talking a few of those things. so talk about transportation initially. right, the concept of actually moving a patient point of injury to safer location or somewhere else. right. one of the first times we saw that was actually to pull psionic wards, right dr. who was a surgeon in poisons army. right, was one of the first to develop utilize some type of transportation system. right. obviously back in the day didn't have cars. so horse and buggies was definitely the luxury bus method of transportation right but then again advancing from that utilize in more so again motorized vehicles our other war so the civil war and stuff like that, we started to see a similar thing of using kind of horse drawn carriages and stuff like that to move our patients from right point of injury to somewhere else. because were finding that, hey,

let's get into safer location and then let's actually treat them right concepts li triage was also developed in the war theater. right as anyone who heard the term before in a medical setting or not, what's triage basic terms. yeah, it's like looking at everyone that's hurt and treating the one the person that's most injured or most that needs the most. so yeah, in basic terms, absolutely right. it's a way of categorizing patients from least severe to not really severe at all. right. and the whole of that is to make sure that we're utilizing resources effectively, which is the biggest thing, and also try to improve or increase the number of patients who are going to survive most. so again, that was initially started to utilize again earlier on, but really wasn't widely accepted until world war one where they utilized kind of like that color coding system that use now where green is, they're fine, red is their a very critical patient a black tag being typically they are in that

imminent death scenario right where they most will die unless they are taken to a hospital, given resources very quickly. right. so some examples of it where, again, now we're starting to see this kind of case of pre-hospital medicine very basic terms of providing whether injury has occurred right. utilizing vehicles actually move some of these patients. okay. so now we move on to then industrial era a little bit and the industrial era then starts to bring some additional issues. and i say issues regards to dangerous for people, right. although a lot of good stuff came out as well too. right. so again, industrialization of course. right, immigration. so we have a huge boom in population, right? we have larger we do have the world wars that occurred. right. which was obviously a huge event. but that being said, though, in regards to medicine because of those improvements, right, we started see decrease in mortality, right. we started to increase of the

capabilities of these doctors that also the hospitals itself because of advanced in clinical medicine technology on and such right a lot of these treatments are also improving from way so what do we see here we saw that the cause of death was starting to change was starting to shift so starting to see a diffent type of patient population in out in the worlde need to now start figure out new ways overcome this new issue. and what were some of the issues so back in the what did we causesgs like infection?ng well, things like the germ theory and penicillin. did really good job knocking a lot of those things. so now people were living longer, right? we went from life expectancy of your early thirties late twenties to now up the 5060s and maybe even the seventies. so what did we now see with with that increase in life expectancy? now we start to see some of those chronic illnesses occur, right cardiovascular disease,

things like cancer where of course not saying that those things can't happen at a young age. of course they do. but we're starting to see a much more increase in those. they are typically more known as chronic diseases, right. illnesses that are associated with typically with age. in addition to that, here's big one, right? accidental are now starting to be, first of all, a thing and also increasing numbers. why. why people are working in factories. they don't have safety protocols. yeah, this picture right here, right. big steel factories and all this stuff, they're buiships and they're building als of different stuff. but what doesn't expect exist back then? osha, right. there's no safety regulations. people wearing hardhats. people are shown to work in shorts. who knows? right. so obviously, again, we have this environment of inherent danger with all this equipment that, oh, the way is probably the first time we're using some of this stuff and we're still

not really sure if it's truly safe or not, but we're using it because it works right. and then on top of that, we have this scenario where people aren't really protected. so yes, obviously we're going to start to see accidental deaths increase. right? so working in more harsh conditions and harsher environments. so what do we do? well, we said we should probably figure out some things to actually help these people where the injury has occurred. now, we already said that that happened in the war setting. right. but what about civilians because now we're starting to see accidental deaths again, more traumatic occur in that civilian civilian population. so what do we do? so we started to come with the concept of things like first aid, which still exists today. right. what is first aid class? right. first aid class for the civilian typically is very basic things that you can do to very quickly assess or identify and then very quickly treat, at least stabilize until you can them to definitive care, which in the

