In the first half of the 20th century, up to the 1960s, only six states had provided educational coursed for rescue workers. What happened to change that attitude? President Johnson formed the 1965 President's Commission on Highway Safety to evaluate risk on the road. Reports were written not just about road safety but about the poor emergency medical care as a factor in many deaths. The government took interest in the increasing number of serioud and fatal vehicle crashes. The rise of rock and roll and teen musical concerts caused haoc in city streets.

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THE EVOLUTION OF THE emergency medical services (EMS) system has been a slow process. Although modern EMS initially developed during Napoleon’s time to aid injured soldiers,1 few major changes occurred in EMS until the 1960s. Between 1960 and 1973, a number of medical, historical, and social forces converged, leading to the development of a more structured EMS system in the United States. These forces have had a tremendous impact on the structure and functioning of the EMS system, resulting in profound public health implications today.

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