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What was the first emergency management agency in the world?

What was the first emergency management agency in the world?

Given the impending landfall of Hurricane Sandy I wondered what was the first established emergency management agency akin to the United States Federal Emergency Management Agency?


Wikipedia's History of Firefighting includes the following snippet:

The first Roman fire brigade of which we have any substantial history was created by Marcus Licinius Crassus. Marcus Licinius Crassus was born into a wealthy Roman family around the year 115 BC, and acquired an enormous fortune through (in the words of Plutarch) "fire and rapine." One of his most lucrative schemes took advantage of the fact that Rome had no fire department. Crassus filled this void by creating his own brigade-500 men strong-which rushed to burning buildings at the first cry of alarm. Upon arriving at the scene, however, the fire fighters did nothing while their employer bargained over the price of their services with the distressed property owner. If Crassus could not negotiate a satisfactory price, his men simply let the structure burn to the ground, after which he offered to purchase it for a fraction of its value.

IMO, this page is being too kind to Crassus (the same one) as it appears to suggest that he was providing a public service for a fee. His own wiki comes closer to the more widely accepted truth which is often recounted in economic history books:

The rest of Crassus's wealth was acquired more conventionally, through traffic in slaves, the working of silver mines, and judicious purchases of land and houses, especially those of proscribed citizens. Most notorious was his acquisition of burning houses: when Crassus received word that a house was on fire, he would arrive and purchase the doomed property along with surrounding buildings for a modest sum, and then employ his army of 500 clients to put the fire out before much damage had been done. Crassus's clients employed the Roman method of firefighting-destroying the burning building to curtail the spread of the flames.

In 6 CE, Augustus, possibly building on Crassus' idea, organised a group of slaves into the Vigiles, a force which functioned both as firefighters as well as policemen of Rome:

Every cohort was equipped with standard firefighting equipment. The sipho or fire engine was pulled by horses and consisted of a large double action pump that was partially submerged in a reservoir of water. The Vigiles designated as aquarii needed to have an accurate knowledge of where water was located, and they also formed bucket brigades to bring water to the fire. Attempts were made to smother the fire by covering it with patchwork quilts (centones) soaked with water. There is even evidence that chemical firefighting methods were used by throwing a vinegar based substance called acetum into fires. In many cases the best way to prevent the spread of flames was to tear down the burning building with hooks and levers. For fires in multiple story buildings, cushions and mattresses were spread out on the ground for people to jump onto from the upper levels.

The Vigiles were commanded by a Praefectus vigilum (Prefect of the Watch) who was appointed by the emperor.

Some sources state that Augustus was inspired to create the Vigiles based on the innovative use of water pumps to combat fires in Egypt.

There do not appear to have been any organised civil emergency services such as paramedics until the 19th century. While flooding was an issue in the Nile valley, I suspect that it was too regular to have necessitated an emergency service. While Japanese earthquakes and tsunamis were meticulously recorded, there again do not appear to have been any dedicated emergency services to provide relief during disasters.


World Health Organization

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World Health Organization (WHO), French Organisation Mondiale de la Santé, specialized agency of the United Nations (UN) established in 1948 to further international cooperation for improved public health conditions. Although it inherited specific tasks relating to epidemic control, quarantine measures, and drug standardization from the Health Organization of the League of Nations (set up in 1923) and the International Office of Public Health at Paris (established in 1907), WHO was given a broad mandate under its constitution to promote the attainment of “the highest possible level of health” by all peoples. WHO defines health positively as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Each year WHO celebrates its date of establishment, April 7, 1948, as World Health Day.

With administrative headquarters in Geneva, governance of WHO operates through the World Health Assembly, which meets annually as the general policy-making body, and through an Executive Board of health specialists elected for three-year terms by the assembly. The WHO Secretariat, which carries out routine operations and helps implement strategies, consists of experts, staff, and field workers who have appointments at the central headquarters or at one of the six regional WHO offices or other offices located in countries around the world. The agency is led by a director general nominated by the Executive Board and appointed by the World Health Assembly. The director general is supported by a deputy director general and multiple assistant directors general, each of whom specializes in a specific area within the WHO framework, such as family, women’s, and children’s health or health systems and innovation. The agency is financed primarily from annual contributions made by member governments on the basis of relative ability to pay. In addition, after 1951 WHO was allocated substantial resources from the expanded technical-assistance program of the UN.

WHO officials periodically review and update the agency’s leadership priorities. Over the period 2014–19, WHO’s leadership priorities were aimed at:

1. Assisting countries that seek progress toward universal health coverage

2. Helping countries establish their capacity to adhere to International Health Regulations

3. Increasing access to essential and high-quality medical products

4. Addressing the role of social, economic, and environmental factors in public health

5. Coordinating responses to noncommunicable disease

6. Promoting public health and well-being in keeping with the Sustainable Development Goals, set forth by the UN.

The work encompassed by those priorities is spread across a number of health-related areas. For example, WHO has established a codified set of international sanitary regulations designed to standardize quarantine measures without interfering unnecessarily with trade and air travel across national boundaries. WHO also keeps member countries informed of the latest developments in cancer research, drug development, disease prevention, control of drug addiction, vaccine use, and health hazards of chemicals and other substances.

WHO sponsors measures for the control of epidemic and endemic disease by promoting mass campaigns involving nationwide vaccination programs, instruction in the use of antibiotics and insecticides, the improvement of laboratory and clinical facilities for early diagnosis and prevention, assistance in providing pure-water supplies and sanitation systems, and health education for people living in rural communities. These campaigns have had some success against AIDS, tuberculosis, malaria, and a variety of other diseases. In May 1980 smallpox was globally eradicated, a feat largely because of the efforts of WHO. In March 2020 WHO declared the global outbreak of COVID-19, a severe respiratory illness caused by a novel coronavirus that first appeared in Wuhan, China, in late 2019, to be a pandemic. The agency acted as a worldwide information centre on the illness, providing regular situation reports and media briefings on its spread and mortality rates dispensing technical guidance and practical advice for governments, public health authorities, health care workers, and the public and issuing updates of ongoing scientific research. As pandemic-related infections and deaths continued to mount in the United States, Pres. Donald J. Trump accused WHO of having conspired with China to conceal the spread of the novel coronavirus in that country in the early stages of the outbreak. In July 2020 the Trump administration formally notified the UN that the United States would withdraw from the agency in July 2021. The U.S. withdrawal was halted by Trump’s successor, Pres. Joe Biden, on the latter’s first day in office in January 2021.

