This is Part 6 in our continued series, Healthcare Heroes, where we look back at the profound legacy of American doctors, nurses, and healers.
Advancements in Pre-hospital Emergency Aid
In Seattle and all over Western Washington, it is now even more difficult to die at the scene of a cardiac arrest or major trauma than it was forty-five years ago. The paramedics won’t let you.
In most hospitals back then, an emergency room was just that, a big room full of acutely ill people, some sitting up, some lying on gurneys divided into almost individual spaces. There were no CT scans, no MRIs, no ultrasound, no sophisticated angiography, no minimally invasive operations, no internal fixation of fractures, no cardioversion, and no CPR. And then things quickly began to change.
Over the space of a very few years, doctors suddenly had a lot more ammunition to fight disease and injury, but it was all stored on shelves and in drawers at emergency rooms, or in the Central Supply Departments. Eventually, hundreds of young men and women without medical school educations learned to do expertly in the field some of the same things doctors do in hospitals, and do them very quickly and well.
The actual vehicle the firefighters would first take into the community was a “large, walk-in type van, large enough to stand and work on a patient,” and loaded with the usual first aid equipment. But in addition, it carried an EKG machine and a portable DC defibrillator (although at thirty-three pounds, the Physio Control early Life Pak device was really only almost portable).
The firefighters immediately christened the unwieldy, underpowered boat of a van with the moniker Moby Pig.16 It hit the streets on October 13, 1969, and although a lot was expected from this first “super ambulance,” it almost immediately bottomed out. The first class of paramedics were all to learn it didn’t work very well, not because the idea was unsound but because the first vehicle was. Still, many firefighters were motivated to become paramedics.
The underpowered and bouncy Moby Pig lasted just a year, and then a Ballard body shop replaced it with a dedicated, well-designed Ford truck rebuilt into an emergency rig.
In 1969, HMC Chief of Medicine Bob Conn had started the first Coronary Care Unit at Harborview. The hospital rebuilt an eight-bed ward on Four Center into its first ICU. In a May 1970 article in the Seattle P-I, Charles Russell wrote, “Yesterday three such patients were recovering in Seattle hospitals. One, a 44-year old man restored to life after a heart attack Wednesday, wanted to play cards with his rescuers.”
In the first six months of operation, paramedics had responded to 630 calls and treated 83 patients in ventricular fibrillation, a life-threatening condition. Even so, by late in 1970, the grant that was supposed to pay the bills for two and a half years was already running dry. Fire Chief Gordon Vickery set up a two-week public subscription drive where the companies and organizations from all over Seattle raised about half of their goal amount in the first week.
In the fall of 1971, Dr. Cobb and Chief Vickery announced the “Medic Two” program. A $100,000 grant from Seattle Rotary and another $9,000 from the Washington State Heart Association aimed to fund CPR training for willing citizens. In 1973, 18,000 Seattle citizens learned CPR from Seattle medics.
Teaching High School Grads How to Think Like Doctors
Initially, the total period of the Harborview paramedic training was three months, and the training classes were held in in the hospital’s old neurology ward. Students also made hospital rounds and, when they weren’t riding one of the rigs, worked in the ED.
There also was an animal lab where they put dogs into ventricular fibrillation electrically and then performed canine resuscitation. The faculty taught them to do cricothyroidotomy on dogs and pigs in the event that a patient could not be intubated in the field.
Paramedic training at Harborview today requires about three thousand hours total. The field internship is ten intensive months long. Students each see about six hundred patients in the field, intubate forty-five human beings (thirty in OR and fifteen in the field), start 325 to 450 IVs, put in five to ten central lines, manage fifteen cardiac arrests themselves, and are the “in charge” medic for about three hundred patients.