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A Career in Public Safety Service as a paramedic
Is there any wonder most cities are short on ambulances, police cars and fire engines. The reason is simple. The majority of voters are cheap and feel fire protection and public safety is an entitlement, having failed to properly understand the risks and costs associated with living in a world where hazzards exist and illness and disease causes failed health.
It's time for citizens to look into the mirror and ask themselves, What value do I place on knowing a firefighter or paramedic or police officer will arrive in time when a family member is having a heart attack or our home is on fire or they are in harms way? Maintaining a adequate fire department and police department is a social contract that demands community involvement and strong financial support from the public. It can not be evaluated by private sector standards such as whether or not it creates wealth or is it competitive. These measures are irrelevant when determining the true value of public service, or any job for that matter.
The total value of an individual's life work is not limited to the cash he or she brings home or the profit created for his or her employer, but the contribution made to society. Unfortunately, based on the lack of support citizens give for public service jobs, sacrificing future wealth in order to help others is becoming an endangered virtue in our cities.
Although many see the private sector as more efficient economically, endeavors concerned with return on capital typically fail to attract the type of people willing to risk their lives for others. If a fire department or police department based its performance goals on monetary return for service, it would not engender much confidence.
There is no substitute for the dedication of individuals who have chosen a career to serve the public good. After many years of service, a battalion chief in the Fire-Rescue Department makes about $95,000 a year, working on-duty about 240 hours per month. When compared with an equal management position in the private sector, this is a bargain. But unlike private sector employees, professional firefighters and paramedics maintain a standard of readiness 24 hours a day, every day.
What can a professional firefighter or paramedic actually do off-duty when there is a continual expectation that he or she will be ready and able to respond to a mandatory call-back order at any time? Certainly not enjoy the freedom to drink an extra glass of beer with friends or swim at the beach with the kids like the rest of us can do without hesitation.
When on duty, there is no time for coffee breaks or meals. They take them when we can get them. It is very common to have a meal interupted by an alarm or a request for service. Likewise, if they sleep all nite they feel lucky. But the real lucky peolpe are the peolpe we serve. They were not awaken either.
Nor can he or she promise to be home for Christmas, Thanks Giving, Easter, Halloween, birthdays, school graduations or soccer games. How much is that kind of uncertainty worth on a paycheck? What value do we place on the possibility of having one's name etched on a firefighter memorial?
It would be helpful for both our community and the success of your region's overall fire preparedness if some of the Fire-Rescue Department's critics and police departmet skeptics would take the time to discover the details of the job. Maybe they can do a ride-a-long or at least visit the fire station or polcie station and learn what is needed and expected of these professionals. They would realize, as I have, that firefighting personnel, paramedics and police officers are worth a lot more than we are paying them.
As public servants, firefighters, paramedics and polcie officers offer an invaluable service, and their compensation needs to reflect that fact. Serving the public good can not be evaluated by an expense sheet. Unfortunately, most citizens don't understand this.
Exerps by Richard W. Halsey California Chaparral Field Institute
I have been stereotyped by the television shows as a hero; a miracle
worker; an angel or cherub, an "ambulance driver" (that phrase hasn't been used
in years, at least formally at the Department of Transportation, and the
Department of Motor Vehicles). Sometimes I am called a "doctor" and, associated
with many other misconceptions. Some emergency personnel (and it has been
depicted on television) refer to me as "The Paragod." I find that
Actually, I believe that the average citizen doesn't even have the basic idea of what I do or what my "job description" is...
Per the Webster's Ninth New Collegiate Dictionary®;
para-med-ic \'par-e-,med-ik\ also par-amed-i-cal \-i-kel\ n (1967) : one who works in a health field in an auxiliary capacity to a physician (as by giving injections and taking x-rays)
In specific terms; a paramedic is defined as a person with an explicit body of knowledge and a set of skills.
In general terms; a paramedic is a "Health Care Professional!"
to sum it up:
A paramedic is an individual having special, well defined skills and knowledge in emergency medicine; one who is concerned for the health and well being of others and who exercises in his or her daily work painstaking attention to all assigned tasks in order to promote the well being of others.
I am a professional, a care giver, a "lifesaver," a clinician, a technician, a diagnostician, a pseudo-lab tech, a pseudo-cardiologist, a pseudo psychiatrist, a politician and diplomat, and a public servant. I am sometimes arrogant, egotistical, and pompous! I walk tall. I am proud of myself and my profession. Nobody understands me unless they are also a paramedic. Some think I am morbid or weird? Some think my job is gory and always ends in a bad way. I don't "scrape people off the street." Actually, most of the responses end in a positive...
Most of the doctors, nurses, firefighters and police officers appreciate and respect me. I've seen horrible things and I've seen beautiful things. I have been confronted with very emotional circumstances under stress. Sometimes I have nightmares and I frequently dream of responses; usually fictionary. In my dreams I sometimes lose equipment or can't find an address or a street. I've brought new life to this earth and I have resuscitated many more. I've watched many people straggle to breathe and take their last breath. I might have been the last image that they glanced at on this earth. I've seen children die. I watch families grieve. I've had partners cry. I've seen nurses emotionally overwhelmed. I watch people suffer. I've pulled people out of the self inflicted, ill-fated, deadly demise of Heroin Overdoses. I've been in dangerous or hazardous situations. I go into neighborhoods that most people never go near in the daylight let alone at night. Sometimes, "I get no respect!!!" People bleed on me, vomit on me, spit on me, curse at me, strike and assault me. I've been stuck by needles. My partner had a urinal tossed on him, the patient had H.I.V. I have even been shot at... And, sometimes patients die in front of me. I try to prevent that from occurring of course, and patients are "brought back to life daily."
Obviously our jobs can be stressful. E.M.S. and other public safety personnel experience the same traumatic stress that service men and women experienced in Vietnam. The stress associated with pediatric trauma patients and pediatric mortality is much more amplified. This stress is complicated and multiplied over time when not releived by the appropriate measures. This stress take its toll on us and our families.
Despite all the negatives, I love my job and look forward to going to work in the morning. It can be a pure adrenaline rush at times...
My paramedic preceptor used this as an analogy for our interventions!
Another partner, an instructor/educator, simply explains it like this:
"We make sure the blood go round and round,
And, the air go in and out..."
My new partner puts it this way:
"You knew the job was dangerous before you took it!!!"
|"Courage is not the absence of fear,
but the mastery of it."
