Rescue Squad

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Later an alarm goes out for a “code” at a nursing home. It means a person whose heart has stopped beating, a woman teetering on the edge of death. The experienced crew of volunteers is unflappable throughout. The driver, Kathy Hagy, is a mother of five; EMT Lena Speck is studying premed at a local college; the crew leader, Luke Chambers, is a respiratory therapist.

At the woman’s bedside in minutes, they follow a practiced routine: Begin cardiopulmonary resuscitation; insert an endotracheal tube, a clear passage for supplying oxygen to the woman’s lungs; establish an intravenous line to administer fluids and drugs; connect a heart monitor (the green line shows the feeble quivering motions of the woman’s heart); apply the paddles of the defibrillator three times (each time the woman stiffens as if startled by a loud noise). No signs of life appear.

The crew wheels the patient to the ambulance, one member astride the gurney to continue chest compressions. As the ambulance rolls, more drugs are administered: epinephrine, lidocame. Another round of shocks. For a moment a pulse returns; the woman’s heart, after seventy-four years of beating, doesn’t want to give up. Stop chest compressions. The patient’s pupils remain fixed and dilated.

As she’s wheeled into the emergency room, the line on the monitor flattens, and the patient “codes” again. Begin CPR. The crew turns her over to waiting physicians and nurses. They proceed with a similar round of efforts. To no avail. A few minutes later the woman is pronounced dead.

Resuscitation, the most heroic of the rescue squad’s storehouse of treatments, always involves swimming against the tide. Something has caused the patient’s heart to stop, and the resulting oxygen starvation quickly diminishes the person’s ability to recover.

The ambulance crew retires to a corner of the emergency ward to wash up and complete the paperwork that will document its futile efforts to save this woman’s life. The ability to look at and accept death is one of the first lessons that every rescue worker learns. Luke Chambers, twenty-nine, muses afterward, “Sometimes you meet somebody in the mall—maybe you don’t even recognize them—whom you helped in an auto accident. But they actually come up to you and say thank you. Things like that make it worthwhile.”

Despite the steady spread of rescue squads, ambulance service in the early 1960s left much to be desired. Undertakers continued to provide emergency transportation to half the country. In many places, even large cities, ambulances ran with only a driver; the patient rode alone in the back. Of two hundred thousand ambulance and rescue personnel, fewer than half were trained to the level of Red Cross advanced first aid. Only six states offered standard courses for rescuers, and only four regulated ambulances.

Washtenaw County, Michigan, which includes the city of Ann Arbor, provides a typical picture. In 1966 the county’s twenty-three ambulances were operated by seventeen different concerns, including hospitals, gas stations, taxi companies, and funeral homes. Service outside urban areas was spotty at best. No standards of any kind were enforced.

Part of the reason emergency care advanced so slowly in the four decades after Wise founded his squad was the determination of the medical establishment to keep laypeople from trespassing on the physician’s territory. Rescue volunteers, their duties only sketchily defined, could be accused of practicing medicine without a license. The American Red Cross, which supervised first-aid training, never took an active role in organizing or supporting rescue squads. Indeed, Julian Wise came into conflict with Red Cross bureaucrats who believed his approach was too progressive. Volunteers wanted to do more, but the tools and skills were kept out of their reach.

The rescue worker’s motto in those days was “Load and go.” “Pre-hospital care was limited solely to transportation,” says a report of the American College of Emergency Physicians. “Medical treatment didn’t begin until the patient arrived at the hospital.”

But the ten years between 1966 and 1976 saw a transformation in emergency medical services (EMS) that affected volunteers profoundly and would permanently alter the public’s expectations about ambulance service. These changes were closely linked to that ubiquitous plague of modern life: the auto accident.

An automobile killed a New Yorker on September 14, 1899. That inaugural death was a harbinger of a coming slaughter on the highways, which would surpass all the casualties of all the wars in the nation’s history.

In the 1960 Presidential campaign John F. Kennedy labeled traffic accidents “the greatest of the nation’s public health problems.” His choice of words was significant. Researchers and policy makers were beginning to change their perspective on accidents. Instead of framing the problem as one involving random acts of carelessness, they began to see an epidemic that followed the pattern of a disease and offered opportunities for prevention and cure.