Continued from Page 3

Fortunately, no one stopped. Certainly not Michael Criley. In the beginning, the procedure of cardiac rescue was doomed without the use of a defibrillator. Criley vividly remembers one of his early associates boldly stating the obvious, "Ventricular fibrillation is not a complication. It's a hurdle that you just have to learn how to jump over. You don't die of ventricular fibrillation in a cath lab. All you have to do is have a defibrillator. It's not a biggy, you know - CPR, defibrillation." With recent gains in computer technology, the once technically foreboding defibrillator is now an educating instrument that allows the ordinary citizen the opportunity to administer the paddles and save a life. Criley is emphatic about the possibilities. "Defibrillators have saved more lives than fire extinguishers. You have, by law, fire extinguishers on every floor of a building. How often are they used? Ever? Why not defibrillators?" Criley further queries, "If you have a heart attack in a high rise in LA, how long would it take a paramedic to work through the traffic and get in the elevator. With our new defibrillators, any normal citizen can respond to the trauma." So, if Criley is right, why not make a change? Is it a code that stands in the way? Lack of public awareness? Or the reservations of insurance companies who determine many of the safety features of our buildings? Certainly targeting the Department of Health with a plan for incorporating defibrillators into civilian structures is a start. Criley concludes, "If you can train people in factories, in office buildings, in every public place how to use a defibrillator, we could save countless lives. All of us. It's as easy as CPR."

Today, that's what Criley and his paramedics continue to do. Save lives. Both County and City paramedics continue to serve a growing community, still maintaining the esprit de corps set by the first six, and then the next twelve of their own.

In 1970, Sid Sheinberg, then President of Universal Studios Television, came to Jack Webb and Robert A. Cinader with an idea for a show along the lines of an international Rescue 8, a show popular two decades earlier. Bob Cinader found something closer to home: the Los Angeles County pilot paramedic program. Cinader thought the mobile coronary-care units would make the basis for a great television series. Before the scripts were written, before the show went on the air, Bob Cinader rode with the paramedics from County Fire Station 36 and learned the ropes firsthand. The resulting series, Emergency!, became a six-and-a-half season hit. Webb had wanted to focus on the emergency doctors and nurses at Harbor General Hospital, but Cinader's fascination with the paramedics prevailed. Cinader's theory was you could educate people if they didn't realize you were doing it. He believed if you presented them with something noble in an entertaining, humorous way, the audience would then demand it in their own lives. He was right. All over the country people began to demand that "paramedic thing" they saw on NBC every Saturday night for six years. They eventually got it.

"It [Emergency!] was a major force in not only legitimizing the paramedics in our country," recalls Criley, "but also for exporting the idea across the country. People would watch and hear the fire sirens, kids would watch and see all these marvelous things going on. That gave us a tremendous impetus. It put the spotlight on L.A. County and its fire department."

Obviously there is no one incident or person responsible for the success of the paramedic program. Pantridge did lead the way, but EMS was a program fated for success. Nagel comments on the process, "At the time, there was no real regionalization of resources. 9-1-1 had not kicked in. Only some of the urban areas were being served by what could be called EMS. We were not carrying the lamp, lighting the way, and certainly not predicting where we were going. What we were doing was to highlight the immediate happenings and how these events could be and were useful. What did eventually happen was the promulgation of EMS through the length and breadth of this country, including those little towns that you never heard of or thought were important."

There are many physicians, fire chiefs, administrators and yes, politicians that supported the EMS program in its critical infancy. There was Richard Lewis in Columbus, Ohio, with two years of military duty as an Army physician in Vietnam under his belt. In April of 1969, Lewis and Dr, James Warren started talking with their fire department about a mobile unit. The Columbus City Fire Department had been in the rescue squad business since 1931. Lewis' Army experience had taught him that medical corpsman could be excellent caregivers with proper direction and training. "We took fifteen of them," said Lewis, "and gave them training in what would essentially be an advanced life-support; much more than that, really." Like Cobb, Nagel and Criley, Warren and Lewis had great confidence in the expertise of their 'Medics'. The same was true of Leonard Rose in Portland, Oregon. His program was the first to train private ambulance personnel as paramedics. Privately operated paramedic programs have now become a common model throughout the nation.

"It wasn't that we were all that visionary," says Leonard Cobb. "We had the opportunity to work with good people. Things and ideas and a lot of enthusiasm. The doctors who volunteered at night-time -- it was unbelievable. Hey guys, we got this new program and we need somebody to ride the rig. They had to stay there all night, on the weekend. No pay, no nothing. That is truly remarkable. I don't know if I would have done anything differently. We just stumbled into some good luck."

Eugene Nagel, recognizing that timing is everything, has said, "The popularity of the show Emergency! emphasized good EMS practice, their value, what it meant to the country, and created a national appetite. There was no way that we could have done what that program did."

As long as the citizens of this country continue to receive quality service through dialing 9-1-1, EMS in this country will continue its mission to improve the life of each and every American, no matter how far away they might be from a hospital. And here is where the crux of the matter lies: how to better serve the people of our communities?

One way is to pay more attention to rural America. By far, most of the articles appearing in medical journals center on urban environments. The fact is, most of our hospitals lie in city and urban areas. What is appropriate for Houston may not work for Hazard, Kentucky. Certainly, new technology is important. However, according to Nagel, "EMS needs old technology properly distributed in rural and wilderness America." Like all emergency physicians, he stresses the importance of 9-1-1. "It was really important in terms of creating regions - in having emergency calls come into a central location and then dispatched regionally." But what good is all our technology if we can't get to the patient in time, if the trauma 'in the field' can't be appropriately treated and transported within a eight minute time zone? Another dilemma is how to adequately staff volunteer programs in order to maintain the level of expertise? Or what is the fair and reasonable response to inadequate billing restrictions? What will the government pay and what will the hospital pay? How can mobile units continue to serve the country when the so-called Balanced Budget Amendment has cut into our medical health program to such a degree that funds are not forthcoming - and then only under documentation so rigorous that community-oriented health programs are foundering across this county!

To survive, EMS must maintain its esprit de corps. We need renewed enthusiasm in the system, meaningful changes, new techniques, new communication methods. The inception of the paramedic program was brought about by the exchange of information, by the enthusiasm of trainer as well as trainee. EMS can survive only as long as those who care continue to collaborate. And what better reason for survival than the saving of a human life.

© 1999-2005 Project 51 & CLAFMA
Site originally designed by Stacey L. Howe
Webmistress and tweaker is Desire' Gonzales