I have to think quick and make life and death decisions rapidly when someone's life is dangling in the balance of time. I usually look calm on the surface, but I am consistently planning, plotting and strategiesing. I am resourceful, creative and innovative. I am exposed to terminal diseases and life threatening hazards. I am rarely thanked and always taken for granted. I don't get a full nights sleep and always get called out during dinner. When I do eat, it is fast. I work bizarre hours and my family suffers. I sometimes do 3 to 4 tasks at the same time like driving, talking on the radio, reading a map and listening to my partner all at once. I am multi-talented and ambidextrious. I can be instinctive. I am underpaid and overworked. I have 9 minutes and 59 seconds to get to your side from the time the address is verified via the 9-1-1 dispatchers. I am out the door (out of chute time) and responding in the ambulance in less than 2 minutes from the time of dispatch at any time of the day or night! We have 12 minutes to clear and become available when off-loading at the hospital. This includes a "turn-over" report, a "written report" and cleaning the ambulance (including blood and...). My job is challenging, exciting and rewarding. It is also demanding and can be very stressful. I've learned a lot about myself and life on this job.
My office is "the streets." The conditions are "always
less than perfect." You are my patient. I am your servant.
Regardless of your sex, race, color or creed: Regardless of your financial status. I am always here, waiting 24 hours a day to unselfishly preform my duties...
A paramedic's reflection
The Ten Commandments of Patient Care
The basic time line and requirements to train for a career as a paramedic.
In light of all of the above and that fact that most of my friends and family do not have a clear and concise understanding or perspective of my job, I am going to make an attempt to explain it here .
The word "Paramedic" has come to mean many things over the thirty-year history of the program. "Para" comes form the Greek word meaning around, or next to, and the word "Medic", is slang meaning doctor. Titles range from "Cardiac EMT" to "Physicians Trained Mobile Intensive Care Paramedic". The two federal agencies that provided funding for these programs, the U.S. Department of Health, Education and Welfare, and the U.S. Department of Transportation, opted for the term "Paramedic".
The show "EMERGENCY!" has done a lot for the careers and desires of the paramedics in the field. The show generated interests within the community to spawn a mobile-based care unit, as well as peaking the desire of many young people to become paramedics themselves. Who would have guessed that the humble beginnings of the Mobile Intensive Care Unit would evolve to one of today's most recognized emergency based services, and one that is used most routinely by millions of people. Emergency Medical Service is celebrating its 30th Anniversary.
The San Diego Paramedics would like to honor all the men and women throughout the United States who have made the evolution to today's high standard of quality care. The impact the T.V. show and the paramedic programs have had on emergency medicine throughout the country is enormous. The many lives that have been saved are a testimonial to emergency medicine today. It is a positive legacy of this nation's history.
Few people realize that modern emergency
medical service has only been around for the past 70 years. This is the
timeline of EMS from the very beginning when mankind started to provide managed
pre-hospital care and its progression through the years.
Chronological time line:
1865 - America's first ambulance service is instituted by the U.S. Army.
1869 - America's first city ambulance service (utilizing horse drawn carriages) is instituted in NewYork City by Bellevue Hospital.
1870 - Prussian siege of Paris used hot air balloons to transported wounded soldiers. This was the first documented case of aeromedical transportation.
1899 - Michael Reese Hospital in Chicago began to operate an automobile ambulance which was capable of speeds up to 16 mph.
1910 - First known air ambulance aircraft was built in North Carolina and tested in Florida. The aircraft failed after flying only 400 yards and crashing.
1926 - Phoenix Fire Department begins "inhalator" calls.
1928 - Julien Stanley Wise implemented the first rescue squad (Roanoke Life Saving Crew) in the nation in Roanoke, VA.
1940's - Prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations. City governments in many cases turned ambulance service over to the police or fire department. No laws required minimal training for ambulance personnel and no training programs existed beyond basic first aid existed. In many fire departments, assignment to ambulance duty became an unofficial form of punishment.
1951 - Helicopters began to be used for medical evacuations during the Korea war.
1956 - Dr. Elan & Dr. Safar developed mouth-to-mouth resuscitation.
1959 - Researchers at John's Hopkins Hospital in Baltimore, MD developed the first portable defibrillator as well as perfected CPR.
1960 - Martin McMahon experimented with various types of artificial respiration by paralyzing Baltimore City firefighters and seeing which method worked best.
Los Angeles County Fire Chief Keith Klinger proudly announced that every engine, ladder and rescue company in his department was equipped with a resuscitator. His department is believed to have been the first large department to adopt uniformly medical emergency responsibility.
1965 - More people died this year in auto accidents (50,000) than in 8 years of the Vietnam War.
President L. Johnson signed into law the National Highway Safety Act which started the National Highway Traffic Safety Administration.
1966 - The National Research Council publishes a research paper, "Accidental Death & Disability - The Neglected Disease of Modern Society". Otherwise known as "The White Paper", this work was the catalyst for improving the delivery of pre-hospital care to this day. An excerpt from the report states: "Expert consultants returning from both Korea and Vietnam have publicly asserted that, if seriously wounded, their chances for survival would be better in the zone of combat than on the average city street."
1966 - The first Cardiac Care Unit was initiated by Dr. Frank Pantridge M.D. (Professor) in Belfast, Northern Ireland. In 1966 it delivered pre-hospital coronary care using ambulances (Cardiac Ambulances). It was staffed with a cardiologist, a nurse and a cardiac technician. It was equiped with an E.C.G monitor, a defibrillator, and cardiac drugs and was dispatched form the Royal Victorian Hospital. His research showed that his program significantly improved patient survivability in out-of-hospital cardiac events.
In Pittsburgh, citizens demanded an ambulance service to transport minority citizens. Freedom House Enterprises took 44 unemployed 18-60 year old men and gave then 3,000 hours of medical training. The program was deemed a success.
1967 - The American Ambulance Association publishes an article that states that as many as 25,000 Americans are either crippled or left permanently disabled as a result of the efforts of untrained or poorly trained ambulance personnel.
1967 - The first paramedic system was initiated in Miami, Florida in 1967-68 organized by Dr. Eugene Nagel and Dr. J. Miller MD. University of Miami Medical School held the first paramedic school at the University of Miami and called these graduates "Physician Extenders." By March, 1967, these paramedics were transmitting heart rhythms to Jackson Memorial Hospital, with a unit that weighed a combined 54 pounds. Experimental programs soon began in Pittsburgh, Seattle, and Los Angeles San Francisco and Jacksonville and several other cities followed the lead.
