"EMS Evolution: 1947-1972: A Timeline"

The following is a general timeline that documents the history of resuscitation and key milestones in the development of EMS during a twenty-five year span of 1947 to 1972 and is not totally inclusive of all developments.  

1947
In Cleveland, Ohio Dr. Beck successfully defibrillates a 14 year old child’s heart during a thoracic surgery procedure using paddles applied to the heart which delivers an alternating current (AC) shock.

1948
Approximately 40,000 citizens are trained in first aid by the American Red Cross as part of a nation-wide Civil Defense Plan.

The first convention of the newly formed International Association of Rescue & First Aid Squads (IARFAS) is held in Atlantic City at the Ritz Carlton Hotel on September 19-20. concurrently with the American Hospital Association’s golden Anniversary Meeting. An Advisory Council is formed consisting of a representative of the American Medical Association, the National Safety Council. The American Red Cross, the International Fire Chief’s Association, the International Association of Chief’s of Police, the United States Coast Guard and the American Hospital Association.

1953-58
Dr. Peter Safar and Dr. James Elam develop mouth-to-mouth breathing after challenging the widely-accepted chest pressure-arm lift technique of that era.

1956-57
In Boston, MA and Baltimore, MD, Dr. Zoll and Dr. Kouwenhoven separately develop closed chest AC defibrillators.

1958
"Intensive care" is said to have began in the United States when Dr. W.E. Dandy opens a three-bed unit for post-operative neuro-surgical patients at the Johns Hopkins Hospital in Baltimore.  

The mouth-to-mouth rescue breathing is featured in its first aid training program to the American public. The method is first used on young children and infants, and is then introduced as a resuscitation method for the general population. Scientific studies show it is much more effective than manual methods (back-pressure-arm-lift and chest-pressure-arm-lift) used for decades.

1960
A scientific article on the newly developed technique of "Closed Chest Cardiac Massage" is published by Dr. Kouwenhoven and Dr. Jude and published in the Journal of the American Medical Association (JAMA). Closed chest cardiac massage, combined with mouth-to-mouth breathing is later called CPR.

In Baltimore, Maryland, Dr. Peter Safer, builds upon the work of Dr. W.E. Dandy and establishes what is considered the first trauma intensive care unit in the United States which is physician-staffed 24/7 for the prolonged care of patients with any life-threatening organ failure. Starting with one trauma unit in 1960, the Baltimore Shock Trauma Center is founded by Dr. R. Adams Cowley, who is appointed its first medical director, and serves as a model for the rest of the Nation including Ben Taub Hospital in Houston, Cook County Hospital in Chicago and the Los Angeles Central Receiving Hospital.

Captain Martin McMahon, commander of the Baltimore City Fire Department Ambulance Division works closely with Dr. Peter Safer in improving resuscitation techniques. These efforts also include designing a concept for an improved ambulance patient care area with improved equipment, piped oxygen and suction. Captain McMahon also develops the “S-Tube” airway resuscitation device and Baltimore City Fire Department ambulance attendants are trained by Dr. Safer in the newly developed CPR technique. A Baltimore City Fire Department municipal ambulance responds to a 68-year-old victim of out-of-hospital cardiac arrest and administers CPR. The patient, Bertie Bish, is then defibrillated at Johns Hopkins Hospital, and recovers.

1960-62
Again, in Boston, MA, Dr. Lown develops the Direct Current (DC) defibrillator which is determined to be safer than AC defibrillators. It is used to correct other rapid arrhythmias in addition to ventricular fibrillation.

In May of 1962, the 200-bed private Bethany Hospital in Kansas City opened the countries first dedicated coronary care unit. Dr. Hughes Day of Kansas City is regarded as the pioneer of hospital coronary care and said to first develop the term "Coronary Care Unit" after reading the scientific studies of Dr. Kouwenhoven. However, modern hospital CCU's will mostly later begin to appear in the latter 60's as cardiac portable monitoring and defibrillation/pacing continues to improve. Hughes also introduced a mobile cart, equipped with defibrillator and external pacemaker at Bethany Hospital's CCU, but served the entire facility. At the same time, Johns Hopkins Hospital also develops a portable cardiac cart with a bulky defibrillator, drugs and airways and coined the term "crash cart" due to its propensity to turn over when rolling it down the hallways.

1962
Dr. Eugene Nagel begins study of resuscitation at New York City’s Columbia-Presbyterian Hospital, later transferring his interest to Jackson Memorial Hospital in Miami.