In its regular activities WHO encourages the strengthening and expansion of the public health administrations of member nations, provides technical advice to governments in the preparation of long-term national health plans, sends out international teams of experts to conduct field surveys and demonstration projects, helps set up local health centres, and offers aid in the development of national training institutions for medical and nursing personnel. Through various education support programs, WHO is able to provide fellowship awards for doctors, public-health administrators, nurses, sanitary inspectors, researchers, and laboratory technicians.

The first director general of WHO was Canadian physician Brock Chisholm, who served from 1948 to 1953. Later directors general of WHO included physician and former prime minister of Norway Gro Harlem Brundtland (1998–2003), South Korean epidemiologist and public health expert Lee Jong-Wook (2003–06), and Chinese civil servant Margaret Chan (2007–17). Ethiopian public health official Tedros Adhanom Ghebreyesus became director general of WHO in 2017.


AAEM History

1960s

The field of emergency medicine evolved out of the necessity of caring for a rapidly growing population of patients seeking immediate and unscheduled medical care for emergency conditions. By 1960, it became clear that the number of emergency department visits was rising across the United States. Physicians lacked the necessary emergency medical skills to properly care for these patients and were frustrated by the growing demand. In response, the Pontiac and Alexandria Plans were enacted in 1961. At Pontiac General Hospital (MI), 23 community physicians began working part-time to staff their emergency department around-the-clock. In Alexandria (VA), another group of physicians left their private patients to become full-time emergency physicians.

Though physicians began devoting varying degrees of their practices to emergency medicine, there was still a need for specialized training. In 1967, the American Medical Association (AMA) established a committee on emergency medicine, and in 1968 John Wiegenstein and seven colleagues founded the American College of Emergency Physicians (ACEP). ACEP's first Scientific Assembly was held in 1969.

1970s

In 1970, the University Association for Emergency Medical Services (UAEMS) was formed for scientific and educational purposes by medical school faculty practicing emergency medicine. Prior to its establishment, medical students were already choosing emergency medicine as a career path. The first university emergency medicine residency arose at the University of Cincinnati in 1970 where Bruce Janiak became the initial resident. Other sentinel university programs include those at Los Angeles County/University of Southern California Medical Center (1971), the Medical College of Pennsylvania (1972), the University of Chicago (1972), and the University of Louisville (1973). R.R. Hannas established the first community hospital emergency medicine residency in 1973 at Evanston Hospital (IL). The Emergency Medicine Residents Association (EMRA) was formed in 1974 to unite the initial residents in our field.

The road to specialty recognition was particularly challenging. A provisional Section Council in emergency medicine was established in the AMA House of Delegates in 1973 and became permanent in 1975. Also in 1975, the Liaison Residency Endorsement Committee, the forerunner to the Residency Review Committee for Emergency Medicine (RRC/EM) was created. In 1976, the American Board of Emergency Medicine (ABEM) was incorporated and the American Board of Medical Specialties (ABMS) finally recognized emergency medicine in 1979. Unlike the boards of other fields, ABEM was initially required to be conjoint with other medical specialties represented.

The emergence of osteopaths in the field occurred in 1975 when the American College of Osteopathic Emergency Physicians (ACOEP) became an affiliate college of the American Osteopathic Association (AOA). The first osteopathic emergency medicine residency began in 1979 and Gerald Reynolds became the initial resident at the Philadelphia College of Osteopathic Emergency Medicine. In July 1978, the American Osteopathic Board of Emergency Medicine (AOBEM) was established as an affiliate specialty board of the AOA. ACOEP's first Scientific Assembly was held in 1978.

1980s

ABEM administered the first emergency medicine board examination in 1980 and AOBEM followed suit in 1981. In 1982, the Accreditation Council for Graduate Medical Education (ACGME) approved special requirements for emergency medicine residency training programs.

In 1988, after a well-publicized 10-year grace period, ABEM eliminated the practice track and began to require emergency medicine residency training to qualify for the ABEM certification exam. Shortly afterward, a one-time exception was granted to about 100 academic emergency physicians boarded in internal medicine. The practice track for AOBEM certification is also effectively closed at this point since it is restricted to those who began emergency medicine practice prior to 1986.

The organization, Board of Certification in Emergency Medicine (BCEM), was formed in 1987 to create a loophole for those choosing to practice emergency medicine without formal training. That same year, BCEM certified the first group of physicians ineligible for ABEM or AOBEM certification.

In 1989, emergency medicine became a primary board by ABMS. This recognition was dependent on, among other things, closing the ABEM practice track. Also in 1989, UAEMS and the Society for Teachers of Emergency Medicine (STEM) merged to become the Society for Academic Emergency Medicine (SAEM). The Council of Residency Directors (CORD) was formed later as a separate entity representing residency program directors and their assistants.

1990s

The 1990s brought turmoil to emergency medicine. In 1990, Gregory Daniel, a general surgeon practicing emergency medicine in Buffalo, New York, filed suit against ABEM and other individuals and institutions in academic emergency medicine. He and numerous co-plaintiffs from the non-academic community alleged that ABEM's closing of the practice track was the result of an illegal conspiracy to enhance the economic position of board-certified emergency physicians. In 1991, the Association of Emergency Physicians (AEP), formerly called the Association of Disenfranchised Emergency Physicians, was formed with the goal of reopening emergency medicine board certification for non-EM residency trained physicians. Dr. Daniel served on the AEP Board of Directors.

In 1992, under the alias "The Phoenix," James Keaney published The Rape of Emergency Medicine, which detailed corruption that negatively impacted patient care. He maintained that exploitation of emergency physicians was rampant. Many "leaders" in the field were siphoning significant profits through unfair business tactics and hiring unqualified emergency physicians willing to work for less pay. This wake-up call beckoned the formation of the American Academy of Emergency Medicine (AAEM).

AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care. Its first Scientific Assembly was held in 1994. AAEM initially defined a specialist in emergency medicine as board-certified by ABEM and this definition was later expanded to include those certified by AOBEM, pediatric emergency medicine (by ABEM or the American Board of Pediatrics) and the Royal College of Physicians and Surgeons of Canada.

The 1994 Macy Foundation Report entitled The Role of Emergency Medicine in the Future of American Medical Care emerged from a conference requested by SAEM and chaired by the president of the National Board of Medical Examiners. It was initially recommended that emergency medicine board certification be required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to certify comprehensive emergency departments. Unfortunately, the term "board-certified emergency physician" was replaced by "qualified emergency physician" after vigorous lobbying by ACEP to prevent dividing its membership. Some interpret "qualified emergency physician" as a physician trained in any field that chooses to practice emergency medicine.

In contrast, AAEM requires board certification in emergency medicine of each and every full voting member. Currently, the only means of acquiring this is to complete an emergency medicine residency or pediatric emergency medicine fellowship.

