The Beginning of EMS

[Dustdevil]

...and the need to transport someone laying down. That is where funeral directors came in, we picked up victims on stretchers, and transported them flat in our hearse be it a wagon or a car. So, naturally, this was the best idea for a modern ambulance. We already had the car, and the bed; why not make a little money on the side?

The significance of this point should not be overlooked. Too often I hear people inaccurately talking about how EMS was a conflict of interest and all about the money for funeral homes. That's a crock of crap. We as funeral homes began running the ambulance services not as a business venture, but simply because our communities requested it of us, as we were the only ones with vehicles suitable for the purpose. There was no money made. It was simply a way to provide a valuable service to the community and establish goodwill and a positive image among the citizens. The best we could hope for was that somewhere down the line, they would remember that service and choose us for their funeral needs. We certainly weren't guaranteed that business.

In 1973, I was paid ten dollars a day to stay at the funeral home. When not making ambulance runs -- which were much more rare back then -- we answered the phones, greeted visitors, carried flowers, cleaned and vacuumed the offices, moved caskets around, and basically assisted in normal business. When we made an ambulance run at night, I think we got an extra ten dollars. We charged about $30 dollars for transportation, so IF they collected on that bill, they really made no money after paying two attendants and costs. And of course, like today, many simply didn't pay. For the most part, funeral homes were not pushed out of EMS, as is popularly theorised. They jumped at the first opportunity, as soon as somebody else filled the need!

All that was required to work on an ambulance in 1973 was a Red Cross Standard First Aid card. To drive, you also had to be at least eighteen years old and have a driver licence. I was only sixteen, but I already had an Advanced First Aid card. I was one of the highest trained guys in the company. They were just beginning to train Paramedics for the fire department in Dallas, but nowhere else. There were a couple EMT schools just opening up, as well as 40 hour courses called "Emergency Care Attendant," or ECA. I got into the ECA course soon after starting to work and became the first ECA in the company at age sixteen. There were two other high schoolers working there. The rest of the guys were probably between 18 and 22, except for the funeral directors, who pretty much left all the ambo work to us kids.

I have to say, that list of supplies that Robert posted is a LOT more extensive than what we carried in 1973! We had a total hodgepodge of assorted first aid supplies that was not consistent in between the units. What any unit had on it was very dependent upon what we could beg, borrow, or steal from the ER. The best ambo -- the new one that all the senior guys used -- had a nice salesman's sample case full of bandages, glass bottles of saline, a stethoscope and sphygmo, and not much more. The others either had a Samsonite briefcase or a Craftsman toolbox for our med kit. Most of the time, we never even took the kits out of the ambo unless we knew it was an injury. Even then, it was rarely used, much like the so-called "trauma kits" today.

We had three ambulances. Top of the line was unit 83, a brand new Chevy Suburban that had been customised by a "professional car" builder in Dallas. Solid white with no markings other than the name of the funeral home painted in black script across the side and a nice new Federal TwinSonic light bar on the roof. I think it was the first ambo we had with an electronic siren. Next was unit 82, an older GMC Suburban that they had built the cabinets and cot-rack for themselves. It had three Federal Beacon Ray's on the roof, the kind that had four bulbs, including two that point up and down, and they oscillated back and forth instead of rotating. It had a Q2 siren in the middle. Finally, unit 81 was a combination car like Robert described. A 1970 Pontiac high top hearse, painted blue with a black vinyl roof. No markings except for the metal signs in the back windows with the name of the funeral home and the numbers "81" stuck on each side of the single Federal Beacon Ray mounted on the roof. It had a Q1 under the hood along with a couple of red flashers behind the grille. We used single channel Motorola low-band VHF radios with our own channel in the 45 mhz range. We constantly got radio skip from hospitals, veterinarians, and other funeral homes all over the country.

...and the need to transport someone laying down. That is where funeral directors came in, we picked up victims on stretchers, and transported them flat in our hearse be it a wagon or a car. So, naturally, this was the best idea for a modern ambulance. We already had the car, and the bed; why not make a little money on the side?

And now, back to the most significant point about the above statement. The fire service does a lot of revisionist mouthing off about their altruistic vitrue and long mission of protecting life leading them into EMS. It's crap. Once you have the historical perspective, you quickly realise that the fire service ended up in EMS for very much the same reasons that the funeral service did. Community leaders stuck the fire service with EMS for one reason, and one reason only. They figured they were already paying those guys to sit around on their arses all day anyhow, so why not make them run the ambos and earn their money? Just like the funeral service, the fire service ended up in EMS simply by default, not because they were best suited to do so.

[bandaidpatrol]

Don't know about you, but I charged to use my hearses as ambulances! We had so many emergencies, we even began to run and buy units that were made to be used as JUST ambulances. Started out as ten or fifteen bucks a pop, then up to fifty by the end of that era.

