History

The Beginnings of Emergency Medical Services

Emergency Medical Services, now widely expected as a public service, is relatively new when compared to other public services. It has evolved locally and nationally since the early 1970s. Prior to that time emergency medical care and transport was largely provided by local law enforcement agencies, with transport undertaken in station wagons and funeral vehicles.

In 1966 the Federal Government passed the Federal Highway Safety Act which called for state highway safety programs that meet uniform standards. The development of Emergency Medical Services was a significant component of this legislation. Criteria were outlined for EMS, including personnel training, equipment, communications, and planning at state and local levels.

In the early 1970s municipalities, counties, and states began to develop EMS programs that responded to federal guidelines. The City of Madison established its paramedic program with the Madison Fire Department in 1972. This was one of the early paramedic programs in the nation. This type of service with trained, paid professional staff became typical of large cities throughout the country.

The State of Wisconsin created Wis. Stats. 146.50 in 1973. This law set standards for qualification and training of ambulance attendants, and authorized administrative rules governing ambulance service operations. These standards and rules took effect in the later part of that decade. This ushered in the era of modern EMS as we know it in Wisconsin, with patients transported by trained personnel in appropriately equipped ambulances.

History and Development of the Dane County EMS System

A Dane County Emergency Medical Services Council was formed 1973. Its task was to review the delivery of emergency medical services in the county, identify problem areas, and recommend necessary changes. This council submitted a report in November 1973 outlining basic elements of a proposed ambulance service for Dane County.

In January 1974, the County Board created the Dane County Emergency Medical Care Committee to evaluate the EMS Council’s report and recommend proposals to implement an EMS system in Dane County. In August 1974, this committee recommended an implementation program in a report to the Board of Supervisors. Its central recommendation was to create an Emergency Medical Services Commission to implement an EMS system in Dane County. The proposed system consisted of six components:

A central dispatch system.
Use of the Dane County Traffic Department for First Response.
Volunteer ambulance services for second response; two persons per vehicle; seven ambulance service districts were proposed.
Ambulances and equipment meeting state standards.
A Medical Advisory Committee to oversee training, equipment, and procedures.
Required 72 hours EMT-basic training or its equivalent for all volunteers and traffic patrol officers.

The most important feature of this recommended system was the volunteer ambulance service. The committee considered a fully paid professional county-level service, but rejected this on the basis of cost. The volunteer system, as recommended, included seven ambulance districts, chosen on the basis of population and anticipated number of calls per day.

Regarding the Madison area, the committee recommended that the City of Madison Fire Department cover the towns of Madison and Blooming Grove, The cities of Middleton and Monona, and the villages of Maple Bluff and Shorewood Hills through contractual arrangements.

On September 5, 1974 the County Board of Supervisors endorsed the Committee’s recommendation by passing an ordinance to create the Dane County Emergency Medical Services Commission. The ordinance gave the Commission authority to create seven medical care areas, establish a central dispatch system, and seek funding for all components of the proposed program. The EMS Commission subsequently formed several subcommittees: the Medical Advisory Subcommittee, the Subcommittee on Ambulance Plans, and the Communications Subcommittee. During the period from late 1974 to 1978, the Commission and its subcommittees implemented the major components of the EMS system, re-evaluating and modifying parts of the original plan as they proceeded.

In July 1976, the Subcommittee on Ambulance Plans recommended a fully staffed, paid county system. The EMS Commission did not adopt this recommendation, and instead emphasized the county’s role in a volunteer system. The rejection of the concept of a paid, county run system occurred partly out of cost considerations, but largely also out of issues of local control. Instead of a county system, local communities opted to develop their own, local, ambulance services and negotiated with the county for funds for ambulances, insurance, and equipment through contractual arrangements.

A more detailed description and analysis of the evolution of Dane County’s present locally based volunteer EMS system, including factors leading to the number of districts presently in existence, can be found in a document entitled “Dane County Emergency Medical System Review - Part I - Organizational Assessment” prepared by Robert Brunning in 1984. (This can be made available on request.) The previous historical discussion is largely abstracted from Mr. Brunning’s report.

The current structure of our EMS system has been in place since the early 1980s. The City of Madison is covered by the Madison Fire Department paramedic program (established previously in 1972). This program has its own Medical Director and its own Medical Advisory Committee. The remainder of the EMS system consists of autonomous districts mainly staffed by volunteer EMTs-Basic. Some districts have a limited number of paid personnel and administrators. Most of these are “third service” operations, independent from other public services although in some districts EMS is part of the local fire department. Several of these districts operate at the EMT-Intermediate level. From 1989 onward, all EMTs of all services have been trained to defibrillate, use Epinephrine for anaphylaxis, and more recently to use advanced airways.

The Dane County EMS Commission continues to meet and coordinate the system, periodically re-evaluating contracts and changes in the system. The County provides coordination for the overall system, provides liability insurance for the districts, and a back-up ambulance. Day to day coordination of the EMS system outside the City of Madison is done through the EMS Division of the Department of Emergency Management. Since 1989 this department has had an EMS Medical Director who oversees the “advanced” programs for all of the services, and provides medical advice to the department. Part of the coordination of the system comes in the form of advice, protocols and policies from various advisory subcommittees. The Medical Advisory Committee continues to meet and develop medical protocols and policies. Other subcommittees include the Training Advisory Subcommittee and Districts Advisory Subcommittee, which also provides input into the department, the commission, and the districts.