MCC Paramedic Program
THE HISTORY OF PARAMEDICS
by Peter Bonadonna
- Man helping man.
- Since the dawn of time man has lived in groups.
- They have worked, hunted together, and aided the group.
- Earliest recorded "ambulance" 900 A.D.
- Ambulance Heritage goes back further than Police or Fire Depts!
- All societies have had a "medical" authority.
- In ancient times one individual had special powers.
- The famous Voo Doo witch doctor is a more recent example.
- Wars are responsible for much of our trauma education.
- 1700s "Ambulance Volantes" developed by Napoleon to carry
wounded to the rear.
- 1861: American Civil War
- By the end of this war, the injury pattern changed
drastically due to the creation of rapid fire guns.
Prior to this, single shot, bayonet, and clubbing
injuries were most prevalent.
- 1900: The lifeless body of a young girl was pulled from
the River Seine in Paris, France. There was no evidence
of violence and it was assumed that she had taken her own
life. Since her identity could not be established, a
death mask was made, as was customary in such a case. Several romantic stories based on this mystery were published.
According to one, her death was the result of an unrequited
romance. This legend became popular throughout Europe, as did
reproductions of her death mask. She was known as the Girl
from the River Seine.
- 1917 WWI
- New forms of warfare led to new injury patterns
- Evacuation for wounded was typically 18 hours.
- Decreased evacuation time tended to decrease morbidity
- Splinting of closed femur Fx decreased mortality from 80 to 20%
- 1939 WWII
- Better Medical Care - First organized effort
- Beginning of first real aeromedical transport
- 1954 Korea - Wide spread use of the helicopter
- 1963 Vietnam
- Field medics (Corpsman) parachute in
- Rapid evacuation by helicopter
- Field hospitals with ORs
- Massive amounts of research
- Describe how man's creations allowed him to aid the ill.
- Bandages, stethoscope, thermometer, ASA, etc.
- Man carry, horse and buggy / first medical transport.
- The first phone call was used to summon help
for an acid burn "Watson come here!"
- One of the earliest emergency radio transmissions was used to
report a large sea liner sinking. "Save Our Souls" (SOS).
- In 1929, Dr. Lieb president of Consolidated Edison in New
York, was looking for ways to deal with the rising number
of deaths of his employees due to electrocution. His
Electrical Company paid for much of the research on
what is now known as external defibrillation.
- In 1947, Beck reported the first successful case of AC
defib in a human. A 14 year old female arrested during thoracic
surgery. Common household current (110 VAC) was applied
directly to her heart using a stripped lamp cord.
- In the 1950s "Modern Medicine" had established itself in
the western world.
- Drs & RNs gave the bulk of medical care.
- Nurses required an MD's order to take a temperature.
- Nurses could be fired for questioning physicians.
- An ambubag could only be used by a physician.
- CPR was only used in a few hospitals experimentally.
- There were no defibrillators in hospitals.
(only in a few investigational centers)
- If your heart stopped you were pronounced dead.
- Ambulances were fast taxi rides, often without
bandages or oxygen. The drivers often lost more
lives than they saved from ambulance accidents.
- In the mid 50's scientists began to appreciate the anti-
arrhythmic properties of Lidocaine.
- Scientists learned that if a man having chest pain
received a dose of Lidocaine, there was a decreased
risk of sudden death.
- A few aggressive, progressive Drs advocated teaching
ambulance drivers how to give Lidocaine. The medical
establishment would not hear of such a thing.
Only a physician could give IV injections at the time.
- The Korean War (1953) was the perfect proving ground
for specially trained medics to render physician-type
care. Helicopters were widely used as ambulances.
- In 1957, the first successful use of the Hopkins External
AC Defibrillator was demonstrated on a human. External
pacing was introduced but had many draw backs.
- 1958: Asmund S. Laerdal of Stavanger, Norway, a doll and
toy maker by trade, began work on a life-like manikin for
training people on mouth to mouth resuscitation. Inspired
by the mask of the young girl who died so young, he
commissioned the well-known sculptress Emma Mathiassen to
model a manikin face in her likeness. Thus, the spirit of
the Girl from the River Seine again came to life as
Resusci Anne in 1960.
- In the late 50s NASA had developed a method of watching
each astronaut's EKG through radio transmissions. This was
a technique called EKG Biotelemetry. This breakthrough started
people thinking about ambulance applications.