Nagel and his associates combined in a single unit, the electrical energy of the radio signal interfered with the modulator's ability to transform the millivolts of an EKG into an audible tone for radio transmission. Miami innovators worked with a small California manufacturer to develop a modulator with sufficient shielding and bypass capability. The Biocom modulator proved successful, and in March 1967, Miami's new "paramedics" began to routinely transmit EKG's to Jackson Memorial Hospital.
Dr. Michael Crawley and Dr. James Lewis commenced a pilot program in Los Angeles, California, at Harbor General Hospital. It consisted of eighteen firefighters, twelve from Los Angeles County Fire Department and six from Los Angeles City Fire Department.
1968 - St. Vincent's Hospital in New York City started this nation's first mobile coronary care unit. The program at first used physicians, then paramedics.
Hayward North Carolina: This unlikely locale was one of the first areas in the United States to utilize non-physician paramedics in taking coronary care to the patient in a prehospital setting. Even more unlikely was the choice of personnel to serve as paramedics: local members of the volunteer Haywood County Rescue Squad.
Dr. Ralph Feichter, a native of Haywood County who had received his medical training in the north, practiced in Waynesville as an internist when he and his medical associates took note of Dr. Pantridge's work in Belfast. Concluding that such a system was possible in their mountains, they assembled 40 of the volunteers for basic training in 1968. At the same time, they applied to the North Carolina Regional Medical Program (RMP) for a grant to equip two mobile intensive care vehicles. In April 1969 the volunteers reassembled for intensive training in cardiac pathophysiology, electrocardiography, arrhythmia recognition, pharmacology (cardio-active drugs) and CPR. Classes were conducted two nights per week for about twelve weeks. The course was then repeated in the fall of 1969.
The American Telephone and Telegraph starts to reserve the digits 9-1-1 for emergency use.
In Virginia,The Virginia Ambulance Law is passed and establishes the state's authority to regulate ambulances, verify first aid training, and issues permits.
1969 - The very first out-of-hospital defibrillation occurred In Miami Florida by paramedics (the patient survived and left the hospital neurologically intact).
Another paramedic program in the United States was conceived in 1968-69 in Seattle Washington by Leonard Cobb, MD, a cardiologist at Harborview Medical Center. In conjunction with Fire Chief Gordon Vickery of the Seattle Fire Department and, Dr. Cobb and his associates began training a select group of Firefighters from Seattle in 1970. In Seattle, Dr. Leonard Cobb teamed up with the Seattle Fire Department and created Medic I. Medic I is a Winnebago, (called "Mobi Pig" by the firefighters manning it), based at the hospital and is dispatched only on cardiac related calls.
In Los Angeles on September 12, 1969, firefighters began intensive 180 hours of training that included classroom, laboratory and chemical instruction, under the tutelage of C.C.U. Nurse Carol Bebout.
1970 - The Charlottesville-Albemarle Rescue Squad in Charlottesville, VA starts the nation's first volunteer paramedic program under Dr. Richard Crampton. One of their first patients was President Lyndon Johnson, who suffered a heart attack while visiting his son-in-law Chuck Robb at UVA.
1971 - The television show Emergency! debuted. Emergency contributed to changed public attitudes concerning the fire service and emergency medical care. At the start of the show, there were only 12 medic units in the entire country. Four years later at least 50% of the population of this country was within 10 minutes of a medic unit.
The Maryland State Police Aviation Division completed the first civilain scene medevac on March 19th, 1971.
1972 - The Department of Transportation and Department of Defense team up to form a helicopter evacuation service.
In Seattle, Medic II is instituted. Medic II is a program to train 100,000 citizens in CPR. Harbor View Medical Center starts up the nation's most intensive training program for paramedics. The course is 5,000 hours long, compared to 3,600 hours a medical student endures to become a doctor!
1973 - St. Anthony's Hospital in Denver starts the nation's first civilian aeromedical transport service. (The program was called "Flight for Life").
The Star of Life is published by the DOT.
The EMS Systems Act (public law 93-144) is passed by Congress, which funds 300 regional EMS systems.
The first All-Vollunteer ALS program was started in Virginia Beach Virginia on August 11th 1973. The State curriculum was by Dr. Willaim Andrew Dickinson and Dr. Jame Perry Charlton both Medical disrectors of Virginia Beach and Dr. Richard Crampton of Charlotteville (UVA). They assisted the Office of EMS at a request from the Governor in creating the Cardiac Technician certification level. Charlottesville launched their program several moths later.
1974 - A Federal report discloses that less than half of the nation's ambulance personnel had completed the Department of Transportation 81-hour basic training course or its equivalent.
The North Carolina General Assembly [legislature] did not legally authorize paramedics until 1974.
1975 - The American Medical Association recognizes emergency medicine as a specialty.
1976 - On April 9, 1976, 19 of America's first paramedics--trained to a higher level of performance and certified under one of the most exacting programs to in the United States--were officially certified as North Carolina MICTs.
The University of Pittsburgh & Nancy Caroline MD, is awarded a contract to develop the first nationwide paramedic training course.
The National Association of EMT's is formed.
1977 - The National Council of EMS Educators is formed.
1978 - Phoenix Fire Department implements paramedic engine companies.
1979 - The Journal of Emergency Medical Services (JEMS) starts publication. The American Ambulance Association is formed.
1980 - The National Registry of EMT's published its first national standard exam for EMT-Intermediate.
1981 - Direct funding of EMS systems by the Federal Government is replaced by block grants.
A study shows that 73 percent of all American fire departments, career and volunteer, are involved in some level of EMS service.
In Salt Lake City, Jeff Lawson, MD, comes out with an emergency medical dispatcher program and priority dispatching.
Nationwide, the medical community first recognizes AIDS.
1983 - Jack Stout starts systems status management in Denver.
"One for Life" law is passed in Virginia. This law assesses one dollar from each motor vehicle license and replaces all other state funding for emergency medical services. This provides funds to each city and county in Virginia and substantially increases support for regional EMS Councils, Rescue Squad Assistance Fund and EMT instructors.
1985 - The National Association of EMS Physicians is formed.
