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Why is EMS a part of the DOT? A look at The White Paper

Note: This entry was originally posted on a blog I created for my History of Medicine class final project during December 2012.

National Academy of Sciences

If you had to guess, what federal body would you think EMS falls under: the Department of Transportation, or the US Public Health Service? If you guessed the US Public Health Service, you'd be wrong. Read on to find out why. This story is crucial to understanding the evolution of EMS in the United States and the problems the system currently faces, problems that should concern every person who could ever need to call an ambulance.

The Nouveau plan de constitution pour la médecine en France published in the 1790's laid down new standards for medical education and practice in France, becoming a charter of sorts. It's true that educational models had existed long before this point, but the Nouveau plan illustrates that in medicine, a single document can serve to bring together many circulating ideas into one coherent system, thereby facilitating its implementation. In 1966, the National Academy of Sciences released its seminal paper, Accidental Death and Disability: The Neglected Disease of Modern Society -- known in the EMS trade as simply "The White Paper" -- which had the same effect of rallying EMS in the United States (you can download the paper here).

The modern EMS system in America owes its roots directly to this White Paper, and had it never been published, EMS might have evolved in a very different way. Particularly, to the modern audience, it makes sense that EMS -- emergency medical services -- might fall under the purview of some federal medical regulatory body, and yet it belongs to the Department of Transportation. Understanding the White Paper can explain this apparently awkward ordering. The White Paper, after all, was written largely in response to the growing problem of car wrecks, as motorized vehicles not only increased the incident of trauma in the US but also provided dramatic examples of just how bad trauma could be. Cars made trauma very visible.

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