Public Safety Training Facility

Monroe Community College
Rochester, New York

MCC Paramedic Program


by Peter Bonadonna

                                                                    Slide #

I.   Man helping man.                                                   1

      A. Since the dawn of time man has lived in groups.

      B. They have worked, hunted together, and aided the group.

      C. Earliest recorded "ambulance" 900 A.D.                         1a

      D. Ambulance Heritage goes back further than Police or Fire Depts !

II.  All societies have had a "medical" authority.

      A. In ancient times one individual had special powers.

      B. The famous Voo Doo witch doctor is a more recent example.      2

III. Wars are responsible for much of our trauma education.

      A. 1700s "Ambulance Volantes" developed by Napoleon to carry      3
         wounded to the rear.

      B. 1861: American Civil War                                       4

             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

      C.  1900s Ambulance in Rochester, NY. Halfway across the world    5
          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.

      D. 1917 WWI

          1. New forms of warfare led to new injury patterns
          2. Evacuation for wounded was typically 18 hours.
          3. Decreased evacuation time tended to decrease morbidity
          4. Splinting of closed femur Fx decreased mortality from 80 to 20%

      E. 1939 WWII

          1. Better Medical Care - First organized effort
          2. Beginning of first real aeromedical transport

      F. 1954 Korea - Wide spread use of the helicopter                  6

      G. 1963 Vietnam                                                    7

          1. Field medics (Corpsman) parachute in
          2. Rapid evacuation by helicopter
          3. Field hospitals with ORs                                    8
          4. Massive amounts of research

IV.  Describe how man's creations allowed him to aid the ill.            9

      A. Bandages, stethoscope, thermometer, ASA, etc.                  10
      B. Man carry, horse and buggy / first medical transport.
      C. The first phone call was used to summon help
         for an acid burn "Watson come here!".
      D. One of the earliest emergency radio transmissions was used to
         report a large sea liner sinking. "Save Our Souls" (SOS).
      E. 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. 
      F. In 1947, Beck reported the first successful case of AC
         defib in a human. A 14 yo f arrested during thoracic
         surgery. Common household current (110 VAC) was applied
         directly to her heart using a stripped lamp cord.

V.   In the 1950s "Modern Medicine" had established itself in
     the western world.

      A. Drs & RNs gave the bulk of medical care.                        11
      B. Nurses required an MD's order to take a temperature.
      C. Nurses could be fired for questioning physicians.
      D. An ambubag could only be used by a physician.
      E. CPR was only used in a few hospitals experimentally.
      F. There were no defibrillators in hospitals.
         (only in a few investigational centers)
      G. If your heart stopped you were pronounced dead.
      H. Ambulances were fast taxi rides, often without                  12
         bandages or oxygen.  The drivers often lost more
         lives than they saved from ambulance accidents.

VI.   In the mid 50's scientists began to appreciate the anti-
      arrhythmic properties of Lidocaine.

       A. Scientists learned that if a man having chest pain
          received a dose of Lidocaine, there was a decreased
          risk of sudden death.

       B. A few aggressive, progressive Drs advocated teaching           13
          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.

       C. The Korean War (1953) was the perfect proving ground
          for specially trained medics to render physician-type
          care.  Helicopters were widely used as ambulances.

       D. 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.

       E. 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.                                          14

VII.   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. 

        A. 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.

        B. 1959: External Defibrillators (AC) were proven to be          15
           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. 

        C. 1959: Moscow, Russia, some Physicians moved out of the        16
           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.

VIII.   The Russian project proved that ALS techniques made a
        significant difference in the outcome of patients.

         A. The Russian Drs also studied the use of a "doctor            17
            of felture" (a Physicians Assistant or Paramedic) in
            the ambulance rather than a MD.  
         B. The Russian and Belfast Investigators found that if
            the assistants were well trained, there was the same
            favorable outcome for the patients.