Beyond 2000

The aforementioned Daniels lawsuit was dismissed in 2005, after an unsuccessful appeal by the plaintiffs. AAEM continues to lead efforts preventing the erosion of board certification by unrecognized organizations that hold themselves out as equivalent to ABEM and AOBEM. As of the current printing we are working in California, Florida and Kentucky on this issue.

Since the end of the millennium, there has been a steady rise in the number of large contract management groups (CMGs) acquiring emergency physician contracts. At this point, about one-third of all practicing emergency physicians work for one of them. This degree of "corporatization" far surpasses any other medical specialty and creates a tenuous situation for the future since emergency physician qualifications, working conditions and professional compensation are tied to the bottom line of an economically volatile industry.

AAEM believes that corporate ownership of emergency department contracts represents a violation of the public protections afforded by state prohibitions of the corporate practice of medicine. Additionally, emergency physicians may unwittingly risk their licensure by aiding and abetting the unlawful corporate practice of medicine. The Board of Trustees of the AMA has provided a comprehensive review on the issue as it relates to practicing physicians. AAEM became involved with legal challenges regarding the corporate practice of medicine with large corporations, TeamHealth in California and EmCare in the state of Minnesota. AAEM also participated in a successful action related to the corporate practice of emergency medicine in California involving Catholic Healthcare West.

AAEM has raised concerns with the Office of the Inspector General and the attorney general's office in various states that such corporate employment arrangements may involve prohibited fee-splitting activities under current state and federal statutes. AAEM members are cautioned about accepting employment with corporate groups and AAEM suggests that hospitals examine such an arrangement with due diligence.

AAEM believes that emergency physicians must remain free of corporate influence because of their difficult role as advocates for the under and uninsured patient. The AAEM firmly believes it is in the best interest of the patients to have emergency physicians unencumbered by the profit concerns of a corporation. AAEM is always willing to assist in this matter in order to help emergency physicians secure a physician-owned group, which is the best model for professional satisfaction and care quality.

In 2010, there were 157 allopathic and 37 osteopathic emergency medicine residency programs, which collectively accept about 2,000 new residents each year. Studies have shown that attending emergency physician supervision of residents directly correlates to a higher quality and more cost-effective practice, especially when an emergency medicine residency exists. The resident section of AAEM, which was formed in 1999, became an organization independent of AAEM in 2005 called the AAEM Resident and Student Association (or AAEM/RSA). Its purpose is to provide EM residents a forum and a means to specifically address resident concerns and issues, develop their own programs and services and have a representative that can impact on the direction and mission of AAEM.

One more goal for the next decade is that autonomous academic departments of emergency medicine become universal. Currently, emergency medicine is recognized as an autonomous department in 72 medical colleges, comprising the majority. Medical college deans should be aware that many of the best medical students are pursuing emergency medicine residencies. An SAEM research group recently published findings that autonomous departments of emergency medicine are mutually beneficial for both academic institutions and our specialty with measurable improvements in medical student and postgraduate education, academic productivity and extramural grant funding.


A Brief History of Federal Emergency Management

Since the founding of the United States, the responsibility for and the locus of emergency and disaster management has moved from one agency to another within the federal government (and the same is true for many state and local governments). Except for two pieces of legislation, however, very little systematic work was done that resembles modern emergency management until the 1930s. Drabek (1991b, p. 6) reports that the first national disaster management effort was the 1803 Fire Disaster Relief Act, which made funds available to help the city of Portsmouth and the state of New Hampshire recover from extensive fires. The next piece of legislation came 125 years later when the Lower Mississippi Flood Control Act of 1928 was passed as a means of responding to the lower Mississippi River flooding in 1927 (Platt, 1998, p.38). It is important to note that both of these pieces of early legislation followed a disaster and were aimed at supporting recovery because this is a pattern that has been continued to the present day. An emphasis on reconstruction after disaster has characterized emergency response efforts at the federal level even in the 21 st Century.

Federal disaster management, if we characterize it as concerted attempts to manage the negative consequences of natural forces, really began when President Franklin Roosevelt created the Reconstruction Finance Corporation in 1933 and authorized it to make loans for repairing public buildings damaged by earthquakes (Drabek, 1991b). In addition, many New Deal social programs provided services and various types of financial aid to natural disaster victims. Aside from individual programs, the National Emergency Council operated within the White House between 1933 and 1939, primarily to cope with the Great Depression, but also to oversee natural disaster relief. The Flood Control Act of 1936 established the Army Corps of Engineers as an important agency in the management of American waterways. In 1939, when the worst part of the Great Depression had begun to subside, the National Emergency Council was moved to the Executive Office of the President and renamed the Office for Emergency Management. Natural disaster relief continued to be centered in this agency, which functioned as a crisis management team for national scale threats of various types.

The beginning of World War II demanded the full attention of the Roosevelt administration in much the same way as the Depression had previously. In addition to its responsibilities for natural hazards, the Office for Emergency Management became the President&rsquos agency for developing civil defense plans and addressing war-related emergencies on the home front. Many programs devised by the Office for Emergency Management were based in the Department of War, under the Office of Civil Defense (directed by Fiorello La Guardia). This office was abolished in 1945, leaving the Office for Emergency Management again as the principal federal emergency agency (Yoshpe, 1981, p.72).

Following World War II, President Harry Truman initially resisted pressures to establish another civil defense agency, believing that civil defense should be the responsibility of the states (Perry, 1982). An Office of Civil Defense Planning was created in 1948 under the year-old Defense Department, and the Office for Emergency Management was again left to concentrate on natural disasters and other domestic emergencies. This separation of planning for civil defense versus natural and domestic disasters continued for nearly two years, but has reappeared over the decades with subsequent reorganizations of federal efforts. After the Soviet Union tested its first atomic bomb in the summer of 1949, Truman relented and created the Federal Civil Defense Administration within the Executive Office of the President as a successor to the Office for Emergency Management. Responsibility for federal assistance in the case of major natural disasters became the responsibility of the Housing and Home Finance Administration. Legislation quickly followed with the passage of the Federal Civil Defense Act of 1950 and the Disaster Relief Act of 1950 (Blanchard, 1986, p. 2). It is noteworthy that this legislation continued to assign responsibility for civil defense and disasters to the states and attempted to spell out specific federal obligations. At the end of President Truman&rsquos administration on January 16, 1953, Executive Order 10427 removed natural disaster relief responsibility from Housing and Home Finance and added it to FCDA (Yoshpe, 1981, p.166).

