Emergency Medical Services

In the early- to mid-1970s, much of the U.S. had no well-developed system for stabilizing victims of accidents, fires, crashes, crimes, and other traumas while rushing them to hospitals appropriately equipped to save them during critical early minutes. A panel of the National Academy of Sciences called accidental trauma “the neglected disease of modern society.” The Robert Wood Johnson Foundation set sights on changing that with a $15 million initiative launched in 1973 called the Emergency Medical Services Program.

When it opened in December 1971, the $1.2 billion of assets at the Robert Wood Johnson Foundation (endowed by the man who turned his father’s family business of Johnson & Johnson into a corporate behemoth) made it the second largest philanthropy in America. This allowed the foundation to undertake large and innovative projects. Its actions to catalyze a forward leap in our emergency medical services were one of its earliest initiatives, and also one of the most successful.

The foundation aimed to develop and standardize emergency services and spread them across the United States. At that point, emergency-room medicine was just beginning to develop as a specialty, EMS training was scanty to non-existent, and most ambulances were little more than hauling vehicles with sirens. RWJF sought to elevate the level of medical treatment offered by first responders, within transports headed to hospitals, and in emergency rooms themselves during the crucial early moments after a trauma arrives.

Participating hospitals developed sophisticated communications systems that linked them to newly trained paramedics in ambulances. Ambulances themselves were redesigned and fitted with essential medical equipment so that patients could be evaluated and given acute treatment before arriving at the hospital. And protocols were put into place at emergency rooms so that teams could pounce on victims with the right targeted care as soon as they arrived. When the Emergency Medical Services Program launched, there were only 12 reasonably organized paramedic units in the U.S. The foundation chose 44 grant recipients in 32 states, working with organizations ranging from fire departments to medical schools. Just four years later, at least 50 percent of the American population was within ten minutes of a paramedic unit. The RWJF efforts spurred parallel expansions funded by the U.S. Department of Health, Education, and Welfare, and together these enhancements saved many thousands of lives, eventually resulting in the 911 emergency-response system.