1964
In January the International First Aid & Rescue Association meeting holds its annual meeting in Miami, Florida. Dr. Eugene Nagel makes a premier CPR demonstration to those assembled. This same year, Dr. James Jude becomes Chief of Cardiovascular Surgery at Jackson Memorial Hospital where he is appointed to chair the CPR development program for the American Heart Association. City of Miami Fire Department "Rescue One" firemen are trained by Dr. Eugene Nagel in basic emergency patient treatment techniques and in a novel resuscitation technique called “closed chest cardiac massage.”  

The President’s commission on Highway Safety called for emergency care and transportation of the sick and injured as one of its community action programs.

1965
Dr. Frank Pantridge and Dr. John Geddes demonstrate that death can occur within one hour of the onset of coronary arrthymias as a foundation for establishing the world’s first Mobile Coronary Care Unit (MCCU). The first successive test of a static 110 volt to 12 volt DC inverter for a hospital defibrillator is also tested by Dr. Pantridge.

During 1965, there are more fatalities from auto accidents (50,000) than from soldier deaths during the 8 years of the Vietnam War. President L. Johnson signed into law the National Highway Safety Act which starts the National Highway Traffic Safety Administration.

The City of Miami Fire Department claims to be the first in the nation to establish radio contact between a hospital based physician and a fire department rescue unit.

1966
On January 1^st  at 5:30 pm, the world’s first Mobile Coronary Care Unit begins operation under the medical direction of Dr. Frank Pantridge and Dr. John Geddes of the Royal Belfast Hospital in Northern Ireland. A conventional ambulance is used and is equipped with an improvised portable defibrillator.

On August 5^th, the clinical findings of Dr. Pantridge’s MCCU are first published in the British medical journal, “The Lancet.”

The National Research Council publishes a research paper, "Accidental Death & Disability - The Neglected Disease of Modern Society” that quickly becomes known as "The White Paper."

1967
In the September issue of Time Magazine, the accomplishments of the Belfast MCCU program is first presented to the American public.

The American Ambulance Association publishes an article stating that as many as 25,000 Americans are either crippled or left permanently disabled as a result of the efforts of untrained or poorly trained ambulance personnel. 

In Miami, Florida, Dr. Eugene Nagel and Dr. John Hirchmann begin to experiment transmitting EKG telemetry and voice radio signals to Jackson Memorial Hospital using the City of Miami Fire Department “Rescue 1” vehicle and firemen. The system uses an early generation rechargeable battery, a Motorola "Dispatcher" model VHF radio and a BIOCOM demodulator which is first packaged in a milk crate. Soon after, the equipment is transferred to an aluminum case and a EKG printout device is added.

1968
Dr. William Grace starts the first U.S. based mobile cardiac care program out of St. Vincent's Hospital in New York City's South Manhattan Borough. Grace had visited Pantridge in Belfast and soon sets 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 .

The American Academy of Orthopedic Surgeons (AAOS) began publishing the historic EMS textbook “Emergency Care and Transportation of the Sick and Injured." This is the modern EMS system's first well-designed and authoritative textbook for EMS personnel and is often called the “Orange Book.”  

Dr. Peter Safer begin trainings of Freedom House Project ambulance personnel as advanced life providers in Pittsburgh, Pennsylvania. Dr. Safer and colleagues then began riding with these newly trained ambulance attendants to staff a mobile coronary care unit. Under direct on-board medical supervision, the ambulance attendants perform advanced life support procedures. One of the Nation’s first out-of-hospital defibrillation occurs shortly thereafter in which the patient survives neurologically intact. However, no EKG telemetry system equipment exists at that time in Pittsburgh.  

In the Summer of 1968, a 56 lb portable defibrillator is developed by the Zenith Corporation. At almost the same time, the 33lb. Life-Pak 33 portable defibrillator/monitor is developed by Dr. K. William Edmark, founder of Physio-Control.

The Task Force of the Committee on EMS of the NAS/NRC is the first to attempt standardizing, on a national level, basic training requirements of EMS personnel. The result is a series of presentations, slides, and manuals from Dunlop and Associates called "Training of Ambulance Personnel and Others Responsible for Emergency Care of the Sick and Injured at the Scene and During Transport. "

The American College of Emergency Physicians (ACEP) is founded by a small group of physicians who share a commitment to improving the quality of emergency care, ACEP sets out to educate and train physicians in emergency medicine to provide quality emergency care in the nation’s hospitals.

In 1968, Anita M. Dorr, RN and Judith C. Kelleher, RN, working at opposite sides of the United States, perceived a need for nurses involved in emergency health care to pool their resources in order to set standards and develop improved methods of effective emergency nursing practice. In addition, they wished to provide continuing education programs for emergency nurses as well as a united voice for nurses involved in emergency care.