This arrangement of functions and agencies persisted through both Eisenhower administrations, though the primary agency name changed first to the Office of Defense and Civilian Mobilization and then to the Office of Civil Defense Mobilization. The Office of Civil Defense Mobilization was the first emergency organization to be given independent agency status (in 1958) rather than being under another cabinet department or the White House. On the policy side, the Federal Civil Defense Act was amended in 1958 to make civil defense a joint responsibility of the federal government and state and local governments. This amendment also provided for federal matching of state and local government civil defense expenditures, which actually began to be funded in 1961 under the administration of President John F. Kennedy. Thus, the Kennedy era saw the first rapid expansion of civil defense agencies at the state and local level. President Kennedy again separated federal responsibility for domestic disasters and civil defense in 1961 when he created the Office of Emergency Planning (in the White House) and the Office of Civil Defense (in the Defense Department). Kennedy&rsquos successor, Lyndon B. Johnson, moved the OCD to the Department of the Army in 1964, signaling a reduction in importance (and funding) for this function. This general separation of functions was maintained until 1978, although the Office of Civil Defense became the Defense Civil Preparedness Agency in 1972. Beginning with the creation of the Office of Emergency Preparedness under the Executive Office of the President in 1968, programs dealing with natural and technological hazards began to be reconstituted and parceled out among a variety of federal agencies. For example, the Federal Insurance Administration was established in 1968 as part of the Department of Housing and Urban Development. In 1973, President Richard M. Nixon dismantled the Office of Emergency Preparedness and assigned responsibility for post-disaster relief and reconstruction to the Federal Disaster Assistance Administration in the Department of Housing and Urban Development. General management and oversight of federal programs was assigned to the Office of Preparedness, which was moved to the General Services Administration and, in 1975, became the Federal Preparedness Agency.

Throughout the 1970s, as new federal legislation or executive orders mandated federal government concern with different aspects of natural and man-made hazards, new programs were created within a variety of federal offices and agencies. These were included in the Department of Commerce&rsquos National Weather Service Community Preparedness Program (1973) and the National Fire Prevention and Control Administration (1974). Following the 1972 havoc wreaked by Hurricane Agnes, the Disaster Relief Act of 1974 was passed granting individual and family assistance to disaster victims (administered through the Federal Disaster Assistance Administration). In the late 1970s, four major programs were established within the Executive Office of the President: Dam Safety Coordination, Earthquake Hazard Reduction Program, Warning and Emergency Broadcast System, and Consequences Management in Terrorism. Other technological hazards programs also involved such agencies as the Environmental Protection Agency, Nuclear Regulatory Commission, and the Departments of Energy and Transportation.

This diffuse assignment of responsibilities for emergency management programs to a diverse set of federal agencies persisted through the late 1970s and, as time passed, created a growing concern in the executive branch and the Congress that federal programs for disaster management were too fragmented. Similar concerns by state and local governments became the focus of the National Governors&rsquo Association (NGA) Disaster Project in the late 1970s. The project&rsquos staff traced many state and local problems in emergency management back to federal administrative arrangements. They argued that federal fragmentation hampered effective preparedness planning and response, masked duplicate efforts, and made national preparedness a very expensive enterprise. The Director of the Federal Preparedness Agency, General Leslie W. Bray, acknowledged that when the emergency preparedness function was taken out of the Executive Office of the President and assigned sub-agency status, many people perceived that the function had been downgraded to a lower priority, and his job of coordinating became more complicated. The states argued that their job of responding to disasters was hampered by being forced to coordinate with so many federal agencies. In 1975, a study of these issues sponsored by the Joint Committee on Defense Production (1976, p. 27) concluded:

The civil preparedness system as it exists today is fraught with problems that seriously hamper its effectiveness even in peacetime disasters. . . It is a system where literally dozens of agencies, often with duplicate, overlapping, and even conflicting responsibilities, interact.

In addition to the administrative and structural difficulties, there was also concern the scope of the functions performed as part of emergency management was too narrow, too many resources were devoted to post-disaster response and recovery, and too few resources devoted to the disaster prevention. When the federal response to the nuclear power plant accident at Three Mile Island was severely criticized, calls for reorganization became very loud (Perry, 1982).

Responding to these concerns in 1978, President Jimmy Carter initiated a process of reorganizing federal agencies charged with emergency planning, response, and recovery. This reorganization resulted in the creation, in 1979, of the Federal Emergency Management Agency (FEMA), whose director reported directly to the President of the United States. Far from being an entirely new organization, FEMA was a consolidation of the major federal disaster agencies and programs. Most of FEMA&rsquos administrative apparatus came from combining the three largest disaster agencies: the Federal Preparedness Agency, Defense Civil Preparedness Agency, and Federal Disaster Assistance Administration. Thirteen separate hazard-relevant programs were moved to FEMA, including most of the programs and offices created in the 1970s (Drabek, 1991b). These moves gave FEMA responsibility for nearly all federal emergency programs of any size, including civil defense, warning dissemination for severe weather threats, hazard insurance, fire prevention and control, dam safety coordination, emergency broadcast and warning system, earthquake hazard reduction, terrorism, and technological hazards planning and response. Where FEMA did not absorb a program in its entirety, interagency agreements were developed giving FEMA coordinating responsibility. These agreements included such agencies as the Environmental Protection Agency (EPA), Department of Transportation (DOT), National Oceanic and Atmospheric Administration (NOAA), and Nuclear Regulatory Commission (NRC).

At least on paper, the Executive Order made FEMA the focal point for all federal efforts in emergency management. Although FEMA remained the designated federal lead agency in most cases, there were 12 other independent agencies with disaster responsibilities. The EPA is the largest of these agencies, but others included the Federal Energy Regulatory Commission (FERC), the National Transportation Safety Board (NTSB), NRC, Small Business Administration (SBA), and the Tennessee Valley Authority (TVA). Because disaster related federal relief programs were so scattered through the government, many small programs remained in their home agencies. For example, the Emergency Hay and Grazing program allows federal officials to authorize the harvesting of hay for emergency feed from land assigned for conservation and environmental uses under the Conservation Reserve Program. This program is operated in the Farm Service Agency of the US Department of Agriculture. Ultimately, some emergency or disaster related programs remained in thirteen cabinet level departments, including Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Housing and Urban Development, Interior, Justice, Labor, State, Transportation and Treasury. Certainly the creation of FEMA moved federal emergency management to a much more central position than it had ever been given previously, but it was not possible to completely consolidate all federal programs and offices within the new agency.

