In the 1970s, Congress enacted the Emergency Medical Services Systems Act of 1973 to authorize the Department of Health, Education, and Welfare to provide funding for planning and development of EMS systems throughout the United States. The act identified 15 specific components of EMS systems including manpower, training, communications, and data collection and led to the development of more than 300 regional EMS systems across the United States, both extending emergency care to the community and delivering higher-acuity patients to the emergency department.

In 1996, NHTSA brought the various participants in EMS together to create a common vision, The EMS Agenda for the Future, which helped modernize EMS and better integrate it with today’s complex health systems. That vision is currently being revised toward 2050, building upon the remarkable progress of the last few decades.

All of these have collectively placed a greater focus on emergency response and care and became a tipping point for emergency medicine, which began to grow as a specialty in response to needs of the increasingly complex patients arriving to emergency departments.

EMTALA, ACA, and Beyond

Congress inserted the Emergency Medical Treatment and Active Labor Act (EMTALA) into a budget bill in 1986 in response to national media focus on stories of unstabilized insured patients, including inpatients, being sent from private hospitals to public hospitals after a “billfold” biopsy. It was signed into law by President Ronald Reagan in 1987 and placed obligations on all hospitals to medically screen patients to determine if an emergency medical condition exists prior to inquiring about payment or insurance, provide care until stabilized for those with an emergency medical condition, and, if a transfer is required, to make it within the provisions of EMTALA. EMTALA has had many changes over the years, and its effects, both good and bad, are significant. It continues to be a major force in the provision of emergency care and establishing emergency departments and emergency physicians as the safety net for the United States.

The Patient Protection and Affordable Care Act (ACA), in response to a growing number of Americans who were uninsured because of low income or rising costs of insurance, passed in 2010 and was signed by President Barack Obama. It reinforced emergency care as an essential health benefit and expanded health insurance coverage for millions of Americans, either through private insurance or Medicaid expansion by states that chose to do so. Mired in politics and the challenges of change, its lasting effects will continue to play out. Increased coverage has not translated to increased access to care and already stressed emergency departments have seen volumes rise.