Why did I quit? I was paying people to run the ambulance, more than EMT's were making in the 80's. But people stopped paying round about 78-79. The state gave me 10% of the bill if an elderly person didn't pay. I made 35% off the county if someone didn't pay for a funeral. It was just a hassle. So it went from a paid service run by the funeral home; to a volunteer service run by the fire dept. They had EMT's, and the manpower, I didn't want them running on my calls. I had a standard, they had shortcuts.

[Dustdevil]

By the way, when I came home from my first stint in the military in 1978, that funeral home was still running EMS for the city. Still running three units, with all of them being high top vans (type III) purchased within the last two years. Everybody was at least an ECA with about half of them being EMT's. By then, a couple true ambulance services, not associated with funeral homes, had sprung up in the Dallas area and were moving towards taking over EMS from the funeral homes. They did so in my hometown in 1976, the same year the first paramedic class in the county graduated, but did not provide ALS until 1986. Dallas Fire Department took over EMS for the City of Dallas around 72 or 73, but didn't provide ALS until 1975. And around 1977 is when funeral homes started getting out of the business around the rest of the area. My old funeral home gave it up to a short-lived hospital-based service out of Dallas about 1980 or 81. The City of Fort Worth continued to be run by the long time funeral home provider up until about 1983 when a private company was contracted. I don't think I have seen a funeral home run ambulance service since then.

[Ridryder 911]

These guys were around when Cain slaughtered Abel.. :wink: I came after Moses... something about a tablet (protocols?) or something. My first exposure to EMS, when I was a kid in the medical explorer program about 1973. Already knew that I wanted to be a physician in the back of a ambulance, after my brother had a major MVC. When Johnny and Roy came out in the t.vshoe Emergency, that was it!

In my Senior year, I worked in ER and then the day after I graduated from high school, I started my Paramedic training, could not attend EMT school because they had just finished the program and had to wait to get the EMT after Paramedic... (I know it was backassward) .

We had 4 units, all with ALS capabilities, this was in 1976-1977. Proclaimed the first "modular" ambulance, was one we purchased from a funeral home, it was what "modular ambulance" designed their "mods" after. It was an old converted bread truck.. there were 10 federal beacons, one visibar, and flood lights on each corner, clear and blue lights in the back, with lights in each of its homemade cabinets, a 64 gallon gas tank, two sirens, and did a whopping 48 mph at top speed. The EMS director (ambulance) was a chevy low top, with a visibar, and push-bar on the grill (in case they would not move out of your way) and a 3 inch star of life emblem on the door. This was the first unit I responded in.

Each unit had a cardiac monitor, a Gould, Burdick, & MRL (physio-control was not invented yet) of none of them had a print out adn they all had the bouncing "ball" oscilloscope, where you had to pull over to see if the patient was in v-fib or not..... no, I am not joking. The Burdick was the favorite because it weighted only 45 pounds, not like the Gould which weighed 65 pounds. Yes, we all looked like body builders. I remember the first time I defibrillated a patient, (yes, we used paddles, and no there was no such thing as defib pads) we carried either the gel (which made it so slick) or a bag of 4X4's soaked in saline.

The med's we carried were the usual ACLS (there were no such abbreviation then) of Epi w/4"cardiac needles to perform intracardiac if you could not get an IV, calcium chloride, and NaHC03, atropine, decadron, mannitol, Lidocaine, Dopamine, Isuprel- (of course there were no such thing as pre-mixed). I still remember the the v-fib procedure was 1 mg of Epi, 2 amps of Bicarb, then shock....

Intubation was performed, but we had to demonstrate that we could ventilate with BVM's for at least 6 months using proper manuever's and not getting gastric distention, before the anesthesiologist would sign off. Betadine Helofoam was used for burns, and we carried 6 liter saline bags to irrigate wounds. There were no such things as helo except for military use, and trauma centers was being formed as Dr. R Adams Cowley was just researching the "Golden Hour".. My work week consisted of 24 hr shifts, with at least 12 working in ER between ambulance calls, this was 24 on 24 off then every other week end you had 48 hr shifts. Of course you only got paid 16 out of 24, which I later found out was gracious because they only had to pay us 12 hrs.... :?

There were only 2 services that had Paramedics in Oklahoma at that time, Tulsa and us (which we were rural). No one ever seen anybody bring in a patient with an I.V., and boy did the sparks fly from nurses (usually most ER's were staffed by LPN's) very few ER's had physicians present in the ER (except teaching hospitals) and paged physicians for any orders.... no, IV's were not usually routine from nursing staff.

There were many times that curtains were pulled in from of me and nurse would grab your stretcher as you entered the ER curtain (usually no separate rooms) and you were informed to "stay out" they would return your stretcher. You were not allowed to touch, perform care, etc. to the patient you might had just resuscitated.. you were not a nurse or Dr. When a physician entered the room usually all stood up and offered their seat. I know of EMT's not allowed to take vital signs in the ER, only to clean equipment and be a gopher or perform tasks. Usually nicknamed "enema maintenance technician " for a reason.

