Let’s start at the beginning…
I had mentioned earlier that paramedicine is a relatively new profession in comparison to say firefighting, or policing. In fact the earliest recorded ambulance dates back to 900AD and predates any other emergency service (1). Napolean himself employed a sort of ambulance service during war time to carry soldiers from the battlefield to nearby hospitals. (2) These services were staffed by “just ambulance drivers,” as paramedics hate to be called now a days. However, the faster time to definitive care of course greatly reduced morbidity rates. When all else fails, high flow diesel (or hooves) is a pretty good treatment!
In the 1900’s medical treatment began to be incorporated into the transport service. For example during the American Civil War, Jonathan Letterman devised a system of mobile field hospitals employing the first uses of the principles of triage. Splinting closed femur fractures reduces morbidity from 80% to 20%. (4) After returning home, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, and commenced the creation of volunteer life-saving squads and ambulance corps. (5) World War 2 recognized the first organized ambulance effort by the medical community, as well as the first effective use of aeromedical transfer. (6)
In the Korean War (1954), specially trained medics were used to deliver physician-type care in the field. In 1957, the first successful use of the Hopkins External Defibrillator was demonstrated on a human. (7) In 1959, external defibrillators were proven to be effective for the treatment of VFIB but were quite heavy (100lbs) and typically placed on unsteady carts that would tip over; hence the term “crash cart”. (8)
During 1959, in Moscow, Russian physicians moved out into the streets as a pilot project, to see if they could positively impact patient care. They proved that Advanced Life Support (ALS) techniques made a significant difference in patient outcome. (9)
From 1958-1960, Asmund Laerdal developed Resusci Anne to be used to train people in mouth to mouth resuscitation. (10) Going off topic for a moment here I’d like to add a note on Resusci Annie, which I have personally used to teach CPR. My current boss, a history buff, gave me an interesting (creepy) bit of information on her yesterday. So Asmund goes into a death mask museum….Wait. What?! Ok so pre-CSI, a death mask was a mold made of a deceased person’s face that would be kept in case family or friends showed up later to identify the body. When touring a death mask museum Asmund had been so struck by “Annie’s” serene features and tragic early death that he adopted her mask for his work. The face is actually that of an unidentified young woman reputedly drowned in the Seine River around the late 1880s. Resusci Anne was based on the research of Peter Safar and James Elam, and was first introduced in 1960. The mannequin is designed to accurately simulate the human respiratory system and external body landmarks in order to facilitate training. (11) Also known as Rescue Annie, she has earned the title of the most kissed face of all time as has been credited with saving lives across generations. Think about that next time you take a CPR class!
Now back to paramedics.
In 1966, the Ontario Ambulance Act was introduced by the Ontario Government in order to delegate authority and responsibility for licensing, standard setting and coordinate services. Prior to 1970, there was no coordination or continuity of service and no standards of training or practice in Ontario. (12) In 1972, Ambulance service branches were put in place within the Ontario Ministry of Health. In 1975, the Emergency Medical Care Attendant (EMCA) program was introduced in Community Colleges and by 1977, Advanced Cardiac Life Support (ACLS) programs were initiated in several communities. (13) The 1980’s and 90’s, saw the addition of skills such as pulse-oximetry and capnometry, 12-lead interpretation, pronouncement in the field and the use of on-board computers for patient care and documentation. (14)
The Paramedic Association of Canada (PAC), formerly the Canadian Society of Ambulance Personnel (CSAP), is Canada’s only EMS organization of prehospital practitioners. The association has been in existence since 1988 and is currently comprised of over 14,000 practitioners located in the following divisional chapters: British Columbia, Manitoba, Ontario, Quebec, New Brunswick, Prince Edward Island, Newfoundland and Labrador, and the Canadian Armed Forces. (15)
The National Paramedic Competition began in 2003 with the hosting of the first event by the Durham Paramedic Association in Whitby, Ontario. (16)
Paramedic regulators from every province began working together informally in 2008 to discuss ways to ensure compliance with the new labour mobility requirements of the Agreement on Internal Trade (AIT) that came in to effective on April 1, 2009. (17)
So, although the idea behind paramedicine and prehospital care has been in the works for centuries, it wasn’t until very recently (the 70’s really) that it was officially recognized. The profession has grown quickly and dramatically in the past few decades. Some scope of practices include scope of Practice with the addition of external transcutaneous cardiac pacing, synchronized cardioversion, chest needle decompression, nasogastric tube insertion and the addition of several new medications, rapid sequence intubation, chest tube insertion, folley catheter insertion to name a few. (18)
Some practitioners, myself included, are often frustrated by various idiosyncrasies in the profession (particularly when moving between provinces). But when considering paramedicines relative infancy, it deserves more patience (haha, get it?). Policy change is often studied and reviewed by either a provincial college or district base hospital to gauge it’s potential benefit to patients and its financial feasibility.
Now for some wise words…
Take care of each other out there!
(1-2, 4, 6, 7, 9, 10, 12, 13, 14, 18) http://www.peelparamedics.ca/history-of-paramedics/