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Significant Moments in U.S. Emergency Medicine, Pt. 1

2020-04-27 | 🔗

In this first episode of a two-parter, we’ll be covering early emergency response services, a little bit of CPR history, and advent of the emergency care specialty for physicians. 

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This episode of stuff you miss than history glass, is brought to you by newly natural's. If you wanna, try CD, but you don't know which see media company to trust, here's a tip just like with food. You should know where the product comes from and what goes into the bottle newly natural's full spectrum. Civilly oil is extracted naturally, from therapeutic hemp plants grown organically in Colorado. There are zero additives that only two ingredients: the organic C b, the extract and USDA certified Organic HEMP seed oil. Just for our listeners visit, and you l, E, F, Natural's, dot com and intricate stuff to get twenty five percent off your order. Today, this episode is brought to you by Milosevic, Keys, look sometimes that long, then yoga classes, just not in the card, so maybe a cookie is peppered farm. Olano believes you should make some time for you self once in a while, I
I have a particular space in my sewing room that I like to just take a few minutes. Every day I sit there. I think about things, it's kind of like meditation and munching at the same time being it that yummy beautiful cookie flavour, it makes it luxurious and delightful and I always feel recharge. Mulatto cookies are truly a treat worthy of your me time, their delicate and crispy, with luxuriously rich chocolate in the middle. You really want to keep these just for you so remember to say something for yourself with peppered farm Olano. Welcome to stuff, you missed in history glass, a production of I heart rate, Hello and welcomed the pot cast on how we fried and I'm Tracy Wilson, ok Tracy. There have always been situations where people have been in need of immediate medical care, thus part of being a human, and we,
oh recently. Pursued about how military needs during wartime have driven a lot of innovation in emergency medicine, but of course, civilians need emergency care as well in our current pandemic has brought the focus on to the medical care providers, who are often doing far more than seems humanly possible to take care patience and, as I continued to see headlines specifically about how to know when to seek emergency care. During this time it may be one talk about some of the really big moments in emergency medicine as a developing field, because it's actually still a baby. It's a fairly new. area in medicine, Also. We want to make sure that, in the interest of expectations management we let everybody knows that this primarily looking it emergency care in the? U S, we briefly mention developments in other countries just here and there, but that's about it,
and even narrowed down mostly to one country. It is still too partner, and it is still were near comprehensive there, our entire books written about the history of emergency here, just in the U S, I wanted to talk about it and kind of honour the people that do it so well limiting here- is cover some of the key areas in developments in its relatively short history. So, in this first episode we're. Gonna talk about early emergency response services and a little bit of CPR history and the advent of the emergency care specialty for physician. point firmer in the next episode. We're talk about the advent of paper that served as a turning point for emergency medicine will also talk about the ad. then of the nine when one service and the ambulance service that set the model for all of the others. The first sitting
ambulance in the United States started rolling in eighteen. Sixty five and we really dont, know a whole lot about it. Records are pretty sparse, but there is a personnel record for an ambulance driver in Cincinnati, Ohio, commercial hospital that person with that in that years, hospital records that driver was a man named James are Jackson when his annual salary was three hundred and sixty dollars a year, that is all we know that and because of the scarcity of documentation for whatever programme was in Cincinnati the ambulance, that's more common, We cited as the first city ambulance was in New York City and it was a new initiative at Bellevue Hospital in eighteen, sixty nine and it was the brainchild of Doktor Edward, be Dalton. Who
in turned before the: U S, civil war as a staff. Surgeon at the hospital Dalton had served with the union during the civil war, working as an inspector of field hospitals for the army of the Potomac one of his duties as establishing a system to get wounded, soldiers to field hospitals really quickly. He set up a similar system to the one that for doctor and recent show subject, Dominic genre Ray had done in Europe a few decades earlier and when The war ended, Dalton was back in New York and then he applied his experience in transporting soldiers to creating similar service for the civilian Population Bear Bellevue. New ambulance, which was a horse drawn wagon, was equipped with a first aid kit that included tourniquets bandages, sponges whisky or brandy. Depending on what Sir she read and a strait jacket in case of patient was unruly or dangerous. It also
floor, slats that could be taken out of the wagon and used as a stretcher, Bellevue amulets didn't have a siren. The driver would bang a gong as he drove to alert. Other people on the road to get clear seems challenging to be downs. Ambulance was called so seems of medical need one thousand four hundred one times over the years, that number grew and even as motorized ambulances were developed in that happened. First in Chicago, these horse drawn wagons of Bellevue still covered their territory alongside their automated colleagues that went on for years. The last of the horse, strong ambulances and the fleet was hired and nineteen. Twenty four in nineteen twenty eight Julian stand we wise of Roanoke Virginia founded the Roanoke Lifesaving and first aid crew, and this was the first volunteer rescue unit in the country. It was made of ten men, including wise, and each man
