Interviews Conducted and Information Compiled
By Kevin Tighe

I portrayed firefighter-paramedic Roy DeSoto on the television series EMERGENCY! during the 1970's. It was all new then, both the reality of what was happening in the world of emergency medicine, and what we were dramatizing for the American public. A certain synergy occurred, more than any of us involved in the series recognized at the time, because the show reflected a concept about which most people were unaware. Now, in the year 2000, the Thirtieth Anniversary of Emergency Medical Services is being celebrated, and I've been asked to provide a retrospective of the events which led to the universal availability of on-site medical care. The research has provided a fascinating journey for me. I was an actor playing a part. Now I want you to meet the real heroes.

In the jungles of Malaya in 1942, a young Northern Irishman named Frank Pantridge was awarded the Military Cross, an honor rarely bestowed upon a physician in the Royal Army Medical Corps. During his tour of duty, while helping the wounded, he was captured by the Japanese and sent to a Burmese prison camp, where, despite his own health problems, he provided medical care to his fellow internees until the end of the war. One of his friends, Dr. Tom Milliken, was aboard the ship transporting prison camp survivors. Milliken later wrote about Pantridge, "The upper half of his body was emaciated, skin and bones. The lower half was bloated with the dropsy of beriberi. The most striking thing were the blue eyes that blazed with defiance. He was a physical wreck, but his spirit was... unbroken."

From this experience, in its own circuitous way, modern Emergency Medical Services was born.

After returning to Belfast and the Royal Victoria Hospital, Pantridge began research on the relationship between cardiac beriberi and sudden death, an interest that led to the world's first mobile coronary care unit in 1965.

Pantridge was inspired by an article describing American servicemen in the Second World War, between the ages of 18 and 36, who had died of heart attacks. Sixty percent had died within one hour of this onset of symptoms. Recognizing that any delay in treatment was potentially catastrophic, Pantridge declared, "we must go out and get those people." And he did.

According to Dr. Leonard Cobb, "All hospital EMS programs and advanced life-support programs can trace their origin to Belfast and the work of Frank Pantridge... A patient would get chest pains and he would ring up his General Practitioner. His GP would go over and see the patient and say, 'Yep, it looks like you might be having a heart attack.' (The GP would then call an easy-to-remember-number --- 2-44-44 --- that was a hot line direct to a phone in the nursing station at the Royal Victoria Hospital.) So Pantridge sends a doctor and nurse out in a vehicle. With the regular ambulance coming out, it would have taken hours. That's the origin before it ever got to the United States."

In the August 5, 1967 issue of the British medical Journal, The Lancet, Pantridge and John Geddes (the Royal Victoria resident who originally brought the article on cardiac beriberi to his attention) reported their findings on 312 patients over a fifteen-month period. Half of the patients had a myocardial infarction and no deaths occurred in transit. The article alerted a few physicians in America who were working independently on the concept of administering aid to cardiac victims outside the walls of the hospital. It was due to the innovative efforts of these men that a small group of EMS pilot programs saw a thin light at the end of the tunnel. What these programs did have in common was that they all received initial funding from local medical grants, rather than from any early national efforts.

In the following September issue of Time Magazine, more news of the Belfast program led to a rather startling pronouncement: "Top U.S. government physicians believe that in the case of at least one patient with a heart-attack history, namely Lyndon Johnson, a defibrillator should be installed in his home." This idea would not prove so startling as EMS moved into the next century.

Dr. William Grace started the first U.S. mobile cardiac care program in 1968, out of St. Vincent's Hospital in New York City. Grace had visited Pantridge in Belfast and soon set up his own mobile cardiac unit along virtually identical lines. Like the Belfast program, the St. Vincent's MICU was not established to provide primary response for cardiac arrest. Its primary purpose was to treat the early period of acute myocardial infarction, before full arrest occurred.

In 1968, Dr. Richard Crampton, a former protégé of Dr. Grace, also visited the Royal Victoria Hospital, and transferred that knowledge to the University of Virginia Hospital. By the end of 1970, the Charlottesville Rescue Squad was certified in CPR and, in March of 1971, became the first all-volunteer mobile cardiac response unit in an essentially rural environment.

Though the programs of Grace and Crampton were certainly innovations, they still lacked a broader scope. Because a physician had to be in attendance, but could not stand by to jump in an ambulance, it was not possible to reach the scene in a few minutes. However, Pantridge's work continued to influence key figures in the Emergency Medical Field. Though based in separate parts of the country, these men kept in contact while working to adapt Pantridge's concept to fit their own particular programs.