From the Civil War to Star Wars: A Brief History of EMS in the United States

I've been writing about EMTs (emergency medical technicians) for a while, and, by extension, fire fighters (who are increasingly required to have some level of EMT training) . All of this medical training falls under prehospital care - emergency medical services (EMS) provided before a patient enters the hospital, either at the site of the illness or injury or during transport to a hospital. EMTs range from first responders to paramedics, who have the most medical training (measured in hours of classroom and clinical training and equipment/techniques used).

Prehospital care is a structured and fairly militaristic culture, with both the camaraderie and tensions of long shifts, and sudden exposure to trauma. EMTs never know exactly what they will encounter each day when they go out on calls, from a simple transport that didn't even require an ambulance to a wrenching pediatric emergency.

Modern EMS, in fact, has military origins, since it arose as a way to manage injured soldiers. During the Civil War, wounded soldiers often languished for days on the battlefield before they were treated, according to a fascinating Elsevier publication on the history of EMS. In 1862, General Jonathan Letterman, a Union surgeon for the Army, implemented a formal system to treat wounded soldiers and transport them quickly to field hospitals. His ideas for improved medical treatment were based on those of a Baron who grappled with the same problems during the French Revolution. In many ways, Letterman is the father EMS in the United States.

Fast-forward about 100 years to the Highway Safety Act and the creation of the U.S. Department of Transportation (DOT) in 1966. The DOT standardized EMT training, and in 1970 Ronald Reagan, then the governor of California, signed an influential law giving paramedics more legal rights to provide advanced treatments to patients.

And then there was Hollywood. Many EMTs were influenced by, or are interested in, the TV series Emergency!, an NBC drama about Los Angeles paramedics that ran from 1972 to 1977. Emergency! was not only extremely popular, but it also helped lead to landmark legislation, the EMS Act of 1973 (Public Law 93-154). Spearheaded by Senator Alan Cranston (D-CA), the law improved funding for paramedic training in the United States (federal support for EMS has decreased since the 1980s, however).

And Star Wars? The Army founded a hospital in San Francisco's Presidio in the 1890s to treat the great numbers of soldiers going the Philippines (and often treating returning soldiers who had contracted complicated tropical diseases there). This hospital was renamed the [Jonathan] Letterman Army Medical Center in 1911. In 1994, the Army turned over the Presidio to the Golden Gate National Recreation Area. The hospital was eventually torn down and George Lucas, of Star Wars fame, of course, built the new Letterman Digital Arts Center there.

The Poinsettia Thief

My youngest child was born in December, narrowly missing both Pearl Harbor Day (an inauspicious birthday) and a nurses' strike and subsequent lockout at my local hospital. To celebrate the holiday season, the lobby of the hospital was full of potted red poinsettias, their pots wrapped in colorful foil.

My recovery room in the maternity ward was across from the nurse's station, which was convenient as a patient but not conducive to getting much sleep. The nurses (who were great, by the way) were a chatty and jovial bunch, post-strike and lockout and pre-holiday. One nurse had a birthday that night, so they belted out "Happy Birthday" to her at some pre-dawn hour of the morning. In far more hushed tones, however, they also talked about The Thief.

Earlier in the evening, a new father had arrived at the hospital to see his wife. As he walked through the lobby, he stopped to pick up one of the poinsettias to bring to his wife as a gift. A hospital staff member saw the man take the plant and called security, who followed the man up to the maternity ward and stopped him.

The father claimed that he thought the plants were free. That's a weak excuse, but I guess he had to say something. Would he help himself to the holiday decorations at his workplace or at a mall? More to the point, would a cash-strapped hospital, fresh from battling the nurses' union, give away free plants in its lobby?

Is a poinsettia even a wise gift for a mother and infant, since the infant soon will start gnawing everything in sight once teething sets in? (Poinsettias are not poisonous, but their sap can irritate the skin.) Maybe the father thought that it was better to visit his wife red-handed than empty-handed.

Roller Coasters and Otolaryngologists

How does an otolaryngologist (an ear, nose, and throat specialist) relax after a long day? On a roller coaster, apparently. I heard this story from an otolaryngologist, and it's either a fact or a clever piece of fiction that a group of otolaryngologists travel the country together to ride roller coasters in their free time.

I have to laugh when I imagine the group stumbling, dizzy, off the latest ride at Great America. Dizziness is a top reason that patients visit their primary care physicians, and some of these cases are referred to otolaryngologists, who treat inner ear problems. The inner ear helps regulate balance in the body.

A wide range of fairly benign problems can trigger dizziness, such as an inner ear infection, a drug interaction, or anxiety. More serious problems such as Meniere's disease (vertigo caused by the fluid imbalance in the inner ear), brain tumors, and multiple sclerosis can also cause dizziness.

Are the roller-coaster otolaryngologists simply so fascinated by the workings of the inner ear that they seek out sensations that are partially regulated by the inner ear? Do they think about their patients as the roller coaster spins them around another loop-de-loop? Or is the irony of the situation part of the fun for them?