need a fishing tackle box. As his med kid inside these kids were tonic acid. compound ammonia, inhale aunt tincture Marseille, late and poison the wash em. When I first looked over this, the idea that poison ivy, Wash I would was included, is obviously very useful to have the poison ivy wash em there. But as like an emergency thing that that delighted me a little bit. Well, I suspect that they were kind of a first aid grew yeah, and this is out in Virginia. There was probably a likelihood that people were get members, some poison, ivy air- calling that emergency tree by women. I I also genus somebody who had to go to that the emergency room because of a poison ivy exposure, because it was it was dead, vines that they didn't recognize is poison ivy and they were outside sweating, and it's like they got that oil
face with was a whole bad situation. Yeah have I didn't go to the emergency room? I went to urgent. I had for Ben allergic to poison ivy until I came into contact with it at the same time that I had a tattoo that was He lived in my body all oh yeah. This is too much at my kind of dealt with the rash and then one morning we are actually invitation, and I woke up in my entire face was swollen- and I will say this get in the car and, let's start me up up up up yet so so wisest volunteer rescue plan had it start almost twenty years,
for when Julian was only nine through witnessed a canoeing accident that resulted in two people, drowning, because the current was quickly carrying these canoeists away from the small amount of help the bystanders we're trying to offer. They are basically trying to extend tree branches out there. The event be, would later say, left an impression on him. They just gave him a determination that he cared for the rest of his life, quote Roy then I resolved that I was going to become a lifesaver, never again what I watch a man die when he could be saved and young man and his twenties wise, had taken a job at the Norfolk and western railroad. He was working as a clerk recruited, his fellow volunteer rescuers from his coworkers there at the railroad and they actually operated there. well set up out of the railroad offices and they use the phone number of the railroads Head clerk Harry Avis as their contact number so,
Harry got an emergency call. He would then really that info to the rest of the crew, and then they would spring into action, was not a huge success. Initially, only six emergencies were called under the crew their first year, and often they weren't speedy enough to do a lot of help by the time they arrived on the scene, but they kept at it. They kept improving driven by wisest at those of quote save seconds, and you have a better chance of saving life there, gained national attention in nineteen thirty one when they revived a sixteen year old boy after responding to a drowning call yeah, they became headline news, and that brings us to the topic of resuscitation. But before we get into that which we are to do, let's take a little breather of our own, and we will have a sponsor break this episode of stuffy miss than history glasses, brought to you by the goal.
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if you want to try this out, go to new leaf, natural's dot com. That's an! U L, E F, Natural's dot com! You can get twenty five percent off your order at new Leaf natural's dot com by entering the promo code, stuff. So about what element that we talked about a sixteen year old boy being rescued after a drowning call, brings us to resuscitation in general. So the idea of artificially restarting a patient's breathing in heartbeat has been part of emergency medical care for hundreds of years. It goes back, at least in the western literature to swiss physician.
Paracelsus in the fifteen hundreds and in those early days. This whole thing was done by using a bellows to pump air into the unconscious person's lungs. They would basically put the end of the bellows in their mouth and then carefully work. The bellows before that common, but not super effective approach, was to whip and unconscious person in the hopes that it would shock them. Awake. The earliest western record of mouth to mouth resuscitation be used dates back to seventeen thousand three hundred and twenty one scottish surgeon Williams Hossack was able to revive a coal miner paint years later. The French Academie DE sales recommendation that mouth to mouth resuscitation should be used for drowning victims
Four years later, Scotland's doctor Toxic wrote a clinical description of the mouth to mouth method that he had used in one thousand, seven hundred and thirty two yeah, when he initially did that he was kind of improvised in trying to figure out a way to save this person, and it wasn't until quite some time later that he actually wrote it up as a way that other people could follow. There was enough concern that people were not getting proper resuscitation attention in the late 18th century, but it's one thousand. Seven hundred and seventy four, the humane society for the recovery of persons apparently drowned, was formed. This group was established in London at the chapter Coffee House, in St Paul's churchyard by Dr William Hawes and Dr Thomas Cogan. The pair had invited a number of friends to help establish the society which was intended to promote techniques of resuscitation
