Baltimore Pioneers Emergency Ambulance Techniques and Equipment
NOT TOO MANY YEARS AGO, standardized first aid courses taught along American Red Cross lines often were considered to be adequate training for crews on ambulances and other emergency vehicles. With today’s advancing medical knowledge and increasing population, as well as the attendant rise in traffic and the number of highways, this hit-or-miss training technique no longer suffices.
Baltimore, Md., the first city to place its emergency ambulance service under the direction of the fire department, answered 37,199 calls for assistance with its fleet of 12 ambulances in 1963. This compares with 5,000 runs made by five ambulances the first year the ambulance service was under the fire department’s jurisdiction.
Because of the large number of cases and the increasing number of serious injuries occurring on highways and in industrial plants, Baltimore, with the assistance of local hospitals, instituted a program of intensive specialized training for fire department personnel assigned to ambulance duty.
Specialized courses have been provided, with a number of doctor-specialists lecturing on various traumatic injuries, illnesses and methods of handling sick and injured patients. Held as a series of two-day training sessions, these special courses were attended last year by more than 2000 persons, including emergency squad members from Maryland and nine adjoining states. For example, among the various courses were the now-accepted methods of artificial respiration and closedchest cardiac compression pioneered by the Baltimore City Fire Department and hospitals in the city. As these techniques have been improved and perfected, particularly by Baltimore City and Johns Hopkins hospitals, the fire department has established schools to teach these life-saving methods.
Since the inception of the closedchest cardiac massage technique, it has been used to save the lives of more than 160 persons in Baltimore alone. However, despite its great value, it is extremely difficult and laborious to administer closed-chest compression manually, particularly in a moving emergency vehicle.
Due to a recently developed device —the Westinghouse Iron Heartmanual massage is no longer necessary. The Iron Heart is a portable, pneumatic device which resuscitates the heart by exerting an external pressure on the chest. Pressing against the victim’s breastbone with a rhythmic force, it pumps blood by alternately compressing and releasing the heart. Operated by compressed gas, the apparatus does not require electricity as a source of power. And newer models, in addition to providing cardiac compression, also oxygenate the blood of the patient, and then push the oxygenated blood throughout the body.
The ambulance model Iron Heart is preset at the factory to deliver a 1 ½ to 2-inch stroke at 60 cycles per minute. The Baltimore ambulance squad purchased three of these units and expects to purchase an additional nine shortly, thus providing one unit for each ambulance in service.
The other rescue skills of Baltimore’s ambulance crews are constantly shaipened. Among the numerous special courses each man must attend during the year is a four-day in-hospital training session given at the Baltimore City Hospital. Each member spends two days in the accident room and two days in the intensive care room, under the supervision of expert medical personnel. By witnessing and participating in actual cases brought in, the crewmen gain valuable experience, enabling them to better cope with similar cases encountered while on duty.
One of the more interesting and valuable programs developed by the Baltimore City Fire Department ambulance service is the “Emergency Squad Doctor.” This plan calls for doctors from four specific hospitals throughout the city to be available to respond to accident scenes when summoned by the fire department.
These doctors, all senior surgeons, can administer sedation, perform surgery, or render other medical services which might be urgently needed by persons trapped in elevator shafts, under train wheels, presses, etc. These Emergency Squad Doctors are assisted by the ambulance crew and a mobile hospital of the fire department which is equipped to handle emergency operations. Since the organization of the ESD program in 1959, it has been used 16 times, with no loss of life in any of these accidents.