The FEMA Director is appointed by the President of the United States and, until the establishment of the Department of Homeland Security, was part of the cabinet. The organization has a regional structure composed of ten offices throughout the United States plus two larger area offices. Although by far the most comprehensive effort, the establishment of FEMA represented the third time that all federal disaster efforts and functions were combined the first was the National Emergency Council (1933-1939), followed by the Office of Civil Defense Mobilization (1958-1961). The early history of FEMA was dominated by attempts to define its mission and organize its own bureaucracy. John Macy, the agency&rsquos first director, was faced with organizational consolidation as a most pressing task: converting thirty separate nation-wide offices to 16 and eight Washington, D.C. offices to five (Macy, 1980). Ultimately, creating a single bureaucracy (with a $630 million budget) from thirteen entrenched organizations proved to be a herculean task.

The efforts to obtain an optimal structure for FEMA continued over the next two decades later directors undertook major reorganizations of headquarters and FEMA&rsquos mission, like its structure, continued to evolve. The early years of FEMA saw much significant legislation and activity. In 1979, the NGA Disaster Project published the first statement of Comprehensive Emergency Management (CEM, the notion that authorities should develop a capacity to manage all phases of all types of disasters), and the concept was subsequently adopted by both the NGA and FEMA. In 1980, the Federal Civil Defense Act of 1950 was amended to emphasize crisis relocation of population (evacuation of people from cities to areas less likely to be Soviet nuclear targets), signaling a fundamental change in US civil defense strategy. Also in 1980, the Comprehensive Environmental Response, Compensation, and Liability Act (called the Superfund Law) was passed, precipitated by the 1978 dioxin contamination of Love Canal, New York (Rubin, Renda-Tanali & Cumming, 2006&mdashwww.disaster-timeline.com). In 1983, FEMA adopted the concept of Integrated Emergency Management System (IEMS) as part of the strategy for achieving CEM (Blanchard, 1986 Drabek, 1985). The basic notion was to identify generic emergency functions&mdashapplicable across a variety of hazards&mdashand develop modules to be used where and when appropriate. For example, population evacuation is a useful protective technique in the case of hurricanes, floods, nuclear power plant accidents, or a wartime attack (Perry, 1985). Similar generic utility exists is developing systems for population warning, interagency communication, victim sheltering, and other functions. Thus, in the early 1980s, FEMA was formed, shaped by organizational growing pains, and also shaped through the adoption of new philosophies of emergency management. While FEMA&rsquos basic charge of developing a strategy and capability to manage all phases of all types of environmental hazards remained, the precise definitions of hazards, the basic conception of emergency management, and the organizational arrangements through which its mission should be accomplished continued to evolve through the end of the 20 th Century.

The end of the 1980s saw passage of the Superfund Amendments and Reauthorization Act (SARA Title III) in 1986 (Lindell & Perry, 2001) and President Ronald Reagan&rsquos Presidential Policy Guidance (1987) that became the last gasp of nuclear attack related civil defense programs in the United States (Blanchard, 1986). Passage of the Robert Stafford Disaster Relief and Emergency Assistance Act of 1988 again boosted state and local emergency management efforts. The Stafford Act established federal cost sharing for planning and public assistance (family grants and housing).

The 1990s opened with controversy for FEMA. In 1989, FEMA response to Hurricane Hugo was criticized as inept&mdasha charge repeated in 1992 when Hurricane Andrew struck Florida. In 1993, flooding in the mid-western US caused more than 15 billion dollars in damage and resulted in six states receiving federal disaster declarations. President Clinton appointed James Lee Witt Director of FEMA in 1993, marking the only time a professional emergency manager held the post. Witt (1995) aggressively increased the federal emergency management emphasis on hazard mitigation and began a reorganization effort. Prior to this time, the federal emphasis had been largely upon emergency response and, to a lesser extent, short-term disaster recovery. Witt began the first real change in federal strategy since emergency management efforts had begun. By the close of the 1990s, FEMA&rsquos organization reflected its critical functions. In 1997, there were seven directorates within FEMA: Mitigation, Preparedness, Response and Recovery, the Federal Insurance Administration, the United States Fire Administration, Information Technology Services, and Operations Support (Witt, 1997). As the 21 st Century began, the overall emphasis of FEMA remained mitigation and both comprehensive emergency management and integrated emergency management systems remained concepts in force.

The most recent epoch in American emergency management began on September 11, 2001, when the attacks on the World Trade Center and the Pentagon shocked Americans and challenged government disaster response capabilities. The attack initiated a comprehensive rethinking of &ldquosecurity&rdquo, &ldquoemergencies&rdquo, and the appropriate role of the federal government. During October, 2001, President George W. Bush used Executive Orders to create the Office of Homeland Security (appointing Governor Tom Ridge as Director) and the Office of Combating Terrorism (General Wayne Downing as Director). On October 29 th , President Bush issued Homeland Security Presidential Directive Number 1 (HSPD-1), establishing the Homeland Security Council, chaired by the President. In June of 2002, President Bush submitted his proposal to Congress to establish a cabinet level Department of Homeland Security (DHS), which was passed later that year.

Since the establishment of DHS, the department&rsquos mission has encompassed three goals: preventing terrorist attacks within the United States, reducing vulnerability to terrorism, and minimizing the damage and recovering rapidly from terrorist attacks (Bush, 2002, p. 8). Although not reflected in the mission statement, DHS would also retain the all hazards responsibilities assigned to FEMA. As was the case in the establishment of FEMA over two decades earlier, DHS incorporated a variety of agencies and programs from many cabinet-level departments, including Agriculture, Commerce, Defense, Energy, Health and Human Services, Interior, Justice, and Treasury. The US Secret Service reports directly to the Secretary of Homeland Security, as does the Coast Guard. The line agencies of DHS comprise four Directorates. The Border and Transportation Security Directorate incorporated the Customs Service from the Department of Treasury, Immigration and Naturalization Service from the Department of Justice, Federal Protective Service, the Transportation Security Agency from the Department of Transportation, Federal Law Enforcement Training Center from the Department of Treasury, Animal and Plant Health Inspection Service from the Department of Agriculture, and Office of Domestic Preparedness from the Department of Justice. The Emergency Preparedness and Response Directorate was built around FEMA and also included the Strategic National Stockpile and National Disaster Medical System of the Department of Health and Human Services, Nuclear Incident Response Team from the Department of Energy, the Department of Justice&rsquos Domestic Emergency Support Teams, and the FBI National Domestic Preparedness Office. The Science and Technology Directorate incorporates the Chemical, Biological, Radiological and Nuclear Countermeasures Programs and the Environmental Measurements Laboratory from the Department of Energy, the National BW Defense Analysis Center from the Department of Defense, and the Plum Island Animal Disease Center from the Department of Agriculture. Finally, the Information Analysis and Infrastructure Protection Directorate absorbed the Federal Computer Incident Response Center from the General Services Administration, the National Communications System from the Department of Defense, the National Infrastructure Protection center from the FBI, and the Energy Security and Assurance Program from the Department of Energy.