first aid world would be again a higher provider like nine one or again things a hospital right and those concepts obviously worse exactly or very close to being same back in the day. so the american red cross was one of the kind of core leaders in regards to developing this first date system or first aid training programs. right so clara barton, who was a nurse, 19 i'm sorry, 1881, founded american red cross. and their main goal was to essentially provide aid and assistance in times of disaster and war. right. which, again today still american red cross, that their main goal. right. so when big disasters like hurricanes and stuff like that come through, who are the ones providing additional shelter, food and stuff like that? that's the american red cross, right? so that goal still exists even today now. again, german, they claim themselves birthplace of first aid training, at least the united states. right. and it was actually one of the first incidents, a recorded

instance of, first aid training to the civilian right in american history. now, why was that so german pennsylvania was a mining town essentially. right. and this first group of people are trained are actually 25 miners who are trained. first aid. now, why miners. do you think that's. do you think that makes sense? was it just a random group of people? what do we think? yeah, it was a dangerous condition to work. yeah, absolutely. and dangerous, but where are you when you are a miner? underground. and who knows how long it takes to get back up, right? who knows if there's a cave in or who knows what? right. so a great example of a group of people, a group of workers needing some type of care. again, not at a hospital, but we need something. and now in here, right? my friend jim broke his leg while he was trying to do something. well, need to stabilize that legs. i could even hopefully get him

out of the mine. right. or going to bleed out because i can't stop the bleeding there. right. so again, very very basic things. right. of course, we've advanced in regards to our first aid training based on, you know, better equipment, stuff like that that we have. right. but here's a picture of one of the first original. right. first aid textbooks back in the day. all right. so like i said, with advances in, equipment comes cooler toys, right. and also ability to provide additional care. so 1928, julian weiss, which i believe he worked for, the railroad, i believe was a group of railroad who developed this initially but founded roanoke in roanoke, virginia the roanoke lifesaving and first aid crew right here is their kind of setup that they had originally and they were kind of known as first ever rescue squad. right. and the rescue squad again, is this picture right here had very minimal equipment and i say minimal as in i think had things

like poison ivy. they had different little potions and lotions, who knows what. right. and some compressed air and stuff like that to provide some of that additional and such for some of these patients. all right. so again, very, very basic. what does this vehicle remind you of it? looks like an ambulance or again, you could probably spin it in a way that looks an ambulance? sure. right. but i'll tell you right now, a lot of these vehicles, what sort of what purpose do you think a lot of these vehicles initially served before it was converted into like rescue squad system thing and they got it rebranded decals and all that stuff. so we think do we know of any vehicles back in the day where people can lay flat the back of the trunk? yeah, funeral homes, right? hearses. so we found that a lot initially in regards to again this

transportation of sick patients and stuff like that and these rescue squads and as they start to become more known throughout the country and more sort of pop up or funeral homes, we're supplying a lot of these right morticians and funeral home workers were essentially of the first ems workers, we call it, because, again, they kind of had the right vehicle for it. right. and what were they already doing? well, they were transporting transporting bodies. so this was just an additional thing. now, back in the day, i will say again, very treatment was being done. the priority. let's just get them to the hospital with the minimal things that we can do right. so again, who are the workers? well, again, like i said, these were just people out in the workforce back in the day. like i said this rescue squad company was developed by railroad workers right. said morticians, funeral home workers were also doing some of these services. it really was a hodgepodge of different coming through and really just trying create a

solution to issue which was things like axonal and people dying outside of the hospital right. so now we get into the issue. we talk about last class, right? which again is motor vehicle collisions. right. so that motor vehicle injuries, again, as cars or automobiles developed. right. increased traffic, well, obviously faster vehicles we started to see improve roads 1956. right. with the federal aid highway act,hich develed an initiative that construction of all the interstate highways in the united or at least some of them. no traffic laws. so again, we said we talked about how it kind of set up the perfect picture for there being needed, a really big solution to solve this issue. now again this issue went for a while. we didn't really have a solution until would talk about it a little bit. but this was the big thing right? that really kind of started and

