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Although not commonly understood, EMS systems nationwide provide emergency care that is almost on par with that of an emergency room. Equipment and procedures are obviously limited, due to the nature of the environment that EMS personnel must work in. EMS providers work under the license and indirect supervision of a medical director[?] (a board-certified physician), who oversees the policies and protocols of a particular EMS system or organization.
EMS workers are trained to follow a formal and carefully designed decision tree which has been created and approved by physicians. The emphasis in emergency services is on following correct procedure quickly and accurately rather than on making in-depth diagnosis which requires much professional experience. The use of a decision tree allows EMS workers to be trained in a much shorter time than physicians.
National EMS standards are drawn up by the U.S. Department of Transportation, modified from state to state by the state's Department of EMS (usually under its Department of Health[?]), and further altered by Regional Medical Advisory Comittees (usually in rural areas) or by other comittees or even individual EMS providers. All alterations to U.S. DOT protocols are made by qualified people and conform to all applicable rules and regulations.
The origins of EMS date back to the days of Napoleon, when the French army utilized horse drawn "ambulances" to transport the injured soldier from the battlefield. Its more recent incarnation can be traced back to 1869, when Dr. Edward L. Dalton at Bellevue Hospital, then known as the Free Hospital of New York, in New York City started a basic transportation service for the sick and injured. The component of care on scene began in 1928, when Julien Stanley Wise started the Roanoke Life Saving Crew, the first rescue squad in the nation. Over the years EMS continued to evolve into much more than a "ride to the hospital."
In particular in the US state of California, a project began to include paramedics in the EMS responses in the late 1960s. Despite opposition from firefighters and doctors, the program eventually gained acceptance as its effectiveness became obvious. Furthermore, the program became widely popularized around North America in the 1970s with the television series, Emergency! which in part followed the adventures of two Los Angeles County Fire Department paramedics as they responded to various types of medical emergency. The popularity of this series encouraged other communities to establish their own equivalent services.
Two levels of care are provided by EMS systems: BLS and ALS (Basic Life Support and Advanced Life Support). BLS providers are CFRs and EMTs and provide all care outlined in the EMS standard of care, except for invasive procedures and (to a certain extent) giving medications. ALS providers are principally paramedics and can perform invasive procedures and give a wide variety of drugs.
In times of economic crisis and in poorer areas, much normal medical care is provided through emergency services to patients who do not have regular physicians or regular medical attention.