HISTORY OF THE STAR OF
LIFE
In 1966, many baby boomers were either
going to war in Viet Nam or going away to college.
When people spoke of surfing, it meant
something having to do with big
waves at the shore, not computers and the Internet. Lyndon Johnson and his Great Society were “happening,”
and, Emergency Medical Services (EMS) was in its infancy
in the United States. The Star of Life is now an easily recognized
symbol of EMS.
It is seen on the sides of ambulances, on signs directing
people to emergency rooms, and on paramedic patches.
However, many people, including
many EMS people, don’t know the meaning and history of the
Star of Life.
On the South Carolina EMS website
it was noted that before 1966, it was common for patients
to be transported to the hospital in vehicles
operated by funeral homes, and few hospitals had doctors
trained in emergency medicine (1).
In the late ‘60’s, a study by the National Academy
of Sciences was published called Accidental Death and
Disability: The Neglected Disease of Modern Society.
Dr. Ricardo Martinez, Administrator
of the National Highway Traffic Safety Administration (NHTSA)
stated in a commemorative edition of this Study: “This paper,
known as the
‘White Paper’ revolutionized the way we view and manage
injured patients in the United States” (inside cover). The
paper studied auto accidents
and the injuries they cause; however, it also studied the
“system,” or lack of an emergency medical care system, that
was in place at the time.
It documented many deficiencies in emergency care.
In NHTSA Leading The Way, the White Paper
is cited and NHTSA states that many
recommendations were made to improve medical response to
injuries. It was time to make a change in America and develop
a true emergency
medical care system (6).
Carl Post, in his book
Omaha Orange – A Popular History of EMS in America,
explains how NHTSA, under the Department of Transportation,
was tasked with overseeing a program that authorized planning
for ambulances and equipment to go in them, after Public
Law 89-56 was passed in
1966 (69).
Under the Department of Transportation,
Emergency Medical Technician (EMT) standards were perfected,
paramedic standards were
developed, and vehicles were purchased for EMTs and paramedics
to use when responding to calls (80). To easily recognize these emergency
care individuals and vehicles, a symbol needed to be designed.
It would become known as the “Star of Life.”
Arline Zatz wrote about the history
of the Star of Life in an article for the July-August 1992
Rescue-EMS Magazine.
In the article she indicated
that at first, EMS used a red cross with four bars, which
is a trademark of the American Red Cross (ARC) and the International
Red Cross (ICRC).
EMS organizations in the late ‘60’s and early ‘70’s
used it or an orange version called Omaha Orange (1).
Paramedic Mitch Mendler, on the risherambulance
web site, indicated that the ARC did not like EMS using
the cross and the ARC stated it
was a violation of an international treaty, backed up by
federal law. The treaty and law states that the red cross
in any form cannot be used by
anyone not connected with the ICRC. Johnson & Johnson is the only corporation
that can do this because it was grand fathered under the
federal law. (3).
Because the Red Cross symbol could
not be used, Leo R. Schwartz, then Chief of the EMS Branch,
NHTSA, took the red Medical Identification
Symbol (Medic Alert) of the American Medical Association,
changed it to blue, and placed it on a white square (Zatz
1). This new Star of Life had six
bars with a serpent entwined around a staff in the middle. It was registered as a certification mark on February 1, 1977
with the Commissioner of
Patents and Trade Marks. The trademark remained in effect for twenty years (Post 81).
In an e-mail discussion, Howard Paul talked about
whether
a federal agency can obtain copyright protection on things
they develop (1). There
has been a lot of controversy over the years about whether
anyone could use the Star of Life without DOT permission.
However, with or without that protection, this star
with the serpent and staff in the
middle has become the symbol of emergency medical services.
On a website by the Irish Emergency
Ambulance Resources (http//ambulance. eire.org), there is
a history of the Staff of Aesculapius.
The
snake and staff in the center of the symbol portray the
staff of Aesculapius who, according to Greek mythology,
was the son of Apollo and the mortal
maiden Coronis. Apollo
was told to instruct his son in the ways of medicine and
healing. Aesculapius became an excellent healer of
the sick – too
excellent. Zeus,
the God of Gods, felt that Aesculapius’ powers were beyond
the powers of mortal men and killed him where he stood with
a bolt of
lightning (1).
After Aesculapius death, he was worshipped
and thought to be a God of healing. People would sleep in his temples. He would appear to them
in their dreams offering cures and remedies. Drawings of Aesculapius usually show him
in a standing position, dressed in a long cloak, holding
a
staff with a serpent coiled around it (1).
Another reason for using the serpent
and staff may come from the Bible, in Numbers 21:8 and 9
(Zatz 2). It makes
reference to a serpent on a
staff.And
the Lord said unto Moses, Make thee a fiery serpent, and
set it upon a pole: and it shall come to pass, that every
one that is
bitten, when he looketh upon it, shall live.
And Moses made a serpent of brass, and put it upon
a pole, and it came to pass, that if a
serpent had bitten any man, when he beheld the serpent of
brass, he lived. (Bible 196).
The six bars of the Star of Life
represent six distinct phases of an EMS response – detection,
reporting, response, on scene care, care in
transit,
and transfer to definitive care (Zatz 3).
On the Complient EMS Education website, each phase
is discussed (2,3). These phases are considered
critical
to producing a good outcome for the patient.
The phases are:
- Detection: Citizens must first recognize
that an emergency exists and must know how to contact
the EMS system in their
community. This
can be by several different methods such as dialing 9-1-1,
using a seven digit local emergency number, or
using amateur radios, or highway call boxes.
2.
Reporting: Callers are asked specific information so
that the proper resources can respond.