1986 - The Comprehensive Omnibus Budget Reconciliation Act (COBRA) is passed by Congress. This affected transfers of patients from ED to ED and prevented "dumping" (financially motivated transfers of patients).
1987 - Automatic Vehicle Locators (AVL) debuts.
1990 - The Trauma Care System Planning & Development Act is passed by Congress.
Fire Department organizations join together in a resolution to expand into EMS.
1991 - The Commission on Accreditation of Ambulance Services sets standards and benchmarks for ambulances services to obtain. The City of San Diego Fire Department starts a paramedic engine company pilot program.
1992 - American Medical Response starts to sell stock on the NYSE and starts a nationwide consolidation of the private ambulance industry. LaidLaw buys MedTrans and all of its assests and subsiderary ambulance services. A public opinion survey conducted for the American College of Emergency Physicians found that nearly half of adult Americans could not identify 9-1-1 as the emergency number, or confused it with 4-1-1, the directory assistance number.
1993 - It is proposed that EMT-P's assume an expanded role in primary care of non-emergent patients by learning expanded skills.
1995 - Los Angeles City Fire Department institutes EMT Assessment & Paramedic Engine companies.
1996 - New York City EMS is absorbed by FDNY.
1997 - San Francisco and Chicago institute paramedic engine companies. Rural Metro Corporation and San Diego Fire and Life Safety Services enters into a joint contract to provide paramedic services to the City of San Diego. This agreement is the first of its kind in which bith enities share in the expense and also the profit of providing 911 servcie and BLS transportation.
1999 - LaidLaw announces in The Wall Street Journal that it is looking for a buyer for its entire ambulance operation.
Paramedicine is a young
only in existence for approximately 30 years now. The very first organized "paramedics" or first-aiders and firefighters were The Knights of Saint John The Baptist of Jerusalem. However, the first "Volunteer Rescue Service" was founded by Julian Stanley Wise in Roanoke Virginia in 1928 It was called "The Roanoke Life Savings and First Aid Crew." They provided first aid, but it wasn't until 1969 that a volunteer squad received the training and equipment to function as paramedics. Emergency care in our cites was influenced by "mash units" and military medicine by "Medics and Corpsman" in Korea and Vietnam. Similar to the care given to soldiers by The Knights of Saint John - Knights of Malta during the great crusades. After World War II the Highway Safety Action Program was drafted up to assist states in preventing automobile accidents. The Hoover Commission reviewed but did not add the prehospital care issues until 1949. In the mid 50's, Dr. James Ealand from The John Hopkins University developed the technique for mouth to mouth ventilation by sustaining life with expired air from rescuers. Anasthesiologist, Dr. Peter Safer and The Baltimore Fire Departments Chief of Ambulance Service, Martin MacMahon practiced, developed and defined these techniques with firefighters, nurses and doctors that allowed themselves to be paralyzed while rescuers "practiced" and studied the new technique. Mouth to mouth was recommended by The National Academy of Science. However it was not approved by The American Red Cross or the American Heart Association for approximately 15 years.
On May 11th. 1959, after 6 years of development with experiments at The Hopkins Institute conducted by Dr. James Jude, Dr. W. D. Kowenhoven, and Dr. Guy Knickorbacker, the first portable defibrillator was delivered. It was produced by The Edison Electric Institute and weighed 45 lbs. Cardio Pulmonary Resuscitation is credited to this group of researchers.
With the A. B. C. recognition (airway, breathing and circulation) and C.P.R. the American Red Cross and the American heart Association established standards for training and delivery of this rescue technique. However, C.P.R. was a primary function for "rescue crews" only and in 1972, Jacksonville Florida was the safest place to be in the U.S. as every firefighter was trained in C.P.R. Years later, Seattle has become the safest place on earth to suffer a "heart attack" as more lay people are trained in C.P.R than any other city due to aggressive marketing by the American Red Cross and The American Heart Association.
President Eisenhower created the Presidents Committee for Traffic Safety to promote the Highway Action Safety program. In 1962 Willaim Randolf Hearst Jr. chairman of the committee formulated an amendment to the Action Program that would deal with prehospital medical care issues. The senior medical advisor to Metropolitan Life Insurance, Dr. George M. Wheatley was appointed to head a task force called the Committee on Health Care, Medical Care and Transportation of the injured. This committee was subdivided into four groups; alcohol and drugs, prehospital care, driver health, and medical treatment. Ambulances were redesigned and training guidelines established. Baltimore Fire Chief Martin MacMahon and anesthesiologist, Peter Safar along with the Public Health Service, The American Red Cross, The American College of Surgeons, and other safety and health agencies, produced the first standards for ambulance design. After four years Dr. Weatley presented the "new guidelines' to Chairman Hearst; Secretary of Health, Education and Welfare; John Gardner; and vice chairman to the Presidents Committee for Traffic Safety's Advisory Council, Russell Brown. Standard 11 of the the Highway Safety Action Program was now finished. Due to an increase in highway related deaths, Joeseph Califano, special assistant to President Lyndon Baynes Johnson drafted up new laws for automobile design and the legislation known as The Highway Safety Act. In 1965 more than 50,000 Americans died in automobile accidents alone on highways. It was signed into law on September 9th. 1966 by President Lyndon Johnson. The National Traffic Safety Advisory Committee was formed which replaced the Presidents Committee on Traffic Safety.
The federal highway safety effort comprised of 18 standards to include;
Standard 11 from this report focused on ambulance redesign and radio communications.
Federal funds were spent on improvements in training:
Also in 1966 national standards for E.M.T. training were established. Federal funds and grants were provided for individual E.M.S. systems likeJacksonville Florida's Fire Departments purchase of new ambulances and equipment and developed a New Model for delivery of care for the sick and injured. And funds were used for helicopter transportation like the Arizona Medical Evacuation System which is still in operation today.
Systems staffed by trained emergency medical technicians (E.M.T.s), the E.M.S., as we know it today, began in 1966. That year, committees on Trauma and Shock of the National Academy of Sciences National Research Council published a document called "Accidental Death and Disability: The Neglected Disease of Modern Society." Public attention brought about reforms that began in the late 60's and early 70's. This report indicated that ambulances were staffed by poorly trained personnel from funeral homes or enthusiastic volunteers without the proper the equipment and or training on how to use them.
