EMS & Trauma Systems History

1970 - 1990

ambulancePrior to 1970, funeral homes were primarily responsible to getting "victims" from the scene of an emergency to the hospital. The personnel had no training and minimal equipment. With the publication of "Death in a Ditch" and "Accidental Death and Disability: the neglected disease of modern society", it was recognized that inadequate training of ambulance attendants may have caused unnecessary death and disability.

star of lifeWith the advent of the national standard training curriculum of Emergency Medical Technicians (developed by the National Highway Traffic Safety Administration), emergency medical services in Montana was "born". The Department of Health and Environmental Sciences was established by statute as the lead agency for EMS development in Montana. The Board of Medical Examiners was charged with the licensing and testing of Emergency Medical Technicians ... a task they delegated to the Department of Health and Environmental Sciences. Recognizing the importance of maintaining consistency with national standards, the National Registry of Emergency Medical Technicians was chosen as the method of assuring provider competency.

transportWith federal funding the Department of Health, Education and Welfare, emphasis was placed on emergency medical services system development. No longer was EMS just a bunch of ambulances and ambulance attendants: there was an organized system involving dispatch, ambulances, hospitals, medical direction, data collection and numerous other components.

In Montana, regional emergency medical services systems were established with federal funding only to disband with the termination of the federal funding in the mid-1980s.

defibHowever, EMT-Basic programs proliferated and, for the first time, advanced level Emergency Medical Technicians were licensed at the EMT- Intermediate and EMT-Paramedic levels. Creation of the EMT-Defibrillation recognized the importance of early defibrillation in reversing cardiac arrest from ventricular fibrillation.

medical directorMedical direction for emergency medical services became increasingly important; however, in rural Montana, medical direction was still difficult to obtain. Statewide prehospital treatment protocols were developed and approved by the Board of Medical Examiners.

helicopterFixed wing and rotor-wing air ambulance services, usually based at hospitals in the larger cities, performed an increasingly important role in scene response and, particularly in interfacility transfers.

Comfort OneThe Montana legislature adopted several landmark statutes in Montana EMS development including a statewide program for recognizing Do Not Resuscitate orders for terminally ill and seriously ill patient. Called Comfort One, this model has now gained national notoriety.

Initially, obtaining volunteers to provide emergency medical services was quite easy. However, toward the end of the period, volunteerism declined significantly. Changes in the economy combined with both persons in a household working, has continued to provide a strain on an emergency medical services system which is heavily reliant on volunteers.

grantsThe decline of federal EMS categorical grant funding caused a significant reduction in statewide support for the emergency medical services system. Although the categorical funding was "rolled" into the federal Preventive Health and Health Services Block grant funding, the amount of funding allocated to EMS continued to decline.

1990 - present

fundingThe Rural Preventable Mortality Study, conducted by the Critical Illness and Trauma Foundation, demonstrated the absence of a trauma system was resulting in preventable trauma-related deaths.

With the assistance of federal funding support for trauma system development, considerable emphasis was placed on developing a statewide trauma care system. With this funding support, a state trauma system plan was approved in 1994. Federal funding for the trauma program was precipitously dropped in 1994 thus delaying trauma system implementation. In 1995, comprehensive trauma system legislation was adopted by the Montana legislature, but no funding was provided for system implementation.

Ttrauma systemrauma system implementation was continued. In an incredible volunteer effort, Regional Trauma Advisory Committees were formed and the State Trauma Care Committee continued to operate. Despite the absence of funding, considerable progress was made in developing a statewide trauma care system. A federal grant from Centers for Disease Control and Prevention re-invigorated the trauma system development effort and allowed the hiring of a state trauma system coordinator.

computerInitially with Highway Traffic Safety support, and subsequently with other federal support, the Montana Trauma Registry, collecting information on seriously injured trauma patients from medical facilities, was initiated.

Despite an increase in trauma system funding, the non-federal funding for overall EMS system support continued to decline.

emscWith an Emergency Medical Services for Children grant, and in a cooperative effort with a grant obtained by the Critical Illness and Trauma Foundation, computers were placed in nearly every ambulance service in the state. These computers, with a link to Burns Telecommunications Center at Montana State University, are used for data collection and EMS education.

preventionRecognizing the importance of prevention, the EMS Section (now in the Department of Public Health and Human Services) was changed to the EMS and Trauma Systems Section. With funding from the EMS for Children grant, an Injury Prevention Program Manager was hired and a state Injury Prevention and Control Plan produced. The Injury Prevention Program is being integrated with the state trauma care system.

aedIn 1999, the Montana legislature passed legislation authorizing an Automated External Defibrillation Program in Montana thus further providing early defibrillation for patients sustaining a cardiac arrest due to ventricular fibrillation.

trauma systemAlso in 1999, the Montana legislature authorized funding to support trauma system development. These funds will help hire a trauma system coordinator and to more consistently support system development activities better than federal funding which only exists for short periods.