Throughout the recent history of EMS there are many important individuals who have contributed greatly to the development of this field. Many of these individuals are not noted here; however, this listing is meant to provide some prospective on the importance of the contributions of individual physicians. These individuals are listed in alphabetical order.
Dr Bledsoe was born in 1955 and became an EMT in 1974 and a paramedic in 1976. As an EMS physician he has contributed much to the literature and to provider education. He is the principal author of Paramedic Care: Principles & Practice, Essentials of Paramedic Care, Intermediate Emergency Care: Principles & Practice, Critical Care Paramedic, Anatomy & Physiology for Emergency Care, Prehospital Emergency Pharmacology, and Pocket Reference for ALS Providers. Dr Bledsoe stands out because of his place in modern EMS education, as well as his ability to communicate important EMS medicine concepts to physicians, EMS providers, other health care providers, and to lay people. He is an internationally recognized and cited EMS physician.7
Dr Boyd began his career as a resident in surgery at Cook County where he and his colleagues sought to improve the management of gunshot wounds and automobile trauma. He became the Illinois State EMS Medical Director and oversaw the development of a comprehensive trauma system that coordinated prehospital and hospital assets from 1970 to 1974. Under his leadership the program realized successful improvements in communication and utilization of more advanced staffing on ground and air ambulances. In 1974, Boyd was appointed to oversee the Department of Health Education and Welfare EMS Division by President Ford. Under his direction a “wall-to-wall” nation-wide EMS system began to take shape. In addition, Dr Boyd successfully advocated for EMS to President Ford, resulting in the White House conferences on EMS and the declaration of EMS Week. He served in the office until 1981 when the position was dissolved in favor of state-administered block grant programs.
NANCY CAROLINE, MD (1944-2002)
Dr Caroline started her career in EMS during her training in critical care medicine under Dr Peter Safar at the University of Pittsburg. Safar had begun work on the Freedom House Ambulance Service and much of the responsibility of organization and training of participants to become paramedics was delegated to Dr Caroline. She excelled at paramedic education and authored a textbook to suite the unique curriculum and scope of practice entitled Emergency Care in the Streets. She was a courageous field provider and innovator. In addition to her work in the United States, she had also been a bush doctor in Africa and after leaving in the States in 1976 became one of the most influential individuals in the development of EMS in Israel. She worked with prehospital programs, developed terrorism medical response tactics, and served as the medical director of Magen David Adom. Her textbook for paramedics was the only dedicated educational text on the topic for a decade and is still one of the most well known to this day.8
In many ways Seattle is considered one of the epicenters of EMS advancement in the United States. One of the key figures in the development of that reputation is Dr Leonard Cobb. In 1967, Dr Cobb was practicing cardiology in Seattle when he learned of the work of Dr Frank Pantridge at the Royal Victoria Hospital in Belfast, Ireland. In an effort to bring this new prehospital cardiac intensive care concept to Seattle, he worked with colleagues to bring about a paramedic training program based on the fire service that could provide similar advance cardiac care in the field. The resulting program developed by the University of Washington, Harborview Medical Center, and the Seattle Fire Department began serving King County under the name Medic One.9
Physicians practicing (and holding board certification in) EMS medicine have a number of key people to thank for the academic and political development of the subspecialty. One of the key concerns during the development of the subspecialty of EMS medicine was a lack of organized scientific productivity. In addition to his publications in peer-reviewed journals on EMS specific topics he also served to guide others in academic productivity in the field. Some of his notable positions from which he effectively served in this role have been as the editor-in-chief of the NAEMSP textbook, project leader for the development of the NAEMSP proposal that was used to petition the American Board of Emergency Medicine (ABEM) to pursue subspecialty board recognition, and also as the editor-in-chief of Academic Emergency Medicine. Dr Cone has provided significant mentorship to young EMS physicians in training and also served as the president of NAEMSP during a critical time in the development of the subspecialty. Dr Cone was the first chair of the Council of EMS Fellowship Directors.10
Dr Richard Crampton had worked with Dr William Grace who had founded the mobile coronary care unit at St Vincent's Hospital in Manhattan and he had taken the time to visit Dr Pentridge personally in order to better understand program developed there in Belfast, Ireland. He successfully implemented these concepts in Charlottesville, Virginia, and in doing so by 1971 the Charlottesville Rescue Squad was trained and certified in CPR and became the nation's second all-volunteer mobile coronary care unit. They operated in a rural environment. Dr Crampton's program did require a physician to respond in order to utilize the advanced coronary care concept.11
