Rescue Squad

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The problem was a grave one. By 1965 annual motor-vehicle deaths had reached forty-nine thousand. Traffic accidents had permanently disabled a hundred and fifty thousand and were the number one cause of death in people up to the age of thirty-seven. During the late sixties observers routinely asserted that a soldier wounded in the jungles of Vietnam had a better chance of survival than did a citizen hurt in a traffic accident back home.

In 1966 a seminal report from the National Academy of Sciences cataloged the inadequacies of the country’s emergency medical services and recommended solutions in terms of training and standards. The time for action had come. Lyndon Johnson’s Washington was a can-do place, and the sea change that would sweep over the country’s ambulance service was a textbook case of big government in effective action.

THE HIGHWAY SAFETY Act of 1966 set federal standards for training, equipment, and procedures, which the states busied themselves implementing. While auto accidents were the target, the legislation transformed EMS across the board. The momentum of the changes was maintained in the 1970s as “systems” became the rallying cry. Emergency service began to become organized for the first time.

As the states began to flesh out the concepts devised in Washington, Congress picked up the tab. Hundreds of millions of dollars were poured into demonstration projects, pilot programs, and block grants to states. Government funding in the 1970s essentially put EMS on its feet.

 

Communications and ambulance design were enhanced as a result of federal involvement. The 911 telephone system spread, allowing for more efficient dispatch. Ambulances acquired radios that attendants could use to communicate with hospitals, a helpful link when a serious case raised questions of treatment. Standards for ambulances emphasized adequate room to treat patients en route.

The development that would have the most direct impact on volunteers was the new standard for training. By the end of the 1960s the National Highway Traffic Safety Administration had established a comprehensive 81-hour course for emergency medical technicians. In 1969, two hundred people took the EMT course; they were the first emergency responders to be trained to a national standard. The course, which was later expanded to 110 hours, has become a rite of passage for rescue volunteers.

The new training and testing represented a challenge, but one that volunteers met with enthusiasm. “All our members, old and young, welcomed the EMT concept,” says Sidney Robertson, a veteran of rescue work in Roanoke and the current head of its volunteer squad, “We wanted to learn more, and we were proud to call ourselves EMTs.”

By the end of the 1960s, the National Highway Traffic Safety Administration had established a comprehensive 81-hour course for emergency medical technicians.

Like every emergency tech, I’ve spent many hours committing to memory the grievous effects of trauma on the human body, with names like tension pneumothorax and subdural hematoma. Where first-aid training takes a surface view of injury and illness, the EMT course helps us fully assess the patient’s condition before we act. We practice taking blood pressures, using oxygen, and immobilizing the spine. We learn how to extricate an injured person from a wreck, how to stop arterial bleeding, how to apply a traction splint to a broken femur. We cover everything from the complications of childbirth to the best way to treat a nosebleed.

Another facet of modern EMS was initiated by Dr. J. Frank Pantridge, who headed the cardiology department of the Royal Victoria Hospital in Belfast, Northern Ireland. Pantridge turned an ambulance into a mobile cardiac-care unit. In fifteen months he saved ten patients by bringing to the scene of heart attacks the full arsenal of modern resuscitation, including CPR and stimulative drugs like epinephrine. He used two car batteries to build up the current for the seven-thousand-volt jolt needed for electric defibrillation.

By the late sixties the idea was afloat to disseminate Pantridge’s concept by training EMTs to apply techniques that were once the jealous preserve of physicians. Technicians would learn to interpret electrocardiograms, establish intravenous lines, administer drugs, and defibrillate patients. These “paramedic” skills were officially recognized in 1969 by the American Academy of Orthopedic Surgeons.

The first volunteer group to make use of them was the Haywood County Rescue Squad in the hills of western North Carolina. A local internist, Dr. Ralph Feitcher, noting Pantridge’s work, brought together forty volunteers for extensive training in 1968. The members began applying their new skills a year later.