Since 2001, the President has issued additional HSPDs defining the fundamental policies governing homeland security operations (www.dhs.gov/dhspublic). Thirteen HSPDs were issued through mid-2006. Recent documents have established the National Incident Management System (HSPD-5), the Homeland Security Advisory System (HSPD-3), the Terrorist Threat Integration Center (HSPD-6), and a common identification standard for all federal employees (HSPD-12). Other documents proposed strategies to combat weapons of mass destruction (HSPD-4), protect critical infrastructure (HSPD-7) and the agriculture and food system (HSPD-9), coordinate incident response (HSPD-8), and enhance protection from biohazards (HSPD-10). In addition, these documents have established policies for protecting international borders from illegal immigration (HSPD-2), promoting terrorist-related screening (HSPD-11), and securing maritime activities (HSPD-13).

These developments make it clear that the President and the Congress consider homeland security to be much broader than emergency management. Incorporation of FEMA into DHS&rsquos Emergency Preparedness and Response Directorate seems to imply FEMA is responsible only for preparedness and response (and perhaps disaster recovery if this is viewed as an extension of the emergency response phase). Consistent with this line of reasoning, one can interpret the mission of the Border and Transportation Security Directorate and the Information Analysis and Infrastructure Protection Directorate in terms of incident prevention. This gives these directorates responsibilities analogous to what emergency managers call hazard mitigation. Even so, the DHS organization chart seems to indicate a significant loss in the priority given to mitigation of natural and accidental technological hazards.


Technology

In 1960, GSA created the Federal Telecommunications System, a governmentwide intercity telephone system. Then, in 1984, GSA introduced the Federal Government to the use of charge cards. Today, the GSA SmartPay program has more than 3 million cardholders.

As the agency transformed itself to enter the 21st century, GSA embraced new technologies, launched electronic government initiatives, and helped develop means of doing government business on the internet. GSA assumed responsibility for George W. Bush’s E-Gov Initiatives: E-Authentication, E-Gov Travel, Federal Asset Sales, and the Integrated Award Environment in 2001.

In 2009, a new Office of Citizen Services and Innovative Technologies was created to foster public engagement by using innovative technologies to connect the public to government information and services. As a result, GSA’s social media outreach efforts grew.

In 2010, GSA became the first federal agency to move email to a cloud-based system, which reduced inefficiencies and lowered costs by 50 percent.

In 2013, GSA began managing the Presidential Innovation Fellows (PIF) program, which Obama then made a part of GSA in 2015. The highly-competitive program pairs talented, diverse technologists and innovators with top civil-servants and change-makers working at the highest levels of the Federal Government to tackle some of our nation’s biggest challenges. GSA also announced the creation of 18F, which consisted of a team of 15 designers, engineers, and product specialists focused on improving the Federal Government’s digital services.GSA was established by President Harry Truman on July 1, 1949, to streamline the administrative work of the federal government. GSA consolidated the National Archives Establishment, the Federal Works Agency, and the Public Buildings Administration the Bureau of Federal Supply and the Office of Contract Settlement and the War Assets Administration into one federal agency tasked with administering supplies and providing workplaces for federal employees.

GSA’s original mission was to dispose of war surplus goods, manage and store government records, handle emergency preparedness, and stockpile strategic supplies for wartime. GSA also regulated the sale of various office supplies to federal agencies.

Today, through its two largest offices – the Public Buildings Service and the Federal Acquisition Service – and various staff offices, GSA provides workspace to more than 1 million federal civilian workers, oversees the preservation of more than 480 historic buildings, and facilitates the federal government's purchase of high-quality, low-cost goods and services from quality commercial vendors.


Until the twentieth century, there was no formal government response system for emergency situations. The fear of an attack on U.S. soil, for example was almost nonexistent the last foreign troops in the United States had been the British during the War of 1812. By the twentieth century, attitudes had changed, but it was not until the 1940s that the federal government felt compelled to take action. President Franklin D. Roosevelt created the first Office of Civilian Defense in 1941, in anticipation of possible attacks on U.S. soil by the Axis forces in Germany and Japan. By 1950,when President Harry S. Truman created the Federal Civil Defense Administration, the main focus of emergency management was guarding against a possible invasion from Communist forces.

During the Cold War years following World War II, civil defense administrators worked with citizens to help them prepare against possible enemy attacks. A major fear was nuclear attack. The devastation of the bombings at Hiroshima and Nagasaki in Japan were still fresh in people’s minds. During the 1950s, many families installed bomb shelters underground or in their basements to guard not only against bombs but also against nuclear fallout. Municipal buildings, schools, and large private office buildings and apartment houses often displayed placards with the Civil Defense logo and the words “Fallout Shelter” (many older buildings still sport these placards). Up until the 1960s, students were led through air-raid drills in which they were instructed to “duck and cover” by ducking under their desks and covering their heads with their arms.


TDEM's Leadership

TDEM Chief - W.NIM KIDD, MPA, CEM®

W. Nim Kidd serves as the Chief of the Texas Division of Emergency Management (TDEM). In this capacity, he is responsible for the state’s emergency preparedness, response, recovery, and mitigation activities. Prior to serving with TDEM, Chief Kidd was appointed to the San Antonio Fire Department (SAFD), where he promoted through the ranks from firefighter to District Fire Chief, including Lieutenant in charge of the SAFD Technical Rescue Team and Captain of the SAFD Hazardous Materials Response
Team. From 2004 to 2010, Chief Kidd served as City Emergency Manager for the City of San Antonio, where he managed the city’s response to over a dozen
state and presidential disaster declarations.

In 1997, Chief Kidd was one of the original members appointed to the Texas Task Force 1 Urban Search and Rescue Team. In 2001, He was the Plans
Section Chief that responded to the 9/11 attack on the World Trade Center. Chief Kidd currently serves as chair for the Federal Emergency Management
Agency’s (FEMA) National Advisory Council (NAC).


Emergency Management

The Final Rule (81 FR 63860, Sept. 16, 2016) assists providers and suppliers to adequately prepare to meet the needs of patients, clients, residents, and participants during disasters and emergency situations, striving to provide consistent requirements across provider and supplier-types, with some variations. Healthcare organizations that receive Medicare or Medicaid must follow Emergency Preparedness regulations in order to participate (aka Conditions of Participation, or CoP).

The requirements set forth in the SOM Appendix Z focus on three key essentials necessary for maintaining access to healthcare during disasters or emergencies: safeguarding human resources, maintaining business continuity, and protecting physical resources. The SOM also provides interpretive guidelines and survey procedures to support the adoption of a standard all- hazards emergency preparedness program for all certified providers and suppliers.

