Читать книгу Emergency Medical Services - Группа авторов - Страница 17

The modern era of prehospital care in the United States began in 1966. In that year, recognition of an urgent need for improved care, the crucial element necessary for development of prehospital systems nationwide, was heralded by a report from the National Academy of Sciences National Research Council (NAS‐NRC), a non‐profit organization chartered by Congress to provide scientific advice to the nation. Accidental Death and Disability: The Neglected Disease of Modern Society (commonly referred to as the “white paper”) documented the enormous failure of the U. S. health care system to provide even minimal care for the emergency patient in both the prehospital and hospital settings. The NAS‐NRC report identified key issues and problems facing the United States in providing emergency care (Box 1.1). Its summary report listed recommendations that would serve as a blueprint for EMS and emergency medicine development, including such things as first aid training for the lay public, state‐level regulation of ambulance services, emergency department improvements, development of trauma registries, single nationwide phone number access for emergencies, and disaster planning [16]. This document established a benchmark against which to measure subsequent progress and change in emergency care.

The 1966 NAS‐NRC document described the care provided by both prehospital services and hospital emergency departments as being woefully inadequate. In the prehospital arena, treatment protocols, trained medical personnel, rapid transportation, and modern communications concepts such as two‐way radios and emergency call numbers, were all identified as necessities that were simply not available to civilians. Although there were more than 7,000 accredited hospitals in the country at the time, very few were prepared to meet the increased demand for volume and clinical care that developed between 1945 and 1965. From 1958 to 1970, the annual number of emergency department visits increased from 18 million to more than 49 million [16]. In addition, emergency departments were staffed by the least experienced personnel, who had little education in the treatment of multiple injuries or critical medical emergencies. Early efforts of the American College of Surgeons (ACS) and the American Academy of Orthopedic Surgeons (AAOS) to improve emergency care were largely unsuccessful because interest and support from the medical community were essentially non‐existent [17–20].