The Nation’s first 911 system becomes operational in Haleyville , Alabama on February 16, 1968, at exactly 2 p.m..

Kennestone Hospital, in the suburban Atlanta city of Marietta, Georgia sends a team of nurses to the Houston Medical Center to train at St. Josephs recently developed coronary care program and later return to Kennestone to open of the Nations first follow-on coronary care units.  

1969
In 1969, Dr. James V. Warren, then chairman of the Department of Medicine at Ohio State University (OSU), and Dr. Richard Lewis, later director of the university medical center's cardiology division, develops the "Heartmobile" as a Mobile Coronary Care Unit designed to deliver care to heart-attack victims more quickly. The vehicle was originally stationed at the OSU Medical Center and staffed by three firemen specially trained in coronary care and an OSU physician. The Heartmobile eventually became part of the Columbus Division of Fire.

In April 1969, the Haywood County Volunteer Rescue Squad members begin intensive training in and within months begin staffing two volunteer paramedic staffed Mobile Coronary Care Unit ambulances begin operation under the medical direction of Dr. Ralph Feichter.

The newly developed 33lb. Life-Pak 33 is first marketed through Mennen-Greatbach by Physio-Control which soon takes over all distribution under its own name. 

In Seattle, Dr. Leonard Cobb & several medical colleagues receive a grant from the Washington/Alaska Regional Medical Program to fund a program building on Pantridge's work in Belfast. They first deploy a Winnebago R/V chassis (nicknamed Moby Pig”) vehicle and configure it as the cities first MCCU. It is first based of Harbor View Medical Center and requires physician staffing supplemented by specially trained Seattle firefighters. The following year, the physician requirement is removed, “Medic 1” program starts using fire department paramedics only.  

The Miami, FL Fire Department initiates its full paramedic program under Dr. Eugene Nagel. One of the Nation’s first out-of-hospital defibrillation occurs shortly thereafter in which the patient survives and is later discharged from Jackson Memorial Hospital neurologically intact. By using radio transmission of the EKG, combined with verbal radio contact with doctors at Jackson Memorial Hospital and the University of Miami School Of Medicine, the firefighters were authorized to “shock” the patient who was revived from a lifeless state.  

The Committee on Ambulance Design Criteria published a report "Medical Requirements for Ambulance Design and Equipment" which it submitted to DOT-NHTSA. This report called for sweeping changes in both the design of vehicles and medical equipment carried aboard.  

During 1969, Dr. Walter Graf, cardiologist at Los Angeles’s Daniel Freeman Hospital, would start a coronary care nurse staffed mobile coronary care unit with grant funds provided by the local chapter of the American Heart Association.  

Dr. J. Michael Criley, head of the Cardiology Division at Harbor General Hospital sponsored and directed the training of six firefighters from the Los Angeles County Fire Department for a MCCU program that became operational by December using a station wagon "Rescue Heart Unit" which still required a nurse to be present.  

Dr. Leonard Rose began training private ambulance personnel as paramedics in Portland, Oregon to staff a Mobile Coronary Care Unit.  

In 1969, the historic “Airlie House EMS Conference is held in Warrenton, Virginia and attended by many prominent pioneering physicians, federal officials and representatives from the noted ambulance, safety, first aid and rescue organizations of that era.  

The first draft curriculum for a proposed National basic emergency technician course is finalized.  

The American Academy of Orthopedic Surgeons (AAOS) continues to sponsor special three-day Emergency Care Practical Courses around the country that build upon the Advanced First Aid course by introducing new patient care equipment innovations and care procedures. Such courses are first presented in such cities as Chicago, Atlanta and New Orleans.

Dr. David Boyd arrives at Chicago's Cook County Hospital to complete his surgical residency training and serve as resident director of one of the Nation's first civilian trauma units.

The American Association of Cardiovascular Nurses is formed, thanks to the efforts of those nurses and the support of physicians who understood the need for qualified nurses with specialized skills. At the time, the association's purpose was to help educate cardiovascular nurses working in newly developed intensive and cardiac care units. 

In late 1969, Metro Ambulance Service, Inc. begins experimenting with the transmission of EKG's to the Kennestone Hospital Coronary Care Unit in the suburban Atlanta city of Marietta. Metro deploys a Cambridge EKG machine which uses a John Walker demodulator at the patients home bedside to encode the EKG impulse to sound and then have it decoded at Kennestone's recently opened coronary care unit.

1970

By late 1970, the California Wedworth-Townsend Paramedic Act would pass to allow paramedics to operate in the field, without a nurse on board.  