When the President declares a major disaster or an emergency under the Stafford Act or an emergency under the National Emergencies Act, and the HHS Secretary declares a public health emergency, the Secretary is authorized to take certain actions in addition to his regular authorities under section 1135 of the Social Security Act. Examples of these 1135 waivers or modifications include:

  • Conditions of participation or other certification requirements
  • Program participation and similar requirements
  • Emergency Medical Treatment and Labor Act (EMTALA) sanctions for redirection of an individual to receive a medical screening examination in an alternative location pursuant to a state emergency preparedness plan

Preparing our hospitals and other healthcare facilities for disasters is a national security priority. Disasters occur nearly every day in the United States, and the frequency is increasing. This includes such diverse events as storms, droughts, wildfires, floods, earthquakes, chemical and industrial accidents, burns, mass shootings and bombings, and epidemics. All sickened or injured people require a well-prepared public health and healthcare system.

Training provides the foundation for understanding Emergency Preparedness and activation of Emergency Operation Plans and role delineation for Incident command structures.

CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

When CDC gets the call to assist in a public health emergency, the Emergency Operations Center (EOC) is ready to respond. The CDC Emergency Operations Center &ndash a place where highly trained experts monitor information, prepare for known (and unknown) public health events, and gather in the event of an emergency to exchange information and make decisions quickly.

The mission of the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) is to save lives and protect Americans from 21st century health security threats.

ASPR leads the nation&rsquos medical and public health preparedness for, response to, and recovery from disasters and public health emergencies. ASPR collaborates with hospitals, healthcare coalitions, biotech firms, community members, state, local, tribal, and territorial governments, and other partners across the country to improve readiness and response capabilities.

The NFPA ® Standards Council established the Disaster Management Committee in January 1991. The committee was given the responsibility for developing documents relating to preparedness for, response to, and recovery from disasters resulting from natural, human, or technological events.

When directed, The Marine led CBIRF forward-deploys and/or responds with minimal warning to a chemical, biological, radiological, nuclear or high-yield explosive (CBRNE) threat or event in order to assist local, state, or federal agencies.

Terrorist organizations throughout the world have used a variety of chemical, biological, and radiological weapons (collectively known as HAZMAT/weapons of mass destruction [WMD]) to further their agendas. The possibility of such incidents requires first responders to prepare for such incidents, which can affect individuals or inflict mass casualties.

Incidents involving HAZMAT/WMD are complicated because victims may become contaminated with the hazardous material. The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and easily.


History of USDA's Farm Service Agency

The Farm Service Agency traces its beginnings to 1933, in the depths of the Great Depression. A wave of discontent caused by mounting unemployment and farm failures had helped elect President Franklin Delano Roosevelt, who promised Americans a "New Deal."

One result was the establishment in 1935 of a Department of Agriculture agency with familiar initials: FSA, which stood for Farm Security Administration. Originally called the Resettlement Administration, and renamed in 1937, its original mission was to relocate entire farm communities to areas in which it was hoped farming could be carried out more profitably. But resettlement was controversial and expensive, and its results ambiguous. Other roles soon became more important, including the Standard Rural Rehabilitation Loan Program, which provided credit, farm and home management planning and technical supervision. This was the forerunner of the farm loan programs of the Farmers Home Administration.

Another related program was Debt Adjustment and Tenure Improvement. FSA county supervisors, sometimes with the help of volunteer committees of local farmers, would work with farmers and their debtors to try to arbitrate agreements and head off foreclosure. The idea was to reach a deal by which the bank could recover as much or more than it would through foreclosure by allowing the farmer to remain in business.

FSA also promoted co-ops and even provided medical care to poor rural families. Although the scope of its programs was limited, poor farm families who took part benefited greatly. One study estimates that families who participated in FSA programs saw their incomes rise by 69 percent between 1937 and 1941! Annual per capita meat consumption increased from 85 pounds to 447 pounds in the same period. Milk consumption increased by more than half.

In 1946 the Farmers Home Administration Act consolidated the Farm Security Administration with the Emergency Crop and Feed Loan Division of the Farm Credit Administration - a quasi-governmental agency that still exists today. This Act added authorities to the new Farmers Home Administration that included insuring loans made by other lenders. Later legislation established lending for rural housing, rural business enterprises, and rural water and waste disposal agencies.

Meanwhile, the Agricultural Adjustment Act of 1933 had established the Agricultural Adjustment Administration, or AAA. The "Triple A's" purpose was to stabilize farm prices at a level at which farmers could survive. The law established state and county committees of farmers called "Triple A committees." These committees oversaw the first federal farm program offering price support loans to farmers to bring about crop reduction.

The old Triple A was built on two major program divisions: the Division of Production and the Division of Processing and Marketing. These were responsible for the work of commodity sections including dairy, rice, tobacco, sugar, wheat, cotton, corn and hogs.

With the passage of the Agricultural Adjustment Act of 1938 and a general reorganization of the Department of Agriculture that October came new, complicated changes in conservation, crop support and marketing legislation. Programs such as commodity marketing controls, and the policy of the Congress to assist farmers in obtaining parity prices and parity income, made the federal government the decision-maker for the nation's farmers.

After Pearl Harbor, the War Food Administration (WFA) was organized to meet the increased needs of a country at war. This reorganization grouped production, supply and marketing authorities under a central agency which coordinated the flow of basic commodities.

Following World War II, the authority of the WFA was terminated. In its place came the Production and Marketing Administration, which, aside from other responsibilities, maintained a field services branch to aid in program oversight.

The post-war period of adjustment to peace-time production levels was almost as difficult as gearing up for war. New priorities had to be established, and at the same time, over-production of certain commodities threatened drops in farm income levels. The increased needs of war-ravaged nations helped absorb surplus production, but surpluses remained a nagging problem for farmers and policymakers.

In 1953, a reorganization of USDA again made changes in the powers and duties of its price support and supply management agency. With the changes came a new name - Commodity Stabilization Service - and an increased emphasis on the preservation of farm income. Conserving programs such as the Soil Bank were introduced to bring production in line with demand by taking land out of production for periods of time ranging up to 10 years. Community, county and state committees were formally identified for the first time as Agricultural Stabilization and Conservation committees.

The Commodity Stabilization Service became the Agricultural Stabilization and Conservation Service (ASCS) in 1961, and the new name reflected the agency's stabilization and resource conservation missions. Field activities in connection with farm programs continue to be carried out through an extensive network of state and county field offices.