kickstarted ems in the country right. so again initially before really ems again that modern ems came into play back in the day they were still having these issues. right. people were still dying from motor vehicle collisions. we talked about how none of the safety regulations, stuff like that weren't there. right so again, new organizations did start to pop up things like fire departments, 65, the first ever civilian ambulance. i believe in ohio, was develed right where again, just like that rescue squad, very simple primary goal of trspting from location a to b b, hopefully being a hospital. right. so funeral, like i said, rescue squads, 1928 being the first one and then more up throughout the country as this issue of motor vehicle collisions and accidental deaths started to increase continuously. right. and then, of course, again, things like police departments also coming to play as well. major cities like boston, new york and philadelphia being one of the first ones to being

developed. the country. right. so again, like i said, we can't talk by the issue of ems without talking about the different wars, but world war one and world war two showed us these wars, unfortunately, showed us creative ways that people could theoretically injured because of all these kind of things that they were doing to try to hurt the opposing side right. so again, obviously increased lethality of weapons the red cross started to become a big factor in this in regards to not hurting people, but helping people. right. started to utilize ambulances. right. world war two, we started to have dedicated people in the military that were their sole job was to provide help. right. we started to see that concept of medics starting to become a real thing. right. it's like pain control and fluid replacement things that we very much do today with our trauma patients. but initially and started to see are examples of that in world war two. right and then also this concept

now delayed evacuation of patients but we just been talking about getting from a to b as quickly as possible. right. but why are we now suddenly saying maybe we've got to slow a little bit? what do we think? which again, is a concept we still see stay true today, right? we don't just always just pick someone up. just go to the hospital as fast as possible. there's a few things that we do. why do we take few of those extra minutes? what do we think of fumbling out side of the road? i got stabbed. what am i actively doing? what's going to me? bleeding and bleeding out, right? how do you save my life? trying to. yeah. some kind of bleeding, control, bleeding. stop edge thing. now, let's say if you're goal was just i got to take this person from a to b and do

nothing else. i just got i just got to get in to the hospital. the doctors will be able to figure this out and fix what am i doing actively going from point a to point b, i'm bleeding out. am i going to make it to point b? hopefully, but maybe not, right. so that's why this concept of delayed evacuation the delayed evacuation was more for stabilize zation of the patients. right stabilizing our patients initially and then moving them so that yeah, there's better chance of survival because we got us to worry that time it takes from getting point of injury to the hospital or whatever definitive care facility was, right. so during the the korean war in the vietnam war is also starting to now utilize things like helicopters right. every war every movie like the vietnam war in it. what do you always see helicopters flying in right there playing fortunate son. right every. single movie. right. that's because again.

and all the movies depict it because well, helicopters were very heavily in these wars and it was not only utilized for combat, but also heavily utilized for medevacs. finally right. which, again, super, because typically a lot of these settings difficult terrain, hard to move through, hard to even drive through. so flying over that terrain and getting them to a much more again, advanced hospital or location or whatever it may be. also, even now utilizing fixed wing aircraft to, move them out of the country and somewhere else, potentially safer with more advanced capabilities. right. all these things we utilize today developed during the wars in regards a lot of these evacuation patients right turn. medevac was coined during this period. right things like the mobile army, surgical hospitals and stuff like that. mash which was a tv show, right. 'all know of it, oly a very much a hollywood depiction of what was going on back in the day. but the unit itself was very much a real thing, right? ovidg some of those advanced

levels and also medical capabilities out into the war setting to get some of those soldiers and stuff like that quicker, which was super important and super right. so again some of the initial kind of iterations that and encer motorized transport vehicle for these soldiers who were getting right. and then of course also the medical and stuff like that being utilized. well. so 1967 comes around and we say, okay what's the other big thing that is killing people out in the world outside of the hospital we talk about trauma so far being, one of the big ones. okay we're working on that a little bit. the other big thing was out of hospital cardiac care. right. what were what was the other people were being affected by cardiac arrest. right. people were dying. so what do we do now if someone into cardiac arrest, right. your heart stops fall to the ground.

