How Far Have We Come In 40 Years?

In 2006, we pass a milestone in the history of EMS delivery. It was 40 years ago when the National Academy of Science published a paper called "Accidental Death and Disability - The Neglected Disease of Modern Society." The 1966 paper spoke of the many people who were dying in the streets of America because of the poor and inefficient manner by which emergency care was delivered. It was also the paper that propelled things forward to create EMS and trauma systems.

I do not profess to know what it was like back then, since I was only 7 years old in 1966, but growing up in the inner city like I did, we kids were always attracted to wherever we would hear the sirens stop. I vividly remember the police "paddy wagons" racing through the streets of St. Louis carrying their World War II canvas military foldable stretchers to emergency scenes. When the "paddy wagons" were not transporting sick or injured people, they doubled as vehicles to transport prisoners.

Usually, one or more police officers would pick up the people who were lying in the street or in a house, place them on the collapsible stretcher, hand-carry them into the back of the "paddy wagon" and lay them on the floor. If the police officer was by himself, he would sometimes solicit bystanders to help him.

I cannot remember ever seeing any kind of first aid or medical treatment being administered. Usually, the patients were loaded in the back of the "paddy wagon" and the police officer would jump in the front and drive off with lights and siren. Sometimes, a police officer would jump in the back for the ride to the hospital, but years later, I found out from now-seasoned veteran police officers in St. Louis that they had no equipment to work with. No oxygen, no bandages, no airway devices - nothing but their bare hands.

Years later, when I heard first-hand accounts of how medical care was delivered from these now-veteran police officers, I wondered how many people died, were paralyzed or fell on some other adversity as a result of being treated and transported in this crude manner. By today's standards, it seems almost barbaric.

As I sit here today, some 40 years after the Academy published its paper, I think about how auto accidents would have been handled 40 years ago. Picture this scenario: In 1966, a 19-year-old male has a single-car accident and hits a tree. The victim is unconscious in the car and has a severe head injury, since he was not wearing a seatbelt. In fact, most cars then did not have seatbelts. As bystanders come to his aid, someone runs home to call for help. Next to the rotary telephone is a seven-digit phone number to the local funeral home ambulance service. (There were no cellular telephones in 1966 and no such thing as 911. The only way someone could summon help in 1966 was to call a seven- digit number from a land phone.)

At the funeral home, someone walking past the office answers the phone. Since there is no 911, there is no automatic number (ANI) identification or automatic location identification (ALI) that pops up on a screen in front of a dispatcher. In fact, the person answering the phone at the funeral home is just a door greeter who happened to be walking past the office when the phone rang.

Since he is just a door greeter, and not a trained dispatcher, there is no such thing as pre-arrival instructions. There is no standardized screening of the call to determine what resources should be sent. All that is going to be sent to the scene is the funeral home's only ambulance, which is a Cadillac with one driver. There is no head room in the back of the Cadillac, since it is really a hearse with a single revolving light and a siren on top. There is no medical equipment in the Cadillac except a stretcher and maybe a bottle of oxygen. The driver of the ambulance has no medical training and his main job is to pick up bodies from hospitals in preparation for a funeral and burial. (Now you know where the term "ambulance driver" comes from).

Once the door greeter has the address, he writes it on a slip of paper and hands it to the driver of the ambulance. Shortly thereafter, the ambulance driver is driving the Cadillac ambulance with lights and sirens to the scene, but he has no emergency vehicle operator training since this too is unheard of at that time.

Between the time someone calls the funeral home and the driver of the ambulance arrives on the scene, bystanders use a crowbar to open the pinned driver's door and free the unconscious accident victim from the car. Of course, nobody has any concept of immobilization of the neck and back, so they literally rip the victim from the car by dragging him out by whatever appendage is closest to them. After the victim is out of the car, they let him lie in the street until the funeral home ambulance arrives.

Once there, the ambulance driver gets the stretcher out of the back of the Cadillac ambulance. With the help of a bystander, he rolls the stretcher next to the victim and then he solicits the help of three other men who are on the scene. Between the three men and the ambulance driver, they each pick up an arm or a leg, lift the critically injured driver and flop him down onto the stretcher. Of course, during this movement, there is no consideration for obtaining a patent airway, immobilizing the neck or the back, or controlling any bleeding. To the ambulance driver's credit, he does strap the patient to the stretcher.

The patient is then wheeled to the back of the ambulance, and with the help of a couple of bystanders who grab who knows what parts of the stretcher, the patient is lifted into the back of the ambulance. The ambulance driver slams the rear door of the ambulance and jumps in front to race off to the closest emergency room, which has a moonlighting dermatologist working in it since there is no such specialty as emergency medicine in 1966.

Once the ambulance arrives at the emergency room, the driver, with the help of a security guard, unloads the stretcher and runs with it into the emergency room. Of course, since there are no standardized radio systems in 1966, the ambulance driver could not relay information to the emergency room that he was coming in with a serious patient. Unfortunately, the patient dies within hours.

Ironically, when I read some of the ridiculous studies coming out today that show that paramedics are not effective and we should just "throw and go," I wonder whether any of these researchers were seriously injured or ill in 1966.