The report better known as "The White Paper" was clear to point out that:
Out of this also gave birth to the "Organized Trauma Systems" in Illinois by Doctor David Boyd and in Maryland by Dr. R. Adams Cowley. He founded the "Cowley Shock Trauma Center" in Maryland and developed the model that all trauma systems follow. His research invented "The Golden Hour" for treatment to prevent irreversible shock.
In Belfast Northern Ireland Dr. Frank Pantridge M.D. (Professor)initiated the first Cardiac Care Unit. It staffed a nurse and a cardiac technician and carried cardiac drugs, and E.K.G. monitor, a defibrillator and ventilation equipment. It was dispatched and responded from the Royal Victoria Hospital. A British Medical Journal published the results form the program and he was requested to speak at the American College of Cardiology in the U.S. The first Coronary Care Unit in the United States was mobilized form Saint Vincent Hospital in New York City in 1968. Doctor William Grace used medical students and Cardiologist to staff the vehicle. Paramedics would eventually take over in this role. However, The Columbus Ohio Coronary Care Program used specially trained firefighters that assumed the role early on from the pilot program staffed by Cardiology students from the Ohio State University. In 1969, North Carolina began the first volunteer paramedic rescue squad. Also in 1969 the Rescue Squad in Roanoke, Virginia received the training and equipment to function as paramedics.
In the late 60's, The City of Miami, Seattle, Los Angeles and Jacksonville also selected firefighters to staff Cardiac care units. In San Francisco and in Portland Oregon, private ambulance personnel were selected and trained. This was about the first time that the term "paramedic" was used.
The 911 system was initiated in 1967 by the Presidential Commission on Law Enforcement and Administration of Justice. AT&T announced "911" as the number to dial after a single number for emergency requests nationwide was recommended. The first 911 call was made in Haleyville, Ala. in February 1968. Presently, an estimated 280,000 calls are made per day. In New York City alone the number of calls is estimated to exceed 12.5 million per year in 2005. A new 911 system in Los Angeles will be completed in 2000 and was approved by a $235 million bond issue. In Chicago and New York the new systems costs $217 million each.
In 1968, AT&T reserved "911" nationally as the recognized number to access in an emergency. The very first call to 911 came into a small town dispatch center in Haleyville, Alabama. Also, in 1968, Emergency Medicine was recognized as a speciality when The American College of Emergency Physicians was formed. In 1969 The American College of Orthopedic Surgeons created the first standard course for training E.M.T.'s for ambulance personnel.
The first paramedic system was initiated in Miami, Florida in 1967-68 organized by Dr. Eugene Nagel and Dr. J. Miller MD.
The pioneer paramedic program was initiated in Miami, Florida at Jackson Memorial Hospital by Dr. Eugene Nagel "The Father of Paramedicine," and Dr. Jim Hersman. Dr. Eugene Nagel from the University of Miami Medical School held the first paramedic school at the University of Miami and called these graduates "Physician Extenders." By March, 1967, these paramedics were transmitting heart rhythms to Jackson Memorial Hospital, with a unit that weighed a combined 54 pounds. Experimental programs soon began in Pittsburgh, Seattle, and Los Angeles as several other cities followed the lead.
The Miami program was operated by the City of Miami Fire Department and administered by Fire Chief Larry Kenny for practical reason due to:
Dr. Nagel developed the first telemetry unit for transmitting E.C.G. recordings via radio waves from the field to the hospital. The very first paramedic unit in the the world responded from The Miami Fire Department's; Station # 1. At first a physician was on board. The first successful defibrillation was preformed in June, 1969 by "Paramedics." It is obvious that the New Emergency Coronary Care Programs opened the door to expanded skills, scope of practice and gave new tools to the field of EMS.
And, in 1967, Dr. Michael Crawley and Dr. James Lewis commenced a pilot program in Los Angeles, California, at Harbor General Hospital, that consisted of eighteen firefighters, twelve from Los Angeles County Fire Department and six from Los Angeles City Fire Department. In Los Angeles on September 12, 1969, the firefighters began an intensive 180 hours of training that included classroom, laboratory and chemical instruction, under the tutelage of C.C.U. Nurse Carol Bebout. They were skilled on intra-cardiac injection and defibrillation as well other advanced techniques. There were 30 nurses in the class and to the surprise of some, the fire department personnel scored 2 through 7 out of 36 students.
Diane Kersten RN. bought the Los Angeles firemen/paramedics their first fishing tackle box to replace the "doc-bag" that was ineffective in carrying the drugs. By December, 1969, they were ready to go; however, they had no legal authority. Los Angeles County Board of Supervisors' Kenny Hahn (who became known as the "Father" of the Los Angeles Paramedic Program) pushed legislation through the Board and presented it to State Senator James Wedworth and State Assemblyman Larry Townsend. Both the house and the senate approved legislation that gave legal authority for paramedics to perform, and on July 14, 1970, Governor Ronald Reagan signed the Wedworth-Townsend Act into law. Los Angeles County and City Paramedics were on the go.
Another Los Angeles area paramedic program was started at Daniel Freeman Hospital, in Inglewood California in 1971. The ambulance was staffed by doctors that only treated cardiac patients.
Another paramedic program in the United States was conceived in 1968-69 in Seattle Washington by Leonard Cobb, MD, a cardiologist at Harborview Medical Center. In conjunction with Fire Chief Gordon Vickery of the Seattle Fire Department and, Dr. Cobb and his associates began training a select group of Firefighters from Seattle in1970. These men were subjected to a grueling program that was comprised of primarily cardiology. The mission of the first Mobile intensive Care Unit was to deliver care, at a physicians level of expertise, to the citizens of Seattle that suffered from catastrophic cardiac events. Over the ensuing years it became evident that the lives of those suffering from other acute medical emergencies could be positively effected by the advanced level of medical care available on the streets of Seattle. Thus, Medic One evolved from treating only cardiac emergencies to managing patients with severe trauma, drug overdoses, poisonings, complicated emergency childbirth and gastro-intestinal bleeds, just to name a few. As Medic One grew in recognition and reputation in Seattle and then into other parts of King County in 1972, so did Harborview Medical Center. It grew from the areas County Hospital to the Northwests only level one Trauma and Burn Center. It currently serves, not only Washington residents but the entire Northwest region, including Oregon, Idaho, Montana, Alaska and parts of British Columbia.