Equipment was usually in short supply, and I didn't realize that there was a short arm splint for years..... I thought IV tubing boxes were for that... I do remember ER docs pitching in to get us supplies... When the federal KKK spec grants came through, it was like Christmas. We received our first van ambulance.. a Collins with the unique colors of course... orange and white inside and out.

Ahhh... memories, yes some was very memorable, mainly the "guys"... and one of the 1'st female EMT. They were truly dedicated, and I remember them stating "We are the pioneers, one day things will be better, just hope they appreciate the sh*t we went through"..

So as you crawl into your $hundred thousand dollar rig, and you hook up your 15 pound monitor, and attach them to the autopulse.. and perform 12 lead EKG's and have the knowledge of interpreting them, have the ability to obtain a accredited degree, remember those that made it possible, it just didn't happen.

Be safe,

R/r 911

[CTEXPLORER]

So as you crawl into your $hundred thousand dollar rig, and you hook up your 15 pound monitor, and attach them to the autopulse.. and perform 12 lead EKG's and have the knowledge of interpreting them, have the ability to obtain a accredited degree, remember those that made it possible, it just didn't happen.

I think this is why this thread is important, not only for me to understand the career Im so passionate about, but also for other people.

You started out in Exploring? Im in an exploring program, hense the ID. Tell me what it was like then.

[Ridryder 911]

I went into speciality exploring, while I remained in my troop. The Explorer Post, as a speciality had just really begin, most were Sea Posts, Scuba, Law Enforcement and a few Firefighting etc.. At that time there were no "EMS" posts, the closest thing was called Emergency Services. My hospital had a very active explorer posts and one of the first co-ed :wink: .. We went to Dallas to see an "open heart" surgery, which in those days was a very big deal, since most cardiac surgeries were only experimental, as well we observed an autopsy. We had classes and guest speakers, we were allowed to observe and assist in each department to make rotations to explore where we might want to pursue. This even included making rounds with physicians, in which they were very active in this posts as well.

We won several local district, national awards for services, and programs we presented. I was a member from age 14 to about 17 or so. After I became a medic, I then started an EMS post. This post was VERY active as well. We required all members to go through 1'st responder course and then EMT if age appropriate. Many were not directly interested in EMS, but; we understood that and developed a more "medical" approach. I later became the Post Advisor and recruited several Professor's from local Universities to assist. We continuously stressed the importance of higher education and attempted to assist in getting grants & information for posts members. Out of the 50 members or so... 8 became physicians, 2 became P.A.'s, and about 4 went on and worked as Paramedics for several years, and many others went into nursing or other health careers. Over-all I considered it a success. I still try to keep in contact with a few... and this has been about 25+ years ago. With HIPPA and many other variables, I would imagine it is more difficult to allow members to actively participate. But yes, Posts can and do work... when operated and directed right.

I wish you luck..

R/r 911

[CTEXPLORER]

Im the Secretary of my post. We just started the post in Fall of '05. We only have about 14 or so members. Were trying to get off the ground first before we accept more members. Everyone has a first-aid card, CPR card, and most everybody has a FR certification. We took classes like airborne and bloodborne courses, and HIPPA, which allows us to actively help out on both routine and emergency calls. I feel lucky to be able to talk to a post advisor that successfully ran a post. What kind of things do you suggest we do? Is having guest speakers a good idea? If so, what kind of person? What kind of events did your post do? What kind of fundraisers did you guys do?

[Defiant1]

Im the Secretary of my post. We just started the post in Fall of '05. We only have about 14 or so members. Were trying to get off the ground first before we accept more members. Everyone has a first-aid card, CPR card, and most everybody has a FR certification. We took classes like airborne and bloodborne courses, and HIPPA, which allows us to actively help out on both routine and emergency calls. I feel lucky to be able to talk to a post advisor that successfully ran a post. What kind of things do you suggest we do? Is having guest speakers a good idea? If so, what kind of person? What kind of events did your post do? What kind of fundraisers did you guys do?

that's a good start, i'm also in an Explorer Post, as far as the training, that's a pretty good start. as for guest speakers, YES!!!!! they are a perfect idea, i remember our first guest speaker was Mike Perry, a FF/ EMT-P/ RN from New Auburn WI. you may be able to get him, www.sneezingcow.com is his web address, so you can learn more about him. also, you could try like haz-mat teams, even the medical examiner/ coroner would be a good idea. a great idea would be getting an EMT-B instructor from your local tech college or whoever teaches EMT-B level in you area to come and speak, kind of give your post an idea of what EMT class is like. that's all i have for suggestions.

scott

[bandaidpatrol]

White and Orange

Cotillion White and Omaha Orange were the colors specified for many ambulances in the late 70's.

[bandaidpatrol]