what do we do to cpr? cpr good start. absolutely killing our woman. right. also what else? yeah, for breathing. yeah. kept breathing or pulse all part of that cpr process. the other machine that we use, what is that? isn't it kind of 80. so an 80 or so, an automatic external, which is what aid stands for. i believe there's one in this building. typically every building has one. right. but what is it? if anyone's ever use an 80 or has done training on it, you open it up, it starts screaming at you. it's super stressful. it's not supposed to be, but right. it starts to yell at you in all these instructions and tells you exactly what to do the main goal of the aid being let's those pads on right. the computer does its thing. it recognizes this potentially shock wave rhythm in very basic terms. and if it does well delivers that shock to reset the heart rate. so that comes with defibrillation was obviously not a thing back in the day. right. that's something that had to be

developed and invented. well, we saw the instances of that being utilized in the in the civilian population. right. dr. eugene nagle was one of the kind of the founding physicians who started this movement in miami in 1967. we started to see the use of portable defibrillats with telemetry, telemetry, just talking about how they can record what the heart's with the ekg right there. slowly lines essentially all right. and be able to record some that stuff for obviously assessment purposes. right. and one of the first times we start to see firefighter ears being trained or cross-trained with of this stuff. right. very much utilizing their original of already services into their equipment, the personnel to be able to kind of create what we have today as we like to call paramedics right. we started to see providers out in the field now provide some more invasive and advanced medical techniques. if we want to call this advanced back in the day. right. but we started to see an example this and not just trauma care

where some of that stuff obviously is a lot more basic like things like splinting or bleeding management. right now we're talking about cardiac care and stuff like that, which is super exciting. right. so again, we talked about how, like i said all the squads and stuff like that being developed right? those were additional things that helped. right. a lot of these companies and stuff like that provide some of these services very quickly to the civilian population. i and of course, the government also gets involved right in regards to the health care of things too big things like that. they initially did because we said that ems systems a system, right. it's not just about the private providers. well, we also need hospitals eventually to also a little bit more advanced to be able to provide some of that care. right. so health care funding and policies related to that was one of the big goals of the federal government initially. so the hospital serving construction act of 1964, also known the hill burton act hill.

burton being the two senators who helped create bill. all right. they so what this bill did essentially was provided grants for the construction of new hospitals in specifically locations where they believed under looking at specific criteria like per like like per capita income to see where are these hospitals needed in regards where is it most heavily populated. and also is it sustainable financially in some of these locations? right. so of course, that didn't give a hospital to every single group, but at least it started to increase the availability of medical right in our civilian world. and then in 1986, the emergency medical treatment and labor act, also known as impala you might have heard of that fancy term if you've ever worked in a hospital or any type of health care setting. right. this is very much something that exists today. very much. right. until it initially was created. prevent patient dumping. right. patient dumping essentially

talking about patients who would come the hospital and they wouldn't get screened or properly treated and, just kind of kicked out of the hospital because of whatever reason. right. whether it's because of race or because of ability to pay, whatever it may be. so what i'm told it was said, okay, you need to go ahead and still these people, especially in your e.r. right. so tala, if you're coming into an e.r. with any type of medical truman medical emergency, things like chest pain or obviously injury and or if you are in active labor the hospital, no matter of what your status to pay or whatever it may be provide you initial assessment, treatment and stabilization no matter what. right again and this law still very much exists today. apply for ems providers as pre hospital because that means that if we respond to you we start to provide care. and if there's a medical necessity, i just say, oh, not today. right. that would breaking them.