I did this by giving awards to people who performed life, saving ACT, so they could draw little attention to it and that society actually continues to this day, although in one thousand seven hundred and seventy six, the name was changed simply to the humane society, and then it changed again in one thousand. Seven hundred and eighty seven to the Royal humane society in the 1850s two different doctors and London came up with methodologies for resuscitation having to do with repositioning the body, Dr Marshall Hall, road up his method in his book. It's rational and it's remedy. Basically, he was in people to roll and unconscious person off their back and onto their side in an effort to eliminate any airway obstructions and in some cases, rolling farther onto the stomach was recommended. Eventually, hall refined his techniques. You include the application of prayer sure to the chest. Two years later, Doktor Henry Sylvester developed an idea along a similar line of thinking that repossessed
the body could help a person breathe in Sylvester method. The patient remained on their back, but their arms were manipulated to try to restart respiration first, the arms were raised up over the heads of the unconscious persons. Chest would naturally expand and then the arms were crossed and placed over the chest to provide pressure to encourage exhalation in eighteen. Fifty nine doktor Sylvester published his method in the british medical journal. He was met with some criticism, primarily that if a patient remained on their back, their tongue could still obstruct the airway. Just the same. This method was widely touted for decades. It was published, as recommended resuscitation technique in the handbook describing AIDS for cases of injuries or sudden illness that was written by surgeon, major Peter Shepherd of the training Organization, Saint John
ambulance in eighteen. Seventy eight and it remained in every subsequent printing of that handbook. Until one thousand nine hundred and seventy two, there were other resuscitation methods being tested during the late 1800's, including chest compression, which was tested on cats in Germany in eighteen. Seventy eight by eighteen. Ninety one chest, compression used alongside ventilation, had saved the lives of two human patients in Germany, Russian, was also seeing some success first in dogs and then in human cases, in the early nineties, hundreds in Cleveland Ohio as part of the work of Doktor, George Crile, but compression as a means of resuscitation kind of fizzled out until it started to be
in tandem with this information. Decades later, the hall and Sylvester methods were eventually replaced by the holder Nielsen method developed by danish military physical fitness instructor in the nineteen thirties during a massage Nielsen notice that when he was lying, face down and therapist applied pressure between his shoulder blades, while standing in his head, he exhaled involuntarily. So he combined this idea with positioning the patient's arms. asked above them with their head, turned sideways and resting on their arms. So yeah he would. Basically it's almost like. You would lie down like in the sun at the beach on your stomach. If you did such things like with your head resting in your arms and then from above and in front of your head, he would apply compressions at a regular period in nineteen. Fifty six, a big breakthrough in emergency medicine came when Doktor Peter so far, and Austrian born physician met Doc
James Elam at a convention of anesthesiologists two years earlier, Elam had published research proving that expired air, that's the air, a person, exhales Ventnor did in a mask or endotracheal tube could, in a adequate oxygenation to keep a patient's blood gases in normal levels. Lives meeting led to the two of us working together and a nineteen. Fifty eight he published a paper in the Journal of the American Medical Association outlining experiments that had compared mouth to mouth ventilation, performed by lay people to the holder, Nielsen method that was being performed by members of the Baltimore City fired apart. mouth to mouth was by far more successful you have. I was like a big deal because it was like we have professionals doing at the old way and we have people. We do strain off the street doing our way and their having better success Ass foreign Elam continued to be at the epicenter of significant developments in resuscitation because they,
went on to collaborate with other medical scientists who were doing research in similar or related areas through a connection to anaesthesia just Bjorn Lynde so far was introduced to a norwegian toy maker, asthma, layered all and working together. This team was able to develop the first recess it an mannequin to train people in resuscitation. Meeks Recess. I am or resuscitation Amy as she is more commonly known here in the: U S is still pretty soon by the leered, all medical company, a separate team engineers, William Cuban hoping and Guy Knickerbocker from Johns Hopkins, had been developing the first electrical cardiac defibrillator around the same time,
I'm doctor, far worked on refining the mouth to mouth resuscitation: technique that he and Elam had come up with an came up with the easy to remember ABC of cardiopulmonary resuscitation. There's ABC are airway breathing in circulation, and the idea was that you would first check to make sure the airway wasn't obstructed and then administer rescue breaths followed by chest compression and that remain the standard and was probably what a lot of us learns fear. In my age group I definitely learned the abysses. When I had a very basic cpr training in high school, we did it until twenty ten and at that point the order of operations recommended was changed for the first time in forty years and then it became see a bee training with chest. Compressions beginning verse and then doing the airway and risky breaths, and this is because has been determined that a patient circulation can be supported through chest, compressions enough to keep oxygenated blood flowing through the tissues and have them
