Paramedic - History of Paramedics - Pre-hospital Emergency Care

Pre-hospital Emergency Care

By the early 1960s experiments in improving care had begun in some civilian centres. One early experiment involved the provision of pre-hospital cardiac care by physicians in Belfast, Northern Ireland, in 1966. This was repeated in Toronto, Canada in 1968 using a single ambulance called Cardiac One, which was staffed by a regular ambulance crew, along with a hospital intern to perform the advanced procedures. While both of these experiments had certain levels of success, the technology had not yet reached a sufficiently advanced level to be fully effective; for example, the Toronto portable defibrillator and heart monitor was powered by lead-acid car batteries, and weighed around 45 kilograms (99 lb).

In 1966 a report called Accidental Death and Disability: The Neglected Disease of Modern Society—commonly known as The White Paper—was published in the United States. This paper presented data showing that soldiers who were seriously wounded on the battlefields during the Vietnam War had a better survival rate than individuals who were seriously injured in motor vehicle accidents on California's freeways. Key factors allowing the victim to survive the journey to definitive care such as a hospital were stated to be comprehensive trauma care, rapid transport to designated trauma facilities, and the presence of medical corpsman who were trained to perform certain critical advanced medical procedures such as fluid replacement and airway management.

As a result of the The White Paper the Federal government moved to develop minimum standards for ambulance attendant training, ambulance equipment and vehicle design. These new standards were incorporated into Federal Highway Safety legislation and the state were advised to either adopt these standards into state laws or risk a reduction in Federal highway safety fundings. The "White Paper" also prompted the inception of a number of emergency medical service (EMS) pilot units across the US including paramedic programs. The success of these units led to a rapid transition to make them fully operational, with the first paramedic program being in Miami, Florida.

New York City's Saint Vincent's Hospital developed America's first Mobile Coronary Care Unit (MCCU) under the medical direction of William Grace, MD and was based on Dr. Frank Pantridge's Belfast, Northern Ireland MCCU project. In 1967 Eugene Nagle, MD and Jim Hirschmann, MD helped pioneer America's first EKG telemetry transmission to a hospital and then in 1968, a functional paramedic program in conjunction with the City of Miami Fire Department. In 1969. the City of Columbus Fire Services joined together with the Ohio State University Medical Center and developed the "HEARTMOBILE" paramedic program under the medical direction of James Warren, MD and Richard Lewis, MD. In 1969. the Haywood County (NC) Volunteer Rescue Squad developed a paramedic program under the medical direction of Ralph Fleicher, MD. In 1969, the initial Los Angeles paramedic training program was instituted in conjunction with Harbor General Hospital under the medical direction of Michael Criley, MD and James Lewis, MD. In 1969, the Seattle "Medic 1" paramedic program was developed in conjunction with the Harborview Medical Center under the medical direction of Leonard, Cobb. The Marietta (GA) initial paramedic project was instituted in the Fall of 1970 in conjunction with Kennestone Hospital and Metro Ambulance Service, Inc. under the medical direction of Luther Fortson, MD. The Los Angeles county and city established paramedic programs following the passage of The Wedworth-Townsend Act in 1970. This was followed by other cities and states passing their own paramedic bills, leading to the formation of services across the US. Many other countries also followed suit, with paramedic units quickly being formed around the world.

In the military, however, the required telemetry and miniaturization technologies were more advanced, particularly due to initiatives such as the space program, but it would take several more years before these technologies drifted through to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such initiatives were implemented, and sometimes still operate, in European countries and Latin America.