firetender
Community Leader Emeritus
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Part I – Introduction
The Paramedic program in the U.S. was based on a simple concept: Ambulances that brought the patient to the hospital would now bring the hospital to the patient.
Have you considered what a tremendous switch in orientation this was? In this series you’ll be surprised at many of the components and personalities that came together to make it all happen.
In 1965 all ambulance “Attendants” were allowed to do was basic stabilization and transportation to a facility (supposedly!) equipped and staffed to do something that would make a difference. Typically, training was a less than ten hour Red Cross (ANRC) First Aid course.
By 1970 the ambulance could do more than offer conveyance from the scene to the beginning of definitive care; it could deliver technology and trained technicians to a stricken person and definitive care could begin as close to the time of the debilitating event as possible. In retrospect, about five years for that magnitude of a transition to take place seems lightning fast!
Underneath it were more than 30 years of hard-won, behind-the-scenes technological developments. Many things had to come together to show there were huge benefits to leaving the old and adopting the new. Additionally, professional, public and political perception had to radically change before anything could happen.
What better place to start getting people’s attention than raising the dead?
Enter the external cardiac defibrillator. It made you what you are, and, in fact, in its most recent incarnation as the AED, this machine is re-defining your future!
I’m not forgetting that information gathered from the battlefields of the Viet Nam war showed that in trauma the more quickly you began aggressive intervention the better the chances were for recovery. That was an important factor in developing the concept of advanced care in the streets.
Nor am I forgetting that CPR played a pivotal role in pre-hospital care as well; after all, it provided an essential link in the chain to combat sudden death. It allowed a “dead” body to remain viable until more advanced care could be provided…and anybody could do it!But it was quite a journey to get CPR out into the public’s view.
Paradoxically, it was advanced technology that made the use of basic intervention worthwhile.
Of course, the concept of a non-Physician rendering care on the scene would never have happened without leaps in our communication technology. Once that occurred it allowed wireless connection between a trained technician and a doctor at the hospital, eliminating the need for the physical presence of the MD on the scene.
Yet, review of the literature indicates that defibrillation may very well have been the hub of the wheel when it comes to the sudden emergence of advanced emergency medical care in the streets. It provided a highly dramatic, immediate result; one that attracted attention to the overall idea of sending ambulances to actually treat medical emergencies. It provided a reason to develop all the other spokes of the wheel.
In terms of publicity, what fueled the spread of the idea of on-scene intervention was that more than 300,000 people a year in the U.S. were keeling over and becoming victims of “sudden death”. Once there was something available to combat it (instantly!) this information became more newsworthy and it became the rallying cry for a radically new way of doing things.
CPR, or medications on their own, however, would probably not have justified this huge shift in orientation; they were far too simple! As preparatory and back-up steps to something technical that literally had to be delivered to the scene, however, they became essential. Remember also that the primary reason for communications with the Doctor was so that he/she could interpret the rhythm and order the treatments.
In the TV show EMERGENCY!, for example, the sequences that got the most public attention were the ones where Johnny and Roy arrived on the scene of a pulseless and apneic patient, hooked him/her up to a monitor, sent a rhythm strip to the Doc, he orders defibrillation, they did it and there on the screen is a beautifully beating heart’s rhythm! What’s the logical response? I want THAT in MY neighborhood!
Here was a brand new development in medicine, everyone thought, that could truly raise the dead!
The truth is, back as early as 1933 we knew that sudden death from a fibrillating heart – one of the most common fatal arrhythmias – could be reversed by electric shock. In cardiac defibrillation we had something that could make an immediate, seemingly miraculous difference; but all that was behind the scenes and limited to one pioneering hospital program. The equipment to defibrillate was quite massive and unsophisticated in design.
But it did provide a reason for the birth of CPR. CPR evolved as “external cardiac compression” from its more gruesome forebear where the chest was cracked open and the heart was rhythmically squeezed and released by hand.
In cases of fibrillation, open cardiac massage was performed until an electrical “shock” could be administered directly to the heart tissue. The administration of drugs was likely to occur as well, yet, compressions along with aeration were all part of an experiment that largely centered on defibrillation.
The development of “closed-chest massage” happened during the time defibrillation was being improved. Initially this took place in (predominantly) Operating Rooms.
Until the defibrillator became portable enough to bring to the stricken person there was little reason to push for mass training of hospital or other personnel in CPR. People just dropped dead in the hospitals (except for some scattered ORs) and on the streets and there were no thoughts of interceding to maintain circulation. Why and for what? Remember, this was at the time when we were just beginning to apply heavy-duty pharmaceutical intervention, and that was limited to the more advanced areas of the hospitals.
Even in the hospitals CPR was developed to buy crucial time until the patient had access to a Crash Cart of some configuration, the central ingredient of which was the external defibrillator. Granted, a fibrillating heart was only one of many arrhythmias, but this was fatal and it could be reversed. How more dramatic could you get? And just imagine if you could bring that kind of intervention to the patient in the streets!
Yet, it took a tremendous amount of effort to get the medical establishment at the time to even consider declaring war on sudden death. As you will soon see, it took quite a cast of characters to change that direction and in the beginning, most weren’t MDs.
It all started with Consolidated Edison of New York, back in 1928!
At the time, there were an alarming number of deaths of electrical linemen while servicing our rapidly expanding electrical needs. “Accidental electrocution” was a common hazard of the job. The Edison Company established the Edison Electrical Institute to see if there was a way to reverse the effects of sudden, fatal electrical shock on its personnel.
The institute contracted with Johns Hopkins University to study the problem. In charge of the project was an electrical engineer.