Dr Criley is credited with founding the Los Angeles County Paramedic Program in 1969 at the time he served as the Chief of the Division of Cardiology at Harbor—UCLA medical center. One of his chief accomplishments was convincing medical and public safety stakeholders as well as politicians that a well-designed prehospital coronary care program could be performed by paramedics. Recognizing legislative shortfalls he successfully petitioned state government, including the then governor Ronald Reagan, to approve legislation making it legal for paramedic personnel to provide advanced level coronary care in the prehospital environment.12
Dr Fletcher, along with Dr Ernie Goodwin, is credited with forming the nation's very first paramedic-level volunteer rescue squad. The Haywood County volunteer rescue squad became a paramedic-level service offering advanced coronary care and the prehospital setting in 1969.13,14
In addition to participating in the formation of the National Association of EMS physicians he also served as one of the early presidents of the organization. He has contributed as an author and as an editor for a number of textbooks. He has worked diligently to develop multidisciplinary training programs for providers and educators at all levels in the fields of EMS, disaster medicine, tactical medicine, and emergency medicine.15,16
WILLIAM GRACE, MD (-1974)
Dr William Grace is credited with founding the nation's first mobile coronary unit based on the program started in Belfast, Ireland, by Dr Pantridge. The program was based out of St Vincent's Hospital and Medical Center in New York. Dr Grace and his associate Dr John Chadbourn recognized the potential for improve survival if cardiac patients could be reached with advanced care in a more immediate fashion. In 1968, St Vincent's first mobile coronary care unit went into service in a van with a driver and attended, an attending physician, a resident physician, an emergency room nurse, an ECG technician, and a student nurse observer. The vehicle carried a portable battery power to defibrillator/ monitor, electrocardiograph, intravenous kit with drugs, and a resuscitation/oxygen kit. It was noted that it could take up to 25 to 30 minutes to reach the patient; however, the effect of the program's prehospital cardiac care was published with a reported reduction in mortality from 21% down to 8%.2 Many consider this first American version of the mobile coronary care unit concept to have directly inspired the development of such programs around the country.17,18
Dr Lewis is credited with participating in the development of the Heartmobile along with Dr James Warren. The City of Columbus Fire Services along with the Ohio State University Medical Center developed the Heartmobile paramedic program in 1969.13
Dr Mc Swain is best known for his work as a trauma surgeon. However, while on faculty at the University of Kansas he helped develop paramedic education and push for the development of the EMS system. At the time of his move to Tulane in New Orleans, he was credited with helping bring about the evolution of the Kansas EMS system to a point where 90% of citizens were covered by paramedic response in less than 10 minutes. While working with stakeholders in New Orleans he was selected to develop a comprehensive emergency medical services system for the city. This led to the introduction of BLS and ALS prehospital provider education and the development of a citywide EMS system. During his work with the American College of Surgeons Committee on Trauma (ACS-COT) he noted gaps in the education of prehospital providers as part of the trauma care team care team and was enlisted to help develop the Pre-Hospital Trauma Life-Support (PHTLS) program, a joint venture between the ACS-COT and the National Association of Emergency Medical Technicians (NAEMT).19
Dr Nagel is credited as being one of the first physicians to recognize that there was a potential impracticality to basing out of hospital coronary care on response of the physician to the field. Working with Miami-Dade fire officials and a cardiologist colleague, Dr Hirschman, to develop a system by which paramedics could transmit an ECG to the hospital and receive voice medical control by a physician. They enlisted the help of a little known company in developing their telemetry package with a defibrillator into a unit known as the Physio-Control LifePak 33. Although the LifePak device required redesign to allow for the rugged field environment, coupling this concept together with fire rescue personnel taught to defibrillate, provide intravenous medications, and advanced airway techniques proved to be a workable combination. At that time, however, there was no legal authority for them to implement their new paramedic skill set. It has been reported that Dr Nagel actually went to the city manager's office and allowed his newly trained paramedics to intubate him in the office to prove their skill set. Ultimately Dr Nagel was able to spearhead the creation of a law (10-D-66) in the state of Florida that made it illegal for paramedics perform the skills and is considered the cornerstone for EMS law in that state. Dr Nagel was also successful in advocacy at the national level and was one of the key individuals who petitioned successfully for the passage of the EMS Systems Act.20,21
FRANK PANTRIDGE, MD (1916-2004)
In one very important way it could be said that Dr Pantridge is in fact the father of prehospital advanced coronary care. Dr Pantridge was a cardiologist working at Royal Victoria Hospital in Belfast, Ireland, when he determined that it would be most appropriate to deliver electrical therapy and advanced coronary care in the prehospital setting rather than delaying care until arrival at the hospital. In order to accomplish this, he developed a portable mobile defibrillator 1965. This was integrated into a prehospital care team which Pantridge then studied and published in the Lancet in 1967. The first prehospital advanced coronary care units in the United States were based on Pantridge's program.22