In the mid 1970's Harborviews Trauma Center, Seattle Medic One, and Paramedic Training for all Paramedics in King County was entrusted to an ex-army Major, Vietnam Veteran, and soon to be world renowned Nuerologist, Dr. Michael Copass. He has been described as a cross between Dr. Schweitzer and General Patton. Under his leadership the Paramedic program in Seattle/King County has become known world wide as the front-runner in pre-hospital Emergency Medicine. Every Paramedic "practicing medicine in the streets" (we do not have protocols!) in the Seattle/King County area is required to complete the Harborview Training Program, now reduced to about 12 months, regardless of prior training. There is NO reciprocity from other programs.
In the early 70's The US Department of Transportation and Defense used U.S. Army helicopter Medivac Units at bases to transport victims to hospitals. Saint Anthony's Hospital in Denver Colorado was the first civilian Air Transportation Service. Soon these organizations were established:
Reform was initiated by The National Highway Traffic Safety Administration of the Department of Transportation (D.O.T.) and the Department of Health, Education and Welfare, through theEmergency Services Act of 1973, created funding for the development of an improved prehospital emergency care system. These reforms and the work of dedicated professionals and organizations designed effective emergency medical Service (E.M.S.) systems locally.
In 1970 The National Highway Safety Administration designed and developed The Star of Life to improve the image of E.M.S. The star contains the familiar serpent and staff which is the recognized image of healing. The Points of the star indicate the following:
For more information on The Star of Life, please preview The Golden Wand of Medicine.
A must stop on the WWW for all emergency personnel traveling through CyberSpace!!!
The E.M.S. Systems Act was introduced in 1973 and became law in 1974. Passed by President Gerald Ford, it defined the 15 components of an E.M.S. System(see below under The System). It also provided funding for 300 regional E.M.S. Systems throughout the nation. Federal funds were allocated to purchase ambulances and equipment required to meet the new specifications similar to the "New Model" developed in Jacksonville Florida.
Prior to this new standard, oversized Cadillacs, Buicks, and Pontiacs were the primarily used ambulances. These new ambulance specifications listed ambulances is 3 categories:
In 1972 the Federal Communications Commission designed a new nationwide system for radio traffic called the common system approach. And in 1973, seven years after The American College of Emergency Physicians were formed, the American Medical Association recommended emergency medicine as a specialty. The National Association of Emergency Medical Technicians was formed. In 1977, the National Council of State E.M.S. Training Coordinators was established to recognize and standardize the need for EMS training. Twelve years after "The White Paper," EMS suffered the first budgetary slashes as the Carter Administration wished to down-size many programs. It was sidetracked by the "crisis" in Iran and the hostage situation. In 1976 the Comptroller General issue a report to the U.S. Congress that indicated that although progress has been made, problems still existed in EMS. Did he have an insight into the future with the City Budget becoming tighter and insurance companies and H. M. O.'s becoming less cooperative with payment. Or did he realize that the overwhelming indigent and non-insured public would put a strain on the system as we now know it as we have become the inner city clinics and doctors on wheels. Or, was he off track all together???
Amblance service in San Diego were operated by private companies from 1940 through pressent. The San Diego Police Department operated the service for the City of San Diego and used sworn officers to respond and drive and treat patients. While this was effective, it was not efficient. There were quality control issues. The ambulances were station wagons that were converted and modified. Most of the private providers were using Cadilacs. As the demands for service increased, the system evolved and paramedic programs were initiated.
The first paramedic unit in San Diego County was established in Lakeside in 1977. Grossmont Hospital in La Mesa was the first "Base Hospital" to give medical control and direction. The first paramedic run in San Diego City was on February 2nd. 1979 at 08:19 am. The service was contracted out to Medivac which operated an ambulance company in Los Angeles. The Paramedics on duty were Patrick McDonald & Cyndi Stankowski. The ambulance responded from Mercy Hospital and the Radio Nurse was Dana Hunt. The MD's on duty in the E.R. were Mark Susselman and Thomas Kravis. The patient had an Dissecting Abdominal Arota. It was documented as the FIRST PARAMEDIC SAVE in the City of San Diego, run number 7900001.
In 1979 emergency medicine became the officially recognized 23rd. medical specialty. In 1980 emergency physicians became certified with an exam by The American Board of Emergency Medicine. The American Ambulance Association was formed in 1979 and a Joint Review Committee was established the standardize all paramedic training.
In 1981 Dr. Jeff Clawson introduced Emergency Medical Dispatching as a career and developed a training program for dispatchers. E.M.S. Jack Stout, an E.M.S. consultant developed "System Status Management" in 1983 and forever changed the way emergency units are deployed. Semi and Automatic Defibrillators were now available for Basic Life Support units and accepted by the medical community as a valuable tool and skill for rescuers.
Currently, fifty percent of the population of the United States is served by paramedics. This partly due to the expense of operation and the low "call or response volume" in rural areas. Changes are taking place in the design and new "models" are being developed to provide paramedic level care to these areas. In San Diego County, Rural Units are staffed with one paramedic and one E.M.T. to offset the costs. In San Diego City and other large metro areas, one paramedic and one E.M.T. staffed in an ambulance will be common place. H.M.O.s are also changing the design as $.$$ for funding are being diverted out of the hospitals and into the homes as patients are being discharged earlier. Besides the fact that funds are tightening up in city budgets. Paramedics may very soon be suturing wounds and providing higher levels of care "at scene" and also dispensing a variety of medicines and writing prescriptions.
It is a far cry from the 70's when Johnny and Roy rescued victims from car wrecks and treated all the medical maladies that they were dispatched to. In 1971 the, "Emergency" show influenced the lay public on a mass medium around the world and did more for the image of E.M.S. Rescuers and paramedics than any of the federally funded programs or organizations had accomplished at that time.
When Emergency! premiered in December 1971 there were less than 12 paramedic units in the entire U.S. Ten years later, more than 1/2 of all Americans were less than 10 minutes away from a paramedic unit. It is still a popular show today viewed by paramedics on VCRs with interest and critique. It got my attention and possibly influence my decision to take up this profession and career. Emergency care would not have evolved as fast without this "Hollywood" production.
" Emergency! was a popular 70's television show
based on the beginning years of
the Paramedic Program in Los Angeles County.