all right. so again, this ensures public access to the civilian population, provides us services to everyone. so public access, right. we know what happens if you break into all. monitored. right. i believe it starts like 50 k for the hospitals and stuff like that. so again, significant amount. so something that we very much take seriously my medicare also being the other big one we'll talk more about this in a future lecture when we talk about finances and stuff. so we're kind of breezed through it. but again, having different insurance programs also available to certain populations is things like the population of low income or people over the age of 65. right. so again, those insurance companies also starting to be dealt. all right. any questions so far. so, again, that all essentially laid out the picture to get to this. right.

so talked about a lot of different things in regards to advances in medicine and also of setting the picture for that public health problem that really to be fixed, which was again deaths and disabilities so what kickstarted it so, this document right here known as the accidental death and disability, the neglected disease of modern society. what this was was it was also known as the white paper. and white paper typically is just something that recommendations for some type of problem right provides a potential solution the white paper or this document right here not any piece of legislation it wasn't bill it wasn't a law wasn't a regulation, anything like that. basic this was a research paper, right? it was a research paper by the national academy sciences and the president's commission on highway safety. and what this paper outlined was that, hey, we have huge issue on our hands. a lot of people are dying on the highways and on the because of

motor vehicle collisions and a lot of the deaths and injuries be prevented if had something in place that if was emc systems or prehospital care. right. so this paper really outlined that there was a huge lack of prehospital care in the system. and that was why one of the reasons or one of the big reasons why a lot people were dying and we couldn't save people. so this paper really kickstarted a huge effort to provide that prehospital right in the united states and where ems was really kind of born. right. that's why the white paper in, the field of ems is so important, because that was really kind of like the true stepping off point in regards to today's modern ems. so in response to said research paper, essentially right, federal government said, okay, we got to do something about this. so the national highway safety act 1966 introduced the department of transportation and

honor that the national highway traffic safety administration, which is what nitzan and dottie stand for. okay. so again, two purposes here. the main goal, the d.o.t. and of course, the national highway traffic safety administration fixed this issue. of course, deal with the traffic side of things as well, because needs continual infrastructure and improvement but dealing with this public health issue, we got to do something about this figure, something out is essentially what was said to them with the creation of the department of transportation. and it's us that wanted such right and again it's exists still today like we talked about let's class nhtsa's in charge they are again their main goal is to provide safety and improve safety on the highways and stuff like that. right. the all those pr things that you see out, you know don't drive and text the all the click it and ticket it all those right. those are all nets of things to try to improve civilian safety out in the highways and stuff like that.

all right. so again, this was probably one of the first federal ems pieces of legislation. right. and what this did was obviously with the creation of this, we fell into this naturally because that's where the majoprlem was. right. we were essentially just a solution were a tool that was being utilized or being to fix this issue was happening on the highways and stuff. all right. so what did it do for ems? well, it standardize education and curriculum for ems. so a curriculum finally created to standardize ems care throughout the country. why was that important? well, just talked about what type of were providing care, right? it was just a culmination. it was a hodgepodge of different people. right. with no health care background. right. these are just kind of workers. they were just civilians. right and obviously, no matter, where i go in the country, i want to be able to get the same level of care. right. whether i'm in california in maryland, florida, alaska, no matter what, i want some type of

standardization in regards to at least the basic level of care i'm going to get. so we standardize again a lot of those training systems or training programs to be able to do that. right, and at least to start providing a standardized level of care for these people who were getting hurt on the highways. so what it also did was, again, it also advance some of the hospital settings as well right, especially with trauma centers, east coast done a lot of things for advances in medicine and especially in pre-hospital medicine. and funny enough, maryland and baltimore specifically has done really a lot right in regards to advancing some of the pre-hospital care aspects. so for example, right with the ems systems, right. it helped to develop or at least fund and stuff like that are recognized trauma center as being an actual thing, right? so the shock trauma center down of downtown baltimore, y'all probably heard of it, right? dr. kiley was one of the