Dr Pepe is an outspoken and prolific academic and lecturer in EMS medicine. He has held numerous prestigious positions, but is well known for his work to develop and popularize many of the clinical concepts focal to our understanding of modern prehospital care. Dr Pepe has been cited as authoring over 400 published papers and abstracts and has provided high-level medical direction in multiple major systems. He coordinates the Eagles Consortium, comprised of medical directors for the nation's major metropolitan areas. He has provided mentorship and leadership to numerous EMS and emergency medicine physicians and is considered by many to be the chief expert on EMS physician interaction with the media.23
Dr Perina is a notable EMS physician and educator who has served since 1999 as the EMS fellowship director at the University of Virginia. She has contributed greatly to the development of the subspecialty through her work at NAEMSP and as the president of the American Board of Emergency Medicine (ABEM). Her leadership was critical during the development of the application to the American Board of Medical Specialties (ABMS) to create the new subspecialty. Her mentorship and guidance (along with other key members of the EMS physician community) in the development of the subspecialty and training program certification process has led to the realization of ACGME-accredited fellowship training programs and board certification.24
PETER SAFAR, MD (1923-2003)
Dr Safar is credited with popularizing the important concepts of CPR and developing the “ABCs” of resuscitation. In 1956, he and Dr James Elan invented mouth-to-mouth resuscitation after demonstrating the effectiveness of mouth-to-mouth rescue breathing through a series of experiments on human volunteers who had been paralyzed. He also advocated for and effectively showed that laypeople could serve as the initial prehospital rescuers for CPR. He partnered with Asmund Laerdal, who at the time was a doll maker, in the development of the initial (and now internationally recognized) prehospital cardiac training tool, Resusci Anne. Dr Safar is also credited with the successful development of one of the first modern ambulances, which he identified as a required replacement for the hearses and station wagons that were being used at the time. While working in the Baltimore system he trained fire department rescuers to add intubation skills to their CPR technique. He developed standards for emergency medical technician education and initiated the Freedom House Enterprise Ambulance Service in Pittsburgh in 1967. In 1976, he cofounded the World Association for Disaster and Emergency Medicine and in 1979 founded the International Resuscitation Research Center. He was nominated three times the Nobel Prize in Medicine.25
Dr Stewart, although a now famous contributor to the development of emergency medicine and EMS medicine, began his career as a general practitioner in Neil's Harbour, Nova Scotia. After completing his training in emergency medicine he became the founding medical director of the Los Angeles County paramedic program and served that community until accepting a position in Pittsburgh, Pennsylvania, where he was the founding director of the Center for Emergency Medicine and the medical director of the Department of Public Safety of the City of Pittsburg. This program soon became one of the preeminent centers for the development of EMS medicine in the country. He eventually returned to Canada and continued to develop his role in the political landscape of health care after taking up a post at Dalhousie University. In 1993, Dr Stuart became a member of the Nova Scotia legislature and was eventually appointed as the Minister of Health and Registrar General for the province until 1996. Dr Stewart's influence on the development of EMS medicine is evidenced by many publications and the productivity of his former students and colleagues in various areas of emergency medicine and EMS.26,27
Like many of the former presidents of the National Association of EMS Physicians, Dr Swor has provided significant academic contributions to the field. He has been politically active in his advocacy for the development of EMS medicine and serves as an advisor to multiple key stakeholder organizations, including the National Highway Traffic Safety Administration and the American Heart Association.28 His book on quality improvement was one of the first publications to address this area of medical direction in an organized and detailed fashion. He remains one of the most prominent EMS educators in the country.
Dr Warren of Columbus Ohio participated in the early development of advanced out-of-hospital coronary care through collaboration with the Ohio State University and the Columbus Division of Fire. In 1969, the Heartmobile program was initiated. The program included three firefighters and the physician responding in the Heartmobile from the hospital.29 In 1971, it was apparently clear to Dr Warren that the firefighters could be trained to operate the Heartmobile without the on-scene presence of the physician. On July 1, 1971, the Columbus vision division of fire took over Heartmobile operations.
PAUL M. ZOLL, MD (1911-1999)
In 1952, Dr Zoll published his work on the use of “external electrical stimulation” (transcutaneous pacing). In 1956, he and his colleagues published the paper detailing the successful termination of ventricular fibrillation with “electric countershock” (transcutaneous defibrillation) and in the same year developed an oscilloscope-based cardiac monitor with built-in audible alerts. Dr Zoll is also credited with advancing the concept of using countershock (electrocardioversion) as a viable alternative to antidysrhythmic medications in the termination of dysrhythmias.