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The History of EMS at NHTSA


40 Years of Leadership


NHTSA and its predecessor agency have supported comprehensive national Emergency Medical Services System development for more than 40 years. In 1966, a report entitled "Accidental Death and Disability" was released by the National Academies of Sciences, bringing to light the "neglected epidemic" of accidental injury. This report, along with passage of the 1966 Highway Safety Act, provided impetus for increased national attention on the plight of victims of motor vehicle trauma. The Federal government was given a leadership role in reducing the number of injuries and deaths on America's highways. As a result, the National Highway Safety Bureau (NHSB), which was the predecessor agency to NHTSA, was created. A part of this new agency, the Division of Emergency Treatment and Transfer of the Injured, was dedicated to EMS.


In 1966, a report entitled "Accidental Death and Disability" was released by the National Academies of Sciences, bringing to light the "neglected epidemic" of accidental injury.


The Haddon Matrix


In 1969, Dr. William Haddon, then Director of the NHSB, introduced the Haddon Matrix at the First DOT Inter-Departmental Safety Seminar. This simple, yet ground-breaking model defined EMS as a critical element of a comprehensive strategy to reduce traffic-related death and injury.


The Haddon Matrix


The Haddon Matrix (illustrated above) applied a public health model to the "epidemic" of traffic-related injury. In this model, crashes can be prevented by changing human factors, vehicle factors, and environmental factors. Likewise, if a crash occurred, injuries can be prevented or minimized by changing the same three factors. Moreover, if these strategies fail, the matrix shows the importance of post-crash emergency care in reducing mortality and morbidity. In 1969, an organized system to provide emergency medical care did not yet exist.


A Vision for the Future


Early on, Dr. Haddon recognized that the only sustainable "emergency medical services system" was one that responded to all types of illness and injury, not just car crashes. In fact, Dr. Haddon stated at the time that, "[Emergency Medical Services]"...are broader and relate to community response to a wide variety of social disruptions involving everything from riots to tornadoes to earthquakes to scattered emergencies such as acute childbirth problem[s], coronaries, and injuries in industry, and you don't go at these any more if you think about this field in systems terms only in isolation, thinking only about the highway [crash patients] or only about the medical [patients]."


Accomplishments and Milestones


In 1970, the NHSB was reorganized as the National Highway Traffic Safety Administration (NHTSA). NHTSA, still under the leadership of Dr. Haddon, built upon the mission of the NHSB, including support for the development of emergency medical services. A brief synopsis of some of NHTSA's accomplishments and contributions to EMS system development over the years follows:



1970s - The Star of Life

In 1977, NHTSA created the Star of Life. Prior to its creation, there was no uniform symbol that represented EMS. Today, the Star of Life identifies emergency medical services not just in this country but across the globe. This symbol can be found on ambulances, emergency medical equipment, patches and apparel worn by EMS providers. It can also be found on road maps and highway signs indicating the location of or access to qualified emergency medical care.



1980s - Statewide EMS Technical Assessment Program

Introduced in 1988, the NHTSA statewide EMS Technical Assessment Program is based on the 10 key components of EMS systems. NHTSA facilitates the process of gathering an independent team of EMS experts to identify EMS system strengths, needs, and strategies. Nearly all the States and U.S. territories have already taken advantage of this process and NHTSA is accepting requests for reassessment from States that have previously conducted an assessment and are interested in gauging subsequent progress.



1990s - Numerous Projects and Key Publications

In the1990s, several key documents were completed by NHTSA and its National and Federal partners. These include the initial NHTSA Uniform Prehospital Dataset (1993), the EMS Agenda for the Future (1996), the EMS Agenda for the Future Implementation Guide (1998), and the Leadership Guide to Quality Improvement for EMS Systems (1998). Also during this time frame, the National Standard Curricula for all the key levels of EMS providers were revised.



Early 2000s - Forward Thinking

In the early 21st century, the EMS Agenda for the Future served as the genesis for a number of publications. Again in collaboration with its Federal partners and the national EMS community, NHTSA completed work on the EMS Education Agenda for the Future: A Systems Approach (2000), the Trauma System Agenda for the Future (2002), and the National EMS Research Agenda (2002).



2005 - An Expanded Role

In 2005, Congress passed reauthorizing legislation for NHTSA. Under the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), Congress mandated the creation of the Federal Interagency Committee on Emergency Medical Services (FICEMS). While NHTSA had for many years collaborated with Federal and national partners on EMS activities, SAFETEA-LU required that NHTSA provide administrative support for FICEMS in coordination with its Federal partners at the Department of Health and Human Services and the Department of Homeland Security.


Systems-Based, Collaborative, and Comprehensive


NHTSA has been a consistent Federal advocate and leader in promoting a systems approach to the development of emergency medical services. By collaborating with its Federal partners (e.g., the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the U.S. Fire Administration and others), NHTSA has successfully developed national standard curricula for EMS providers, guided the development and implementation of the National EMS Agenda for the Future, spearheaded the initiation of a National Emergency Medical Services Information System (NEMSIS), and assisted with the deployment of Wireless Enhanced 9-1-1.


Consensus-building, collaboration and leveraging of limited resources into significant projects are the hallmarks of NHTSA's modus operandi in EMS system development. An efficient EMS system is integral to reducing traffic morbidity and mortality, essential to traffic mobility, and key to ensuring prompt emergency response to any type of incident. The Nation's best preparation for any incident is a comprehensive EMS system, ready every day for every emergency.

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