Coming next: Your Grandfather, the Geek!
The Paramedic program in the U.S. was based on a simple concept: Ambulances that brought the patient to the hospital would now bring the hospital to the patient.
Have you considered what a tremendous switch in orientation this was? In this series you’ll be surprised at many of the components and personalities that came together to make it all happen.
In 1965 all ambulance “Attendants” were allowed to do was basic stabilization and transportation to a facility (supposedly!) equipped and staffed to do something that would make a difference. Typically, training was a less than ten hour Red Cross (ANRC) First Aid course.
By 1970 the ambulance could do more than offer conveyance from the scene to the beginning of definitive care; it could deliver technology and trained technicians to a stricken person and definitive care could begin as close to the time of the debilitating event as possible. In retrospect, about five years for that magnitude of a transition to take place seems lightning fast!
Underneath it were more than 30 years of hard-won, behind-the-scenes technological developments. Many things had to come together to show there were huge benefits to leaving the old and adopting the new. Additionally, professional, public and political perception had to radically change before anything could happen.
What better place to start getting people’s attention than raising the dead?
Enter the external cardiac defibrillator. It made you what you are, and, in fact, in its most recent incarnation as the AED, this machine is re-defining your future!
I’m not forgetting that information gathered from the battlefields of the Viet Nam war showed that in trauma the more quickly you began aggressive intervention the better the chances were for recovery. That was an important factor in developing the concept of advanced care in the streets.
Nor am I forgetting that CPR played a pivotal role in pre-hospital care as well; after all, it provided an essential link in the chain to combat sudden death. It allowed a “dead” body to remain viable until more advanced care could be provided…and anybody could do it!But it was quite a journey to get CPR out into the public’s view.
Paradoxically, it was advanced technology that made the use of basic intervention worthwhile.
Of course, the concept of a non-Physician rendering care on the scene would never have happened without leaps in our communication technology. Once that occurred it allowed wireless connection between a trained technician and a doctor at the hospital, eliminating the need for the physical presence of the MD on the scene.
Yet, review of the literature indicates that defibrillation may very well have been the hub of the wheel when it comes to the sudden emergence of advanced emergency medical care in the streets. It provided a highly dramatic, immediate result; one that attracted attention to the overall idea of sending ambulances to actually treat medical emergencies. It provided a reason to develop all the other spokes of the wheel.
In terms of publicity, what fueled the spread of the idea of on-scene intervention was that more than 300,000 people a year in the U.S. were keeling over and becoming victims of “sudden death”. Once there was something available to combat it (instantly!) this information became more newsworthy and it became the rallying cry for a radically new way of doing things.
CPR, or medications on their own, however, would probably not have justified this huge shift in orientation; they were far too simple! As preparatory and back-up steps to something technical that literally had to be delivered to the scene, however, they became essential. Remember also that the primary reason for communications with the Doctor was so that he/she could interpret the rhythm and order the treatments.
In the TV show EMERGENCY!, for example, the sequences that got the most public attention were the ones where Johnny and Roy arrived on the scene of a pulseless and apneic patient, hooked him/her up to a monitor, sent a rhythm strip to the Doc, he orders defibrillation, they did it and there on the screen is a beautifully beating heart’s rhythm! What’s the logical response? I want THAT in MY neighborhood!
Here was a brand new development in medicine, everyone thought, that could truly raise the dead!
The truth is, back as early as 1933 we knew that sudden death from a fibrillating heart – one of the most common fatal arrhythmias – could be reversed by electric shock. In cardiac defibrillation we had something that could make an immediate, seemingly miraculous difference; but all that was behind the scenes and limited to one pioneering hospital program. The equipment to defibrillate was quite massive and unsophisticated in design.
But it did provide a reason for the birth of CPR. CPR evolved as “external cardiac compression” from its more gruesome forebear where the chest was cracked open and the heart was rhythmically squeezed and released by hand.
In cases of fibrillation, open cardiac massage was performed until an electrical “shock” could be administered directly to the heart tissue. The administration of drugs was likely to occur as well, yet, compressions along with aeration were all part of an experiment that largely centered on defibrillation.
The development of “closed-chest massage” happened during the time defibrillation was being improved. Initially this took place in (predominantly) Operating Rooms.
Until the defibrillator became portable enough to bring to the stricken person there was little reason to push for mass training of hospital or other personnel in CPR. People just dropped dead in the hospitals (except for some scattered ORs) and on the streets and there were no thoughts of interceding to maintain circulation. Why and for what? Remember, this was at the time when we were just beginning to apply heavy-duty pharmaceutical intervention, and that was limited to the more advanced areas of the hospitals.
Even in the hospitals CPR was developed to buy crucial time until the patient had access to a Crash Cart of some configuration, the central ingredient of which was the external defibrillator. Granted, a fibrillating heart was only one of many arrhythmias, but this was fatal and it could be reversed. How more dramatic could you get? And just imagine if you could bring that kind of intervention to the patient in the streets!
Yet, it took a tremendous amount of effort to get the medical establishment at the time to even consider declaring war on sudden death. As you will soon see, it took quite a cast of characters to change that direction and in the beginning, most weren’t MDs.
It all started with Consolidated Edison of New York, back in 1928!
At the time, there were an alarming number of deaths of electrical linemen while servicing our rapidly expanding electrical needs. “Accidental electrocution” was a common hazard of the job. The Edison Company established the Edison Electrical Institute to see if there was a way to reverse the effects of sudden, fatal electrical shock on its personnel.
The institute contracted with Johns Hopkins University to study the problem. In charge of the project was an electrical engineer.
Coming next: Your Grandfather, the Geek!
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