In an ideal system,
certified
Emergency Medical Dispatchers (EMDs) ask a pre-defined set
of questions. If
someone were having a heart attack, then they
would look under the heart attack algorithm for appropriate
questions to ask and also give appropriate pre-arrival instructions
(such as CPR). In this phase, dispatchers also become
a link between the scene and the responding units and can
provide
additional information as it becomes available.
3.
Response: This is the response of the EMS resources
to the scene. This
may be a tiered response with First
Responder s and EMTs responding initially and backed up
by paramedics shortly thereafter (EMS…A System To Save
Lives, 2).
It may mean that a fire engine and crew are also dispatched
to help with lifting and moving the patient or getting them
out of a
smashed automobile.
- On Scene Care: A lot of types
of care can be provided on the scene, versus waiting until
the patient arrives at the hospital.
Standing orders and radio or cellular contact with the
emergency physician has broadened the range of on-scene
care that can be
provided. A long algorithm of procedures and drugs
may be used before the patient is removed from the scene. When the EMS
system was just getting started, all patients were transported
to a hospital. Today, in certain instances such as
cardiac arrest, or
when a patient is not seriously ill or injured, not all
patients are transported from the scene to a hospital.
5.
Care in Transit: As stated earlier, patients
were once transported in hearses or station wagons, with
nobody taking
care of them in the back.
With the advent of federal regulations and the maturing
of EMS, specially designed trucks now carry
mobile oxygen, suction, patient monitoring and communications
equipment, as well as special drugs for emergency care of
patients (EMS…A System To Save Lives , 2).
Station wagons and hearses have been replaced with
huge 15,000-pound trucks
that our EMS personnel call “monster medics.”
- Transfer to Definitive Care: Up until the passage of the Trauma Care Systems Planning and Development
Act of 1990, a patient
might be seen in the emergency room (ER) by a physician
trained in a certain kind of specialty, such as a cardiologist
or a surgeon
(NHTSA Leading The Way, 7). They usually did not have the training
necessary to address the many types of injuries and illnesses
that present themselves in an ER.
Today, there are board certified emergency medical
care physicians waiting to help patients.
Nurses now receive certification in emergency care and
specialized training in trauma.
Hospitals may hold special levels of
designation in trauma care.
This means they have additional specific equipment,
rooms and physicians available for the most
traumatically injured patients (NHTSA Leading the Way,
12). There are
specialized burn centers to handle burn patients and special
children’s hospitals that handle only pediatric patients.
Definitive care has come a long way, as has EMS,
in a relatively short time.
According
to Paramedic Mitch Mendler, originally, the Star of Life
was supposed to be something different for the different
types of EMS
personnel. For administrative and dispatch personnel,
the Star of Life was to have a silver colored edge and the
staff of Aesculapius, a
silver colored serpent.
For EMT's and Paramedic’s patches, the edge was supposed
to be gold in color with a gold serpent (4).
Jeffrey Linzer indicated in an e-mail message that there
is also a version that is supposed to be used to identify
receiving facilities,
such as hospitals or emergent care facilities [a white star
on a blue background] (1).
EMS is a system and the Star of Life represents that system. The system has grown immensely over the past
thirty years and will
be changing and evolving rapidly in the 21st
century. The Ohio
state website, Division of EMS, discusses how the EMS system
depends
on many different elements to make it one of the best in
the world (1). It depends on an informed public being able
to recognize when to
call for emergency help, the availability of specially trained
people and equipment, and a network of specialized trauma
centers (1).
The Star of Life symbolizes these elements and, hopefully,
once people understand the meaning of the Star, they will
understand what
actually makes up the EMS system.
By: Melinda
Duncan, Executive Director
Northern Virginia EMS Council
Works Cited
Compliment EMS Education and the American College
of Emergency Physicians. “
EMS – A System To Save Lives.” 21 January 2000.
Complient National Website: teammeei.com. 2 August 2000.
<http://www.teameei.com.staroflife.htm>.
“Emergency Medical Services.” What
EMS Is and How It Began. state.oh.us. 31
July 2000. Access date.
<http://www.state.oh.us/odps/division/ems/data/cat7/emswhat.html>.
“History Index.” The Staff of
Aesculapius. ambulance.ie.eu.org. 13 August 2000. <http://ambulance.eire.org/index1.html>.
Linzer, Jeffrey F. “Re: Star of Life.” e-mail to JosephM408@aol.com.
13 April 1995. Infomatics.famed.sunsb.edu. 2 August 2000.
<http://www.infomatics.emed.sunsb.edu/ emed/paramedic/archives/1995/0183.html>.
Mendler, Mitch. History of the Star of Life.” Emergency
S
ervices Inc. 1977. risherambulance.com. 2 August
2000. <http://risherambulance.com/www.star.html>.
National Academy of Sciences, National Research Council.
Accidental Death & Disability: The Neglected Disease
of Modern Society.
Washington, D.C., 1996.
“Old Testament, Numbers, Chapter 21:8 and 9.” The
Holy Bible. Chicago, New York, St. Louis: Presbyterian
Board of Publication, 1899.
Paul, Howard. “Re: Star of Life.” e-mail to JosephM408@aol.com
11 April 1995. infomatics.famed.sunysyb.edu. 2 August 2000.
<http:www.infomatics.famed.sunsyb.edu/ emed/paramedic/archives/1995/0175.html>.
Post, Carl J., PhD, EMT. Omaha Orange, A Popular
History of EMS In America. Boston: Jones & Bartlett,
1992.
United States. Department of Transportation. National
Highway Traffic Safety Administration, EMS Division. NHTSA
Leading the Way.
Washington, D.C., 1995.
Zatz, Arline. “The Blue ‘Star of Life’ – The Emergency
Medical Care Symbol.” Rescue-EMS Magazine July-August
1992. portage.net. 2
August 2000. <http://www.2.portage.net/~agumieny/star.html>.
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