is already in place, while the airway check and rescue breathing is done. There is a better chance of success for resuscitation and we're gonna come back actually to doktor. So far in the second part of this to partner coming up. We will find out how a general practitioners exhaustion led to the developments of the first full time emergency jobs for physicians. First, we will take a quick sponsor break. Here's something good is a new Chopin, the Seneca women pockets network and on how radio, each day with to bring the good the silver lining the glass half full, because there is good happening in the world everywhere every day. We just need to look for and sharing here's something good as a short daily show that offers inspiring stories, helpful tips and shared sperience, is to motivate and inspire you every day we're letting you in on the best advice, weaken the news
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or who normally had other patients and duties manifested in the work of Doktor James Mills, Junior mills was the general practitioner. in Alexandria Virginia who was the President Elect of the medical staff at Alexandria Hospital and the Alex Miriam hospital's emergency department was really in a state of crisis, a crisis that mills was tasked with fixing for one thing. Patient visits to the emergency department had increased by three hundred percent in the decades, between one thousand nine hundred and fifty and sixty by the end of nineteen sixty they were seeing as many as eighteen thousand Patients a year that average. That's you a little more than forty nine a day, and that was in an apartment that did not have a dedicated medical staff. There had been a plan in place to use medical students from near by George Town to cover shifts
didn't quite worked out, and mills was one of several doctors on staff at the hospital who did shifts in the emergency department that there were a lot of doctors who didn't they their distant onto or couldn't fit into their schedule. So wait times were getting longer and longer, and the hospital struggled to have enough medical staff on hand to see to their growing emergency patient load in the meantime, but for males was really having his own problems. He worked incredibly long hours the gnp and an interview that he gave in nineteen sixty five, he said quote one night: I came home after one a m from working a day that had started that morning at seven. I remember thinking that is chronically tired and overworked JP. I wasn't being fair to myself my family or my patients. It came to me that emergency service with regular hours, I would be able to practise much better medicine. If I could get three other good men to join me, we'd have a team that could provide top notch.
Doktor, William Weaver and Mills and his colleagues negotiated. Emergency medicine specialization. He recruited three other doctors from the hospital to This novel idea with him Doktor John Mc Dade. Doktor CLO Ridge and Doktor, William Weaver and mills. His colleague negotiated a deal with the hospital that would both fill the needs of the emergency department. Am give these doctors a much better work life balance from a financial point of view. It was a
contract that would give them the same or better income than they had already. The hospital received a subsidy to cover the cost of impoverished patients and for other patients they charge five dollars. A visit, but their shifts were really the big revolution hear. The emergency department was a small room. Essentially at this point in this hospital I was just four hundred and fifty square feet and it had four stretchers and to cover that each doctor works twelve hour shifts for five days straight, so they would either work midnight to noon or noon to midnight and then, after working five days on the schedule, they would have five days off, which was a completely
I d blowing schedule for any doktor at the time and it gave them all much more downtime than they had his gps, but to be clear, although they were very glad to have more time off. Of course, the team that mills had assembled was completely dedicated. They really wanted to make this system work not just for themselves, but for the hospital staff, the hospital administration and, of course, for the patients outside of that economic and life balance. Drivers. Mills was also motivated by a desire to meet the health care needs of Alexandria, impoverished and address population because he had taken in the emergency department and because he had done volunteer outreach to provide care to the cities poor. He was keenly aware of two things. First, there is a gap in the system that hard for poor and minority communities to get healthcare. Many of them were turning to the emergency department to fill that gap, SEC
he recognised that not having health care contributed to ongoing poverty, so he also wanted, with this move, to full time emergency care to dedicate as much effort as he could to seeing to the needs of communities that might not ever have access to a regular jp. This effort to make emergency call into its own fully staff department came to be known as the Alexandria Plan and the alleys free of Lamb got a lot of attention and that attention came not just from the hospital staff in the community, but also the media and other hospitals who start the wonder if similar organizational structures might work for them over the next several years. The emergency department at Alexandria is patient, lewd doubled and other hospitals soon started to emulate them. Seven years after
beginning of the Alexandria plan. The idea of emergency medicine as a specialty was established enough and demand for specialised training was high enough that the American College of Emergency physicians was founded, doktor mills and his trailblazing colleagues serving positions within this organization, but in the interim, something else had happened, which change the emergency landscape on July 30th, one thousand nine hundred and sixty five President Lyndon B Johnson signed a set of social security amendments into law, which included provisions for the creation of two important program Medicare and Medicaid. So, just in case you are not familiar with these two forms of healthcare coverage. Here is a very brief broad, strokes. Rundown Medicare is federally funded.