         C. In 1959 Mine Safety Appliance Co. insisted on the            18
            need for a portable defibrillator to be used in the
            mines. Electrocution was common because the mine cars
            were powered by electricity.

IX.     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. A daring California Governor realized the importance      19
               of such a program and took the bull by the horns. 
               He enacted laws that would allow Physician Delegates
               to act for the Physician.(Wedworth Townsend Paramedic
               Act, 7/14/70.) The governor's name....
               Ronald Reagan. 

            B. Shortly thereafter other states enacted similar laws.

            C. 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.

X.    In 1966 Dr. Nagel worked to refine portable radio telemetry.       20

            A. The development of portable telemetry was difficult       21
               due to the RF that interfered with the EKG as well
               as the modulator.

            B. Many inventors began to shield EKG cases and wires.

            C. Paramedics were being trained by Physicians, often        22
               using large mongrel dogs as the "patient".

            D. 1966: The White Papers, a major study, showed 
               the inadequacies of field and ED care.
            E. 1968: Motorola developed the APCOR.  It was used          23
               without a monitor and the Paramedics sent a continuous
               EKG so the Physician could watch the EKG.

            F. 1968: ATT designates 911 as national emergency access number

            G. 1968: Founding of ACEP.  Established standards for EDs & EMS

            H. 1970: Physio-Control developed the Lifepak 4.              24
               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.

            I. 1970's Local physicians, Dr. Banner, Dr. David Kluge and 
               Dr. Milton Luria advance ALS in the Rochester, NY region.

            J. The STEP (Society for Total Emergency Preparedness) organization
               donated two lifepak 4's to the region. One went to SEQ, the other
               to National Ambulance.

XI.    In the early 70s radio frequency space became a premium.

            A. Paramedics were given the responsibility to read
               and monitor EKGs so that continuous radio transmission
               could be stopped.

            B. In 1972, by a stroke of luck, the Paramedic Program       25
               had a multi-million dollar publicity vehicle. That 
               stroke of luck was the TV series "Emergency".

            C. In 1975, Physio-Control released the Lifepak R5, a        26
               full featured, small monitor/defibrillator at 18 lbs!

XII.   In the 1980s, paramedic programs improved and spread to most 
       large cities.  The training technology also improved:

            A. Patient simulators, arrhythmia generators, video tape,    27
               and computers aided the new Paramedic Student.

            B. External pacing came back into vogue, with many           28

            C. Automatic & Semiautomatic Defibrillators are developed.   29
            D. Intraosseous (in the bone) injections came back into vogue
            E. Thrombolytic therapy proved successful in Emergency              
               Departments for MI cases.

XIII.  In the 1990s .......

            A. Pulse Oximetry and Capnometry                             30

            B. Paramedics are trained to read 12 leads and the new       31
               field cardiac monitors are 12 lead capable.

            C. Several EMS systems are conducting trials to determine
               if thrombolytic therapy will aid the prehospital patient.

            D. Computers are used routinely in dispatch, and on board    32
               the ambulance for patient care and documentation. 

            E. Better EMT and Paramedic Education

            F. Better Physician involvement                              33

            G. Better prehospital research                               34

            I. Increasing Scope of Practice and Responsibilities         35

            J. Pronouncement in the field                                36

XIV.   The next Century.....2000                                         37

            A. New smaller, better Ultrasound machines in EDs and soon 
               to be in ambulances will increase the diagnostic abilities

            B. Paramedics Trained to give vaccinations in prep for bioterrorism

            C. More and more Paramedic Programs become Accredited

            D. Paramedics learn more advanced Pharmacology due to increased
               threats of terrorist acts. Additions to our knowledge base include 
               antidotes and procedures for chemical poisons, antibiotic and 
               vaccinations for pathogens used as weapons of mass distruction.

            E. Paramedics now employed by Emergency Departments and Intensive
               Care Units with full use of their training and skills!

            F. ............

For more information on Paramedic history visit: JEMS.COM

URL: /depts/pstc/backup/parashis.htm

Updated: Sept. 24, 2003