Emergency! made paramedics popular in the 70's. It was started by a film producer and it was conceived from actual experiences at the Los Angeles Fire Department. It was born at Fire Station # 7 on Sunset Blvd. in Hollywood. Ex-Fire Chief and Publisher-Attorney, Jim Page was a consultant for the show. Emergency! was a popular television show based on the beginning years of the Paramedic Program in Los Angeles County. The action-packed drama premiered as a mid-season replacement series in January of 1972, and became an instant classic. The series had two main locations: Fire Station 51 and the ER at Rampart Hospital In Los Angeles. Paramedics Johnny Gage and Roy DeSoto were in the lead on Squad 51, with Drs. Brackett, Early and Morton - along with the help of head nurse Dixie McCall - at Rampart. The series opened with a 2-hour pilot movie in 1971 and was a series from 1972 to 1977 on NBC. It had six seasons of regular episodes and many festive two-hour movie specials that followed. The series ended in 1978 with a final two-hour episode where Johhny and Roy were promoted to Captain. Engine 51 is still in servcie at Yosemity Valley National Park. Project 51 is a WEB site desgined to inform NetSurfers of a National tour of the cast and artifacts of the show and the induction of an exhibit in the Smithsonian Institution's National Museum of American History.
"Emergency!" was a show that had it all. Drama, action, realism and a sense of humor that always knew how to break the tension. "Emergency!" was another of the high-quality, reality-based dramas created by law enforcement cognate and producer Jack Webb. It focused on the day-to-day operations of fictional Station 51, and the inter-woven dramas that ensued. The action was divided equally between on-site response with Squad 51's intrepid rescue team (usually headed up by paramedics Gage and DeSoto), and the follow-up drama back at Rampart, where Dr. Bracket, Nurse McCall and their trained professionals performed their life-saving duties. Every imaginable crisis was handled professionally and dutifully from a parachutist stuck in power wires to a kitty stuck in a tree.
It also helped to elevate the public's knowledge of firefighters and paramedics in ways no one had ever imagined. The term "paramedic" had not been widely known before "Emergency!" aired, but it soon became a household word. Sparked by the popularity of the show, volunteer recruiting went up at fire stations all over the US, and countless citizens were inspired to join in real-life emergency training courses. Many teenage, female fans were inspired to subscribe to "Tiger Beat" magazine, to read all about dreamy Randy Mantooth (Johnny Gage) as well.
During its 6 1/2-year prime-time run, "Emergency!" was always one of the top-30 rated programs. Adults and kids alike were drawn into the reality-based adventure as well as the personal exploits of the characters portrayed. Kids were treated to a Saturday morning cartoon version of the show called "Emergency + 4" in addition to a number of accompanying tie-in items like lunch boxes and plastic fire helmets. "Emergency!" never lost its popularity, and remains an inspiration for many of today's top-rated programs like "ER" and "NYPD Blue.
(download the "Emergency Alarm Tone" from the show: ".wav file") (compliments from the Sonoma County Paramedic Association)
Prehospital care has evolved out of an era that was chiefly run by mortuaries using hearses to transport patients form the streets and homes to hospitals using basic equipment and technology. There weren't any policies and procedures. There were no guidelines or regulations, either locally or nationally. There was limited control and the compensation was minimal and work conditions substandard by today's labor laws. Soon, mortuaries expanded their operation to include ambulance services or gave up the medical transportation as other companies became larger and more professional.
The market became competitive and only the strong survived. This was possibly the most beneficial event that helped to shape the pre-hospital transportation business as free enterprise and marketing help to bring higher standards to the young growing industry. Most of the services were run and operated by private companies, mostly small at first of course expanding and growing as the need for service expanded. These service sometimes referred to "mom and pop" organizations were the true for-founders of the prehospital industry. Soon public agencies such as fire departments became involved. City agencies and county services began to regulate and monitor the ambulance services. And finally the State and governmental agencies got involved as stated above. We are monitored by various internal and external groups and quality assurance networks. Medicine is not an exact science, but in the 1990's prehospital care has reached an era of scientific study and research and has truly evolved into an organized finely structured and managed service for the public.
We now have a system of transporting sick and injured people to hospitals that is regulated and monitored by the Department of Transportation; OSHA ; The California State E.M.S. (Emergency Medical Service) Authority ; local County E.M.S. agencies usually a division of the local Health Department; local hospitals, city agencies, and the Department of Motor Vehicles. The E.M.T. National Standard Curriculum was developed by the U.S. Department of Transportation in 1984. These agencies design policies and procedures, define the scope of practice, the course content for training, and the vehicle specifications and inspections. High "Standards of Care" are established and recognized and I am bound to follow them. Protocols and Policies give us parameters and guidelines for treatment modalities and direction. In San Diego these "policies" are subject to change or revision at 6 month intervals and are altered with scientific data and study outcomes. We contact our assigned BASE HOSPITALS for direction and management when needed. We transport to the facility of choice or the insured provider as requested. We will divert form this when necessary for patient. care and transport to the closest appropriate E.R. This is especially true with "trauma patients" as we transport the the designated "Trauma Center" for the area that we encountered the patient in.
The 15 Elements of "The E.M.S. System"
Our system design:
Training consists of a basic E.M.T. (Emergency Medical Technician) course that is a minimum of 110 hours long and includes The American Heart Association, Basic Life Support (BLS) certification and State and County certification and licensing . After approximately six months, paramedic training can begin if the applicant qualifies and passes all the entrance tests and interviews. This laborious and taxing class last for a minimum of 1032 hours that includes a didactic (classroom) phase (392 hours), hospital training (clinical) phase (160 hours), and a field training (practical) phase (480 hours) with at least 40 A.L.S. contacts. There is an approximate 65% pass rate for students. Also included are countless tests and quizzes and Advanced Cardiac Life Support (ACLS) certification. Some colleges incorporate other certificates such as Pediatric Life Support (PALS) and Prehospital Trauma Life Support (PHTLS). In San Diego all paramedics have in addition to a State Paramedic license and a County accreditation certificate; ACLS, PALS, PHTLS, BLS, Medical Examiner and D.M.V. (Dept. of Motor Vehicles) Emergency Driving Certificates, and a current D.M.V. Drivers license . Other advanced training is offered like twelve lead cardiography, grief support, domestic violence, hazardous materials training, infectious disease training, incident command structure, drivers training and rescue techniques. Continuing Education is mandatory and consists of a minimum of 48 hours per a two year period.
Do you think you have what it takes??? Go here for
A Career as an EMT, Paramedic or firefighter.