In 1994, a reorganization of USDA resulted in the Consolidated Farm Service Agency, renamed Farm Service Agency in November 1995. The new FSA encompassed the Agricultural Stabilization and Conservation Service, Federal Crop Insurance Corporation (FCIC) and the farm credit portion of the Farmers Home Administration. In May 1996 FCIC became the Risk Management Agency.

Today, FSA's responsibilities are organized into five areas: Farm Programs, Farm Loans, Commodity Operations, Management and State Operations. The agency continues to provide America's farmers with a strong safety net through the administration of farm commodity programs. FSA also implements ad hoc disaster programs. FSA's long-standing tradition of conserving the nation's natural resources continues through the Conservation Reserve Program. The agency provides credit to agricultural producers who are unable to receive private, commercial credit. FSA places special emphasis on providing loans to beginning, minority and women farmers and ranchers. Its Commodity Operations division purchases and delivers commodities for use in humanitarian programs at home and abroad. FSA programs help feed America's school children and hungry people around the globe. Additionally, the agency supports the nation's disabled citizens by purchasing products made by these persons.


A Brief History of Emergency Medical Services in the United States

Pre-hospital emergency care in the modern age is often described as a “hierarchy” of human and physical resources utilized in the acute setting to provide the best possible patient care until definitive care can be established. Like most hierarchies, the system we have in place today was forged one link at time, dating as far back as the Civil War. With widespread trauma, a systematic and organized method of field care and transport of the injured was born out of necessity. It wasn’t until 1865, however, that the first civilian ambulance was put into service in Cincinnati followed by a civilian Ambulance Surgeon in New York four years later1 . The New York service differed slightly from the modern approach as they arrived equipped with a quart of emergency brandy for each patient.

Once again, military conflicts and necessity provided much of the impetus to develop innovations in the transportation and treatment of injured. In the wake of World War I, the roaring 20s saw the first volunteer rescue squads forming in locations such as Virginia and New Jersey. Control began to shift towards municipal hospitals or fire departments as funeral home hearses were slowly joined by fire departments, rescue squads and private ambulances in the transportation of the ill and injured. Landmark articles in the late 50’s and early 60’s began to detail the science and methods for initial cardiopulmonary resuscitation (CPR), forging yet another vital link in the chain as EMS began its first steps into the treatment of pre-hospital cardiac patients. Departments trained in cardiac resuscitation began to reveal successes in major urban areas such as Columbus, Los Angeles, Seattle and Miami.

The 1960’s provided another challenge to public health as traffic accidents began to lead to considerable trauma and death. This “neglected disease of modern society”2 was detailed in the infamous 1966 white paper titled “Accidental Death and Disability: The Neglected Disease of Modern Society.” The paper, prepared by the National Academy of Sciences and the President's Commission on Highway Safety, detailed the injury epidemic and the lack of appropriate pre-hospital care and lack of an organized system to treat patients suffering from critical traumatic injuries. Reforms were indicated in the education and training, systems design, staffing, and response in the nation’s ambulance services. The white paper and its recommendations for a standardized emergency response gave way to National Highway Safety Act of 1966 that established the Department of Transportation (DOT). The DOT, and it’s daughter organization the National Highway Traffic Safety Administration (NHTSA), were critical in pushing for the development of EMS systems while standardizing education and curriculum standards, encouraging involvement at the state level, and providing oversight into the creation of regional pre-hospital emergency systems and regional trauma center systems, forming the birth of trauma center accreditation by the American College of Surgeons Committee on Trauma. For the first time in US history, a curriculum standard was being set in skills and qualifications required to become an Emergency Medical Technician. Paramedic education arrived shortly afterwards, but still has a ways to go in terms of scope and depth.

The EMS Systems Act of 1973 provided funding for the creation of more than 300 EMS systems across the nation, as well as set aside funding for key future planning and growth. It was during this time that while EMS began to get a stable foothold, emergency medicine began to establish itself as a distinct specialty with the first residency training program in 1972 at the University of Cincinnati3. By 1975, there were 32 EM residencies across the nation preparing physicians that would interface with EMS at all levels from responders and educators all the way to medical directors.

Advances in care standards and education continued well throughout the 1980’s, including changes in the principles of funding for EMS with the Omnibus Budget Reconciliation Act. The act established EMS funding from state preventative health block grants rather than funding from the EMS Systems Act. EMS also began to see its role change towards the front line of healthcare as its practice was no longer just for adult trauma and cardiac emergencies. Chronic diseases, pediatric patients, and the underserved all began to play major roles in defining who EMS is dispatched for. Recognizing the need for a cohesive approach between EMS and the remaining healthcare world, the 1996 EMS Agenda for the Future was drafted to detail how EMS can integrate into the other medical and care fields as well as advance its own practice. The EMS Education Agenda for the Future was published shortly after and described more modern recommendations for core curriculum content, scope of practice, and certification of EMS professionals4.

Within the last 10 years, EMS has become a focus of intense research of pre-hospital interventions into many commonly encountered acute care issues seen in emergency medicine, such as acute respiratory distress, cardiac arrest, chest pain and more. With increasingly integrated technology between pre-hospital care and the emergency department, patient data is beginning to be transmitted real time allowing for earlier determination of patient severity and care management prior to arrival. Quality improvement with integrated electronic charting including patient outcomes is beginning to provide much needed feedback to allow EMS to grow as a dedicated subspecialty of emergency medicine. Within regional stroke centers, cardiac catheterization centers and trauma systems, EMS has become the forefront of emergency medical care and can only serve to advance how emergency medicine is conducted in the future.

EMS has come a long ways from its infancy in the days of horse and buggy. As it grows alongside emergency medicine, there are opportunities for physicians to become involved at every level. While EMTs are not independent practitioners and require operating under a medical director’s scope and license, the situations they face require considerable problem solving, judgment, and clinical decision making skills. Physicians are needed at every step to help develop treatment protocols, provide quality improvement, hold regular training sessions and ensure all personnel have the tools they need to perform high quality pre-hospital care. In addition, physicians may be called upon for situations that require their presence on scene in the field including mass casualty incidents, high acuity and high risk scenarios, tactical situations, or patients that require advanced skills such as surgical airways, pericardiocentesis, chest tubes and others. Large scale operations including concerts, conventions, and city events also benefit form physician input.

EMS will continue to be the front line of emergency medicine as the field expands in the coming future. Physicians involved with pre-hospital care will be paramount to providing the support and knowledge required to help EMS systems grow, as evidenced by the recent recognition of EMS as an official clinical subspecialty.


Watch the video: 29 SMART SOLUTIONS FOR EMERGENCY SITUATIONS. Parenting, Camping, FIRST AID (January 2022).