founders for shock trauma and was one of the first shock trauma or trauma major trauma centers in, the united states. right. so obviously had a lot of innovative things. one of the big things that came out was the golden hour. anyone ever heard of the term golden before? heart of it. what is it that i heard of it? i saw i saw oc fair. okay, what else? anyone to to. i think it's like that the time frame you need to get to the hospital. yeah it's, exactly right. and especially trauma patients. so the golden which i will say is a little bit under hot water because not nursing hot water because, the golden hours and wrong by any means but with research we probably found it. yeah. the sooner the better. right? maybe an hour is a little too much. maybe like 45 minutes is a little bit better, right? but anyway, so the golden hour initially. yeah, that is something that they developed and it stated

that if you get to them to a trauma center within an hour who has had a significant traumatic injury, the survivability increases significantly but over an hour survivability decreases. right. so shock trauma center was one of the big ones that did that. and with golden hour shock trauma worked with maryland state police to create. right. one of the very first civilian ems or i'm sorry not dms systems medevac system specifically for trauma. right. so again in the state of maryland, the maryland state police have an aviation division still very much today. they provide ride the civilian on one medevac services for state of maryland right in 1970 was one of the first times in this apparently is picture i can't confirm nor deny but it was on their website so i'm going to believe right out of one of the first instances they utilize the helicopter to actually transport a patient to so maryland state police one of the first ones to do it which is pretty cool.

huge advances obviously now in gards to technology, right. so you're looking at there is the helipad of sho trauma where they have those helipads where again, helicopters can land, could take them straight into tuma resuscitation unit at truck trauma, which is pretty cool. right. and obviously they've had some pretty, pretty big advances in rd to the helicopters, the ones that they have, i believe, 2013, they got their iteration. and just again, for example, not test material by any means, but just good for you all to know. state police has about oh what is that, four, seven, right. seven helicopters throughout the ate of, maryland, they have more on backups. i e division has something like ten helicopters and also one fixewing aircraft for all their services. but they seven kind of strategically placed throughout the entire state of maryland so that yeah, they can get to you within a certain amount of time and. also get downtown or to neighboring states to get you to a trauma center pretty right, which is pretty cool. so again, maryland has a lot of

firsts in regard to trauma, which is pretty awesome. so as we get more into again, this modern ems system, so to point, we know that it's an issue we've started to fix it by, you know, advancing hospital systems. we start to develop curriculum. but we really don't really have ems truly yet quite developed right. we don't have ems companies or, stuff like that truly developed throughout the country we just have a group of people essentially still doing what they're doing. they're getting better, but we don't have anything established yet. well, 1973, that changed the systems act or ems act of 1973, what it did was, it provided that systems approach by providing category categorical project grants to people to be able to develop and fund the creation of new ems system. because of this, about 300 ems systems were created. the country right. and what it did it provided a funding to be able to create

these systems based on if you could prove that you could have or provide these 15 essential components of ems is what they decided right? these 15 components what it did was, essentially, it laid out what are the minimum things needed for what they believed, at least for an ems system, to. right. we talked to some about a few of these things last class. but if look at some of these lists write things like manpower, training, communications again the 15 things very much again essential to what ems systems pretty much have today and really to to and we'll talk more specifically about some of those things again next class, i believe. all right. so now again, we start really have ems systems. we truly do today starting to be for the first time. so now starting to look a little bit better. trauma hospitals, we start to have better and standardized personnel. and now we also have a system in place that can provide things

like the transportation services and operations a little bit more effectively as well. so we're looking pretty good. 1980s, 1981, specifically, we started to see a change in funding and a change of a little bit right up until then, the federal government really had kind of a stake regards to what ems systems looked like for the country. 1981 actually ended funding under the ems us act, something alex came in and actually the government started to provide block grants. the specifically for ems and not to the ems agency specifically. what this did was, it provided a state approach to ems systems which again today every state has their own ems agency. right. my ems license doesn't work in pennsylvania. right. because i'm a maryland provider. if i want to go to pennsylvania, i got to go through their system. why you think in the united states, not a federal ems system, we're state approach. what do you think? and i want to think difference