Most shifts are based around a twenty four hour schedule and works on a three platoon division. The schedule consists of 10 (24 hour) shifts per month. There are variations of this routine and some systems like the one operating in San Diego add 12 hour peak load units. Most of the units are based out of fire stations.
In San Diego City we drive Horton and Road Rescue Ambulances built on Ford chassis. Most have "Turbo Charged" 490 engines. We also have two Kenwood Recue Ambulances. We have Mobile Data Terminals (MDT's) in our cabs that link us to the city main frame computer via 800 MHz. Motorola radios. We obtain information about responses and dispatch data that is vital for us and our patients. We can also can send messages to other units including ambulances, police units, fire apparatus and dispatch. Our mobile and portable radios are also 800 MHz frequencies. They operate like cellular phones and behave like small computers. The message is sent via a digital signal, confirmed by the main computer center and transmitted in micro seconds with our identifier (I.D.) attached to our dispatch center or whoever we are communicating with. We now contact the hospitals for direction and medical control on the same radios. San Diego Medical Dispatch (the best dispatchers in the world) uses P.R.C. systems (rated number one in the country) combined with Motorola equipment. Approximately 200 calls a day are dispatched in San Diego City proper. Units are tracked with Global Positioning Satellites (G.P.S.) with Automatic Vehicle Locators (A.V.L.'s). "911 operators" receive the call for help and patch it through to the appropriate Dispatch Center; fire, police or medical. Obviously in most incidents any two or all three are on-line simultaneously. Addresses are confirmed with Automatic Locator Indicator (A.L.I.) computers on a screen. Computer Aided Dispatch (C.A.D.) computers assist the dispatchers in sending the most appropriate and closets unit. All this confirmed and counter checked in less than one minute. Dispatchers are trained under the guidelines established by the National Emergency Medical Dispatch Group (N.E.M.D.).
In the back we have state of the art prehospital equipment to treat and care for our patients. This includes:
I have medicine that "wakes up" heroin overdose patients. And other meds that can "jump start" the heart, speed it up or slow it down. And still others that can relieve someone suffering form acute Asthma. It is like magic!!! Medicine is not an exact science, but we have guideline and procedures to follow. These routines and medicine usage have been designed by studies and are modified as necessary when indicated.
Our arsenal of pharmacology includes:
- Standing Order
- Base Hospital Order
- Base Hospital Physician Order
Some of our more advanced and invasive procedures include:
Please note: Some of the above skills are "Standing Order" such as; Defibrillation or Narcan, Abuterol, Lidocain Epinephrine administration ect. for the initial dose or "loading dose." Follow up or maintenance dosing is a Base Hospital Order. And, some of the indications for administration of drugs or procedures require a Base Hospital Order or a Base Hospital Physician Order. Also, all of the procedures can be altered or modified with a Variation of Protocol by the Base Hospital Physician.
In San Diego City the average response volume is 8 per unit. We have 18 twenty-four hour units 10 12 hour units. Each unit is staffed with at least one qualified paramedic and one E.M.T. which is also in most cases paramedic trained. Some units are staffed with two paramedics and some are staffed with paramedic / firefighters. The ambulances are fully stocked with everything we need to treat anything we encounter. This includes 4 twentyfour hour Rescue Paramedic Ambulances equiped with heavy recuse equipment such as Halmatro Hydraulic Spreaders and Air Bags and Chain Saws. The San Diego Fire Department staffs all 43 engine companies with at least one firefighter / paramedic that are cross trained to assist with medical aids. All of the truck companies in San Diego City are also fully E.M.T. trained and equipped with automatic defibrillator units. Elsewhere in San Diego County, other departments operate very similar systems and in the rural areas, some paramedic units are staffed with one E.M.T. and one paramedic. We have maps and on-board computer terminals that assist us with routing and special lights; Opticom "Stobe Lights," that change all the electronically controlled intersection signals to green in our direction. We sometimes travel at speeds greater than 60 M.P.H. Time is of the essence because sometimes every second counts.
We also have additional ambulances staffed by Paramedics and E.M.T.'s from Rural Metro Corporation to assist in the delivery of Advanced Life Support. The expertise that they have brought to this system has benefitted every aspect of our E.M.S. model design. This combination of Public and Private cooperation brings the best of both organizations together with one common goal; patient care.
Team work is a great way to describe our system...
The average age of a city paramedic is 28 years old. Most were trained in San Diego locally. We have paramedics working here that were trained in Denver, Seattle, Portland, Los Angeles, Chicago, New York City, Detroit and one of our medics came form Germany. A few of the paramedics have grandchildren and most are married with children. Some have 4 year college degrees, some have masters degrees. We are all continuing in our educational needs and requirements. We are a professional and mature responsible work force. We treat all our patients with respect and dignity. We are dedicated and committed to our service.
The citizens of San Diego and visitors to
"our beautiful city" can rest at ease tonight when they sleep or when
they commute to work or recreate in our beautiful parks or beaches, because
they have the very best paramedics, firefighters, police officers and
dispatchers in the world standing by ready to respond unselfishly, 24 hours a
day, 7 days a week, just in case we are needed.
We are America's Finest!
by Mitch Mendler E.M.T. Paramedic Firefighter
The Paramedics Jems.com by James O. Page
More information on the progression of EMS was obtained from the
following sources: Emergency Medical Services - 2nd Edition (1978) by James O.
Making a Difference - The History of Modern EMS (1997) by James O. Page
The Paramedics (1979) by James O. Page
15 Years of Paramedic Engines (1993) by Gary Morris
The Paramedics by James O. Page
For more info on "who we are and what we do...:" Go to The San Diego Paramedics: Who we Are & What we do!!!!!
For information on our State Skills, Guidelines, Policies, Procedures, Regulations and "The Scope of Practice including testing and licensing information and training institutions: please check out California EMS Authority.
For information on how the Star of Life was adopted as our symbol and how The Caduceus became the recognized symbol for medicine; go to The Golden Wand of Medicine.
Terminology pertaining to paramedics and E.M.S..
Back to the S.D.
Web page design and maintenance by Mitch Mendler E.M.T. Paramedic /Firefighter; The WebMaster!All aspects of this page are copyright © 1996 The San Diego Paramedics & or S.D.C.P.A. and unless otherwise stated are the property of the San Diego Paramedics and or the San Diego County Paramedic Association.