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| 1970 - 1990 |
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Prior to 1970, funeral
homes were primarily responsible to getting
"victims" from the scene of an emergency to the
hospital. The personnel had no training and minimal equipment.
With the publication of "Death in a Ditch" and "Accidental
Death and Disability: the neglected disease of modern society",
it was recognized that inadequate training of ambulance attendants
may have caused unnecessary death and disability.
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| With the advent of the national standard
training curriculum of Emergency Medical Technicians (developed
by the National Highway Traffic Safety Administration), emergency
medical services in Montana was "born". The Department
of Health and Environmental Sciences was established by statute
as the lead agency for EMS development in Montana. The Board
of Medical Examiners was charged with the licensing and testing
of Emergency Medical Technicians ... a task they delegated to
the Department of Health and Environmental Sciences. Recognizing
the importance of maintaining consistency with national standards,
the National Registry of Emergency Medical Technicians was chosen
as the method of assuring provider competency. |
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With federal funding the
Department of Health, Education and Welfare, emphasis was placed
on emergency medical services system development. No longer was
EMS just a bunch of ambulances and ambulance attendants: there
was an organized system involving dispatch, ambulances, hospitals,
medical direction, data collection and numerous other components.
In Montana, regional emergency medical
services systems were established with federal funding only
to disband with the termination of the federal funding in the
mid-1980s. |
| However, EMT-Basic programs proliferated
and, for the first time, advanced level Emergency Medical Technicians
were licensed at the EMT- Intermediate and EMT-Paramedic levels.
Creation of the EMT-Defibrillation recognized the importance
of early defibrillation in reversing cardiac arrest from ventricular
fibrillation. |
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Medical direction for
emergency medical services became increasingly important; however,
in rural Montana, medical direction was still difficult to obtain.
Statewide prehospital treatment protocols were developed and
approved by the Board of Medical Examiners. |
| Fixed wing and rotor-wing air ambulance
services, usually based at hospitals in the larger cities, performed
an increasingly important role in scene response and, particularly
in interfacility transfers. |
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The Montana legislature
adopted several landmark statutes in Montana EMS development
including a statewide program for recognizing Do Not Resuscitate
orders for terminally ill and seriously ill patient. Called Comfort
One, this model has now gained national notoriety. |
| Initially, obtaining volunteers to
provide emergency medical services was quite easy. However, toward
the end of the period, volunteerism declined significantly. Changes
in the economy combined with both persons in a household working,
has continued to provide a strain on an emergency medical services
system which is heavily reliant on volunteers.
The decline of federal EMS categorical
grant funding caused a significant reduction in statewide support
for the emergency medical services system. Although the categorical
funding was "rolled"
into the federal Preventive Health and Health Services Block
grant funding, the amount of funding allocated to EMS continued
to decline. |
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The Rural Preventable
Mortality Study, conducted by the Critical Illness and Trauma
Foundation, demonstrated the absence of a trauma system was resulting
in preventable trauma-related deaths.
With the assistance of federal funding support for trauma
system development, considerable emphasis was placed on developing
a statewide trauma care system. With this funding support,
a state trauma system plan was approved in 1994. Federal funding
for the trauma program was precipitously dropped in 1994 thus
delaying trauma system implementation. In 1995, comprehensive
trauma system legislation was adopted by the Montana legislature,
but no funding was provided for system implementation. |
| Trauma system implementation was continued.
In an incredible volunteer effort, Regional Trauma Advisory Committees
were formed and the State Trauma Care Committee continued to
operate. Despite the absence of funding, considerable progress
was made in developing a statewide trauma care system. A federal
grant from Centers for Disease Control and Prevention re-invigorated
the trauma system development effort and allowed the hiring of
a state trauma system coordinator. |
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Initially with Highway
Traffic Safety support, and subsequently with other federal support,
the Montana Trauma Register, collecting information on seriously
injured trauma patients from medical facilities, was initiated.
Despite an increase in trauma system funding, the non-federal
funding for overall EMS system support continued to decline. |
| With an Emergency Medical Services
for Children grant, and in a cooperative effort with a grant
obtained by the Critical Illness and Trauma Foundation, computers
were placed in nearly every ambulance service in the state. These
computers, with a link to Burns Telecommunications Center at
Montana State University, are used for data collection and EMS
education. |
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Recognizing
the importance of prevention, the EMS Section (now in the Department
of Public Health and Human Services) was changed to the EMS and
Trauma Systems Section. With funding from the EMS for Children
grant, an Injury Prevention Coordinator was hired and a state
Injury Prevention and Control Plan produced. The Injury Prevention
Program is being integrated with the state trauma care system. |
| In 1999, the Montana legislature passed
legislation authorizing an Automated External Defibrillation
Program in Montana thus further providing early defibrillation
for patients sustaining a cardiac arrest due to ventricular fibrillation. |
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Also in 1999,
the Montana legislature authorized funding to support trauma
system development. These funds will help hire a trauma system
coordinator and to more consistently support system development
activities better than federal funding which only exists for
short periods. |
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