in regards states. i think the difference between and alaska both for the us population. okay population wise some areas have more populations. sure great differences and like issues that would happen to people sort of knows a lot. so that would be like, yeah, absolutely. every state is very right. some states similar. sure. right. but again, we very much realize the fact that each state has its own needs. like we can't just do this cookie cutter cookie cutter method for every single state. right. so this allows the states to customize a little bit based on the standard right and be able to mold it their specific needs a little bit. so again our protocols in the state of maryland are different from, let's say, california, right. or definitely places like alaska, where alaska has a lot more about things like, quote, emergencies and how to treat patients who are hypothermic, like in florida. that's not the main goal of what they do down there right over in

california and kind of in our kind of central states right, we might do more things with wilderness rescue, things like that, because, again, national parks, more of the terrain out there as well. so again, operationally and clinically, there's a lot of difference being from state to state. so this provided a little bit more of a customizable approach which was super great, right? in addition to that, we were not only just worried about adult trauma and cardiac care, but we started to expand there are absolutely different patient populations out there, right? things like our pediatric population right. so the imc was developed, which is emergency medical services for children's right. and they kind of dictate of the protocols that we utilize in ems in regards to our relating to children. so 1990s. okay. so at this point, we started to develop things are stabilized right. we started to see stabilized care, we started to see systems exist out in the field. right. but we need continual we're seeing at this point lot of

these systems, the 300 around that was created right, they have those 50 components that components essential. so they're really kind functioning at the minimal level. right. just get by great. but can we now get up to optimal, right? how do we get up to the high to present? well, in 1990, right emi systems development was kind of a big thing that we were thinking about looking into the future. so the ems gender for the future in 96 was published and that's when over 14 attributes of vms that they believed needed further improvement. right. things like finance ems research, like i said, we'll talk about the 14 in another class, specifically, it laid out again what is now the 50 year goal essentially for ems. during that time. we also revise the emt and paramedic curriculum. obviously, since then we revised it again. multiple, right? so we started to really start to see a change in regard to not only just operating at a minimal

level at this point. we're saying we did, but how can we now improve and become efficient? right. and start to get a little bit more exciting and because now we're starting to see again pulling and research and pulling different technologies. all right. to see, what else can we do? and that's very much what we're doing now. right. so in regards that ems agenda for the future, we ended class talk about ems 2050. right. which in 90 i'm sorry, 2019. right. that is kind of our new agenda now going into the future, saying that we've kind of met the goals of the 1996 one. all right so a similar concept but in addition to that like i said we can have a little bit more fun now and that fun comes in the of improved technology improvedlinical practices where we now have special care transport teams. ght. that are dedicated it for those like icu type patients or those critical ce patients. so have itical care paramedics. we're flying on a helicopter is

ivg an ambulance ambulances so on and such. we talk about all the hospitals having specialty services as well. right. we have our stroke trauma centers, but also of burn centers in maryland, we have an ai center, a hand trauma center to be able to provide some of very specialized types of care to those specific types of patients. right. we start see continued provider type diversity. so we start see a lot of different types of providers out there. right, kind of doing interdisciplinary approach to public care or public health and just pre-hospital care. right. and then also providing that care based on evidence and research and not just doing it because we've been always doing it in the past. right. we've a huge shift in that in probably the past five, ten years of really advancing medicine in the pre-hospital setting and providing evidence approach. right. versus things we've just always done. right. i'll tell you things like back boarding, you'll have seen kind of like the concept of someone getting pulled out of a vehicle if they got into a collision.