and was initially created to offer coverage to people sixty five and older who, in the nineteen sixty insurance market, had a really hard time getting coverage. That programme has since expanded to include coverage for people with disabilities, He will meeting specific criteria related to end stage renal disease. The programme also added coverage for things like prescription drugs overtime. many decades function was and is to provide medical insurance to low income, families and individuals. This is a federal and state programme where the fair
governments subsidizes at least half of the states costs in providing services to Medicaid beneficiaries. Just as has been the case with Medicare, the Medicaid programme has evolved over time and it has expanded to include pregnant women, people with disabilities and those of long term care needs in their coverage. Guidelines. Medicaid is not consistent state to state, though each state has leeway to shape the programme into what theoretically best suits that states students- and it is also possible for a person to qualify for both programmes. So he mentioned a moment ago that the Alexandria, hospitals, patient loud and the emergency department doubled over the course of several years, and those new programmes were a significant driver of that uptake and numbers, because more people had insurance coverage. That meant that there were more cases where people were using the emergency department instead of seeking out
A gdp for their routine health care needs in the five years following the legislation that created Medicare and Medicaid Emergency Department visits in the. U S went from twenty nine million a year to forty three million and this all who created an entirely new problem in terms of poor communities, which was a growing population in cities. In the nineteen sixties, most inner cities had hospitals which were considered urban teaching hospitals that meant that their emergency departments were staffed by interns and residence, and there were often few or no full time emergency doctors working there to supervise or guide the department. Naturally, this meant that the poor often receive
sub standard care Cincinnati residents from the primarily black neighborhoods around Cincinnati General Hospital became so frustrated with the mediocre care and long wait times at the hospital that a group of demonstrators marched on the facility. Their protest led a meaningful change to fill the gap and dedicated emergency physicians in the city. The University of Cincinnati started the country's first emergency medicine, residency training programme when the programme began in nineteen, seventy, it had only one resident, but it quickly group and others he's around the country that had similarly left teaching hospital emergency departments without dedicated fulltime physicians also began partnering with their local universities to offer similar programmes. Even so, it took almost a full decade for emergency medicine to be right. nice as a board certified specialty by the American Board of Medical specialities and that
We will leave this off for today makes Samuel kick off by talking about a paper that addressed all the problems in a more the medical care in the? U S at the need for that care was on the rise. I have instead of listener mail today Oh, please, sort of really a plea. It is a request that was put out by the way my history centre, I saw it am. I think it's a really cool idea, because it enables are listeners, particularly if they are the Atlantic area, to take part in documenting history. They pose a blog at the history you're on the seventh of this month, that's April twenty twenty and they are asking for people because they recognise that we are living through a very unique time, so they are asking for Beef Particularly Atlanta residence to send them documentation of how they are living in what is going They have an ongoing donation form and if you are interested in participating there like you, can do that
with photo video social media post. Your grocery lists a lesson plans of your teacher letters, etc that you can share with them said they will make an archive of what we are living through, which is so cool. If you want information on this, you can go to Atlanta history, centre, dot, com, slash blogs, lashed corona virus dash collective or you can just go to Atlanta History Centre and if you just do a search for Corona collective, it comes up. I just think it's a really cool thing. Atlanta is in a weird place. This won't air for a little bit, but. are restrictions on what businesses can be open have just been shifted to opening a lot of things will earlier than anybody anticipated. I hope everybody is still saying very safe and I really
really hope that they take advantage of this opportunity. If you live in Atlanta to contribute and make your voice part of this, this ongoing record, they have some specific things that they would love answered from different parts of the community like if you work in a medical profession or if your local business sooner etc it s all in that that blog post, I for instance, I hope that everybody goes and participates in this from the Atlantic area, if you're not for me at land area, its we're, taking a look at just to think about the kinds of things here, in your day to day lives. It might seem mundane or every day, but are important documents and see if there is a similar programme in your area. So again, that's it. The Atlanta history centre, dot com, there's no thee in that It led to history, centre, dot com and you can go to their blog and look for it or you can do a search for Corona collective supercool program. If you would like to write
was. He could do so at history pie cast an eye heart radio dot com. You can also find us everywhere on social media as missed in history, and if you would like to subscribe to the show, we would like that to you can do that on me radio, app at Apple pie, gas murmur. Wherever it is, you listen stuff. You missed in history class. The production of I have for more part. As for my heart, radio visit by her radio have added my cans or wherever you listen to your favorite. this episode is brought to you by new Leaf Natural's. What makes new leave now c b, the oil so effective for starters, its full spectrum. So that means not only is it highly concentrated instability, but it also contains significant amounts of secondary cannabis, oil slick, C, B, C, C, B D. C and more, these are more effective together than when their isolated more than
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