In the Winter of 1970, Metro Ambulance Service, Inc., in the Atlanta suburban City of Marietta, institutes a mobile coronary care unit program in conjunction with Kennestone Hospital under the medical direction of Dr. Luther Fortson. The Georgia Attorney General, after a previous year of research, issues a legal opinion allowing such patient care. The requirements are that the program be accepted by the county medical society, hospital coronary care program and that all authorized medics must be trained, supervised and operate under the physicians personal license authority. This legal opinion took on the force of law, in absence of formal legislation, allowing advanced life support procedures which formal legislation would not be passed until 1976. Metro Ambulance Service became the first private ambulance service to institute paramedics, pre-dating a number of noted fire department programs that would follow. One of the Nation’s first out-of-hospital defibrillation by Metro Ambulance Service paramedics also occurred in Marietta, GA shortly thereafter in which the patient survives neurologically intact.  

On March 7th, 1970, Seattle's "Medic One" had its first response to a cardiac emergency without requiring the direct supervision of an on-board physician.  

New Ambulance Design Criteria is finalized and published by the National Academy of Engineering which features new recommendations for dramatically improving the design and equipment aboard ambulances.  

The Federal Office of Highway safety mandates individual states to pass new ambulance regulations or risk losing Highway Safety Matching Funds.  

Five demonstration areas were selected to explore the feasibility of using military helicopters and service paramedical personnel in civilian emergencies (Military Assistance to Safety and Traffic or MAST). Colonel William Hammett and Dr. Charles Gillespie help develop this initiative using the "Medivac" model used in both Korea and Vietnam out of Fort Sam Houston, Texas.  

The National Registry of Emergency Medical Technicians is established to attempt unification of exam and certification EMT on the national level and spearheaded by Rocco Morando.

The Emergency Room Nurses Organization on the east coast and the Emergency Department Nurses Association on the west coast joined forces and the Association is initially incorporated as the Emergency Department Nurses Association (EDNA) in Rochester, New York on December 1, 1970. 

The Society for Critical Care Medicine (SCCM) is established at meeting of 29 physicians in Los Angeles , California. Maxwell Harry Weil, MD, FCCM becomes the first president of the Society.

Dr. Norman McSwain develops a "Crash & Burn" course for ambulance and medical personnel who serve as volunteers at the newly built "Road Atlanta" Sports Club Car of America (SCCA) race track Northeast of Atlanta. This course is a pre-cursor for the later Pre-Hospital Trauma Life Support (PHTLS) that McSwain would develop some years later. 

1971
In Lafayette and Southwest Louisiana, Acadian Ambulance Service, Inc. (AASI) begins operation through a unique subscription membership program and rapidly expands to provide service to adjoining parishes (counties) when funeral homes elect to cease providing ambulance services. AASI eventually grows to serve over half of Louisiana with a fleet of medical configured helicopters serving both their service area as well as a huge number of off-shore oil production platforms using the latest advancements in EMS patient care and communications technology for that era..  

The first National Association meeting of the Emergency Department Nurses Association (EDNA) is held in New York.

The American Association of Cardiovascular Nurses changes and adopts the name "American Association of Critical-Care Nurses" to include all nurses who care for critically ill patients, regardless of the setting or diagnosis.

1972
In January- 1972, the NBC television program “EMERGENCY” made its debut and introduced "paramedics" to America.  

The American Medical Association's Commission of EMS publishes "Categorization of Hospital Emergency Capabilities." It established hospital guidelines for providing comprehensive emergency medical care and also the means to measure and classify the capabilities of a hospital for providing emergency care.

As Chair of the Committee on Planning for a Statewide System of Trauma Facilities, State Comprehensive Health Planning Agency in Illinois , Dr. Boyd planned and implemented a statewide trauma and emergency medical services ( EMS ) system (1970-72). 

The first civilian, hospital-based medical helicopter program in the United States begins operation  as the "Flight For Life" using a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado.

The US Department of Health, Education and Welfare (DHEW) are directed, during President Nixon's State of the Union Message, to develop new ways to organize EMS. Five demonstration areas are awarded $16 million. The following year, the EMS Systems Act is passed as Public Law 93-154 "EMS Systems Act of 1973" which amends the Public Health Services Act of 1944 by adding Title XII and allowing EMS to develop a comprehensive system. David Boyd becomes a significant force in directing this nationwide movement.

MUSEUM WEBSITE 

The museum website continues enhancement as we add new items to the Virtual Museum and continue to grow as the Nations premier EMS history source. If you have a historic ambulance or EMS photo that you have rightful ownership to and are interested in having it displayed on the Museum website, please contact the Museum Director at MedicMomSI@aol.com.

Mark Peck, Virtual Museum Director