- More scientists and Drs realized the importance of
early Lidocaine therapy in the field. They knew that
EKG modulation or "EKG Telemetry" might be the key to
convincing the medical establishment. If MDs could
oversee and direct the use of Lidocaine then maybe they
would come around to the idea.
- 1959: External Defibrillators (AC) were proven to be
effective in the treatment of VFib. The units were
100 lbs and often perched on an unstable cart. It was
not uncommon to round a corner and have it tip over,
hence the name "Crash Cart." Besides its heavy weight,
another draw back was the wall power requirement.
- 1959: Moscow, Russia, some Physicians moved out of the
hospital and into an ambulance to see if they could
impact patient care. This was the first M.C.C.U. on
record. Dr. Pantridge had his people out in the streets
of Belfast shortly thereafter.
- The Russian project proved that ALS techniques made a
significant difference in the outcome of patients.
- The Russian Drs also studied the use of a "doctor
of felture" (a Physicians Assistant or Paramedic) in
the ambulance rather than a MD.
- The Russian and Belfast Investigators found that if
the assistants were well trained, there was the same
favorable outcome for the patients.
- In 1959 Mine Safety Appliance Co. insisted on the
need for a portable defibrillator to be used in the
mines. Electrocution was common because the mine cars
were powered by electricity.
- In 1965 CPR became widely used in hospitals and by
ambulance crews. American Drs wanted to improve the field
management of patients. Unfortunately, there were no laws
that allowed non-physicians to administer advanced care. Even though a few Paramedics were already trained, they could
not practice. The newly trained Paramedics often referred
to themselves as the "Impotent Wonders" out of frustration.
- A daring California Governor realized the importance
of such a program and took the bull by the horns. He enacted laws that would allow Physician Delegates
to act for the Physician. The governor's name . . . Ronald Reagan.
- Shortly thereafter other states enacted similar laws.
- DC shock was found to be as effective but had fewer
side effects on the heart. Several companies developed
portable, battery operated defibrillators. These
portable models weighed in at 80 lbs.
- In 1966 Dr. Nagel worked to refine portable radio telemetry.
- The development of portable telemetry was difficult
due to the RF that interfered with the EKG as well
as the modulator.
- Many inventors began to shield EKG cases and wires.
- Paramedics were being trained by Physicians, often
using large mongrel dogs as the "patient."
- 1966: The White Papers, a major study, showed
the inadequacies of field and ED care.
- 1968: Motorola developed the APCOR. It was used
without a monitor and the Paramedics sent a continuous
EKG so the Physician could watch the EKG.
- 1968: ATT designates 911 as national emergency access number
- 1968: Founding of ACEP. Established standards for EDs & EMS
- 1970: Physio-Control developed the Lifepak 4.
Other vendors created similar mon/defibs.
Although these DC defibrillators were smaller
than the hospital units they still weighed in at
approx. 40-60 lbs.
- In the early 70s radio frequency space became a premium.
- Paramedics were given the responsibility to read
and monitor EKGs so that continuous radio transmission
could be stopped.
- In 1971, by a stroke of luck, the Paramedic Program
had a multi-million dollar publicity vehicle for over
five years. That stroke of luck was the TV series
- In 1975, Physio-Control released the Lifepak R5, a
full feature monitor/defibrillator at 18 lbs!
- In the 1980s, paramedic programs improved and spread to most
large cities. The training technology also improved:
- Patient simulators, arrhythmia generators, video tape,
and computers aided the new Paramedic Student.
- External pacing came back into vogue, with many
- Automatic & Semiautomatic Defibrillators are developed.
- Intraosseous (in the bone) injections came back into vogue
- Thrombolytic therapy proved successful in Emergency
Departments for MI cases.
- In the 1990s . . .
- Pulse Oximetry and Capnometry
- Paramedics are trained to read 12 leads and the new
field cardiac monitors are 12 lead capable.
- Several EMS systems are conducting trials to determine
if thrombolytic therapy will aid the prehospital patient.
- Computers are used routinely in dispatch, and on board
the ambulance for patient care and documentation.
- Better EMT and Paramedic Education
- Better Physician involvement
- Better prehospital research
- Increasing Scope of Practice and Responsibilities
- Pronouncement in the field
- The next Century . . .