we put this stiff board behind and strapped them all up and stuff like that, right? even that concept wasn't evidence based fun enough. right? so again, we've now expanded on that, did some research and yeah, found some better ways to potentially stabilize our patients. maybe not every single patient, all that stuff because how comfortable do you think that is after? you just got into a motor vehicle collision. you already saw hardy not want to strap you down to this hardcore cold plastic board. probably not super comfortable, right seeing that. sometimes you can do a little bit more damage than good, right? so again, we've done some research and provide now that evidence based approach, things like back boarding, which is just one example, right. and then technology and education. right, huge, huge, huge advancements again, especially in the past few years. right. in regards to technology out in the field, in regards to only pre hospital was in hospital care as well. right. and then education and training. it's insane the type of things at we available now in regards

training and rht. that go over more in another class but being able to provide kind of that hands on experience before they had the actual at the actual streets right. huge thing. right where. we have mannequins who can literally again, this one can they can breathe they can talk they can shed tears. they could do all kinds of right, which is pretty cool. okay. okay. and like i said, that technology aspect of things, right. huge huge, huge advancements. we went from the wine barrel essentially right at the beginning of class to things like this that cost obviously a significant amountf money, but capride some really cool of care to our patients out in the field in the pre-hospital setting. right. a lot of the things that we've been dng the hospital, but now let's miniaturize it, hopefully take it out to theield. we can provide that advanced level of care even sooner, which is pretty awesome, right. things like our video laryngoscope piece. right. the thing we use to stick a breathing tube down someone's

throat. right. we'll we're going to see down there. well, back in the day, we didn't have a fancy camera. at the end of it. so now we have a screen that helps process. right? we have portable labs we could do out in the field, take a little bit of blood tells us kind of what's going on with the blood. right. we talked about manual cpr machine, right but things like portab ultrasound. rit. portable ventilators. right. and again, also advances our defibrillatorsnd telemetry. right. types of equipment. this specifically being the life pack 15, which is the pretty commonly utilized one out there. zoals, another big company that provides these services, our ems systems right causes a good chunk of money, but again, the things that we can do now right. i'll tell you right now, again, i started about ten, 15 years ago, half of this stuff didn't exist yet. so we've had even in those past ten years, huge advances in technology in regards to prehospital care. right. howard county and state police now also blood for the first time, which is a super exciting

for a trauma patients. right. so again, they provide that service also before again a few months you had to get to the hospital to receive blood. right. and of course, that comes with its own evidence based, protocols and research and clinical and equipment as well. right. in regards to a lot of those things. okay. so again, to look into the future right talk about ems 2050 being kind of the new guiding for us moving in kind of into the new era ems, where we say we're doing pretty good right now. right. but again just like the on for the future, what else can we still further improve right. and we kind of noted some of those being public health right providing that equitable type of care to our patients. right. being more sustainable and also, well integrated with a lot of these systems we kept talking about right. and then, of course, can operate certainly things to consider for the future right. things like infectious diseases, public health, which again, we very much felt felt the effects of with covid and stuff like

that. right. homeland disaster responses. right. those thnevitably, unfortunately, are still happening. so operationally, clinically, how we further support those things and diving he world of disaster management, disaster health as we right. that all comes down to the whole well integrated aspect. all right. all right. so any questions questions? any questions. all right. i'll get questions on. are you a part of any research into like how you talked about how patients don't relate the plastic board. do you do anything like that? so i personally currently am not doing something, but in the past i have and then also we obviously have a department of faculty who do that all the time. but yeah, but again, paramedics and stuff like that very have a say in regards to some of those protocols i know this they're maryland specific we have a protocol review board essentially that every single year we get through get together

and try to figure out what are the new protocols that we want to implement for this year or again, what are some of the ones that we got to revise and stuff like that. right. and those change from year to year, at least in the pre-hospital setting. right. so yeah. research absolutely occurring. yeah, a good question. any other question question? all right, great. so next class, we'll talk a little bit more about some of those legislative pieces that we talked today. go a little bit more in depth with it. okay. and that's gonna be it. all right. thank you.