EMS then and NOW .........

[crotchitymedic1986]

Moving a conversation from another post: In my "if you could wish for one thing post" the conversation morphed into a commentary of how little EMS has changed in its 40+ year history --- pay is low, need for more education, need for better national standards. And while I can not refute some of the negative views about the state of EMS today, I would like to add a little sunnier historical view (realize that many items that were new or non-existant to me at the time, may have been available in other parts of the country -- I can only speak about my experience).

. I got into EMS in the early 80's, went to medic school in 85, became a medic in 01/1986. Here are the changes I have noted, most of which were technological changes, but were improvements none the less. In 1986, you only had to have one certified person on the ambulance, the driver could be certified in CPR only. There were few women or minorities in the field (EMS & Fire). We had two man stretchers that had to be lowered to the ground and lifted up into the ambulance. Our cardiac monitor was a LP3, with no pacing or 12 lead capability, and was the size of a 20" tv set -- guessing 40-50lbs. We did not have glucometers or pulse oximetry -- much less capnography -- some services had Byrd respirators, but there were no ventilators. We had NO pediatric equipment at all, unless you count the wooden short back board we used for extrication that doubled as a pediatric LBB. Speaking of that, there were no KEDs, and back boards were made of 3/4 inch plywood, that each company made for themselves. We used sand bags and 2 inch cloth tape (no 1/4, 1/2 inch tape or transpore tape - you tore the size you needed) for immobilization, there were no CIDs or foam blocks (and ccollars were one size fits all). Oxygen tanks were M and E cylinders, and the M cylinder was housed under the squad bench in your van ambulance or suburban (Type 1s were around, but not used as much); it was alot of fun to change out your cylinder back then. You had to choose between using your federal Q siren, or having lights in the back of the truck when patient loaded, you couldnt have both. Emergency lighting consisted of beacon lights only, no strobes, no LEDs, no wigwags, no lightbars. Air conditioning in an ambulance was a luxury, not a necessity. Ambulances were gasoline powered. There was no 911, and everyone operated off of the HEAR system for radio traffic (pagers were the new, most incredible technology). A drug box consisted of Epi, atropine, bicarb, calcium, Lidocaine, NTG, and D50 --- there were no respiratory meds (aminophylline was in the more advanced providers box), no pressors, no medication drips, no antiemetics, and no narcotics. You had to call a doctor for all orders including IVs, and you would be denied over 50% of the time. The average EMT made about $12k per year, with the average medic making $14-16k, there were no health benefits or 401ks at most private companies, and you pretty much had to do a year of convalescent at a mom&pop before a 911 provider would hire you (then you got benefits). PLS was the new class to take, PALS, BTLS, PHTLS were not around yet. EMT was a 120 hour course, Pmdc was 200 hours. If you had any kind of critical care transport, a nurse from the hospital had to accompany you. And the thing that most company's advertised in the phone book was "Oxygen equipped and Radio Dispatched" -- that was what we were most proud of !

Have we come as far as we could have in 40 years, probably not ? But we have come a long way baby !

[crotchitymedic1986]

Also, no PPE except the sterile gloves in your OB kit, no safety vests, no safety needles or sharps containers on the truck.

[fiznat]

[firedoc5]

Well, Crotchity, we started at the same time and I'm in total agreement of what we did and didn't have back then. And just think, back then some of those things were considered cutting edge. Look how far EMS has come since then. I look now at what is all there now, and if we had them back them, just think how much easier it could have been for us.

Right now I'm just sort of glancing over threads, but later on I may add to your list of have and have nots.

[Chief1C]

You still, didn't have backboards, locally, in the 1980's?

[firedoc5]

You still, didn't have backboards, locally, in the 1980's?

Actually, we made our own. Plywood with a jig-saw, cutting out the pattern of an older spine board or even experimenting with a new shape.

[crotchitymedic1986]

as doc said, we had them, but you had to make your own -- folding aluminum boards had hit the market, but were too expensive versus making your own -- I cant imagine bringing the wooden ones back; splinters in the hand, couldnt really get blood out of them once the polyurethane wore off -- and there was nothing like the pucker factor you experienced when you lifted a large patient and heard the board "crack".

The last service i worked at before getting out had the hydraulic/battery powered stretchers -- god, what a difference there would be in my spinal cord if we had those back in the day.

[Kiwiology]

I believe as late as the 1980s here you had to call for orders to defibrillate and unless the doctor knew you were qualified to defibrillate you'd likely get denied.

Man I saw an old wooden longboard behind the second stetcher the other night, apparently its for show ony

[spenac]

Man I saw an old wooden longboard behind the second stetcher the other night, apparently its for show ony

We have several that still get used in disasters or if the hospital fails to return enough of them new fangled plastic ones.

[Chief1C]

We have wooden boards for patients that are being flown. We also make our own.. as well as use manufactured. Our service made a reputation for always having up to date equipment and supplies. Too bad they can't do that now.