Jack Kelly writer
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RESCUE SQUAD
(American Heritage Magazine – May/June 1996)
A warm May afternoon in 1909 -- the quiet along the
river in Roanoke, Virginia, is broken by cries for help. Two
canoeists have capsized. Bystanders rush to the banks,
throw branches toward the foundering men. In vain -- the
swift current carries them under; they drown. A nine-year-
old boy watches them perish.
This childhood memory, not just the watery death but
the utter helplessness of those on shore, would haunt
Julian Stanley Wise into adulthood. “Right then I resolved
that I was going to become a life saver,” he said. “Never
again would I watch a man die when he could be saved.”
His resolve would lead Wise to a lifetime of organizing
ordinary citizens to respond to emergencies. Today
450,000 volunteers, organized into squads modelled on
Wise's idea, provide ambulance and rescue service to
more than two thirds of the United States.
Wise grew to a slender, highly energetic young man,
with big jug ears and a quick wit. During the Roaring
Twenties he formed a dance band and strummed
Charlestons on his mandolin in Myrtle Beach resorts. He
held a day job as a lifeguard and a life saving instructor.
In 1927 he returned to his native Roanoke, a railroad
town in western Virginia tucked between the Allegheny and
Blue Ridge Mountains. He married and went to work as a
clerk for the Norfolk and Western Railroad. In the following
year he formed the Roanoke Life Saving and First Aid
Crew: ten volunteers intent on bringing emergency care to
those in need.
Today we take ambulance service for granted. But
unlike volunteer fire departments, which date to colonial
times, rescue squads developed relatively recently in
American life. Before modern emergency medical services
were established, a person who was injured or gravely ill
faced a grim ordeal.
Frederick R. Johnson, of White Township, New Jersey,
remembered breaking his leg as a young boy. He fell from
a ladder during the winter of 1914. Because his father was
away, his mother had to carry him through the snow to a
neighbor's house. Lacking a phone, the neighbor rode a
horse six miles to town. The doctor came out at noon the
next day, confirmed that the bone was fractured, and
advised Johnson's mother to get him to the hospital in
Easton, Pennsylvania, about 15 miles away.
Johnson remembered making the trip to town on an
iron bed mounted on a buckboard. “I hollered all the way
as the bumps sent pain shooting into my leg.”
After a twenty-minute wait, the bed was placed on the
baggage car of a southbound train to the city. A horse-
drawn ambulance carried the boy to Easton Hospital,
where his leg was finally set.
Johnson's experience reflected the type of emergency
medical care that was to change only slowly during the first
65 years of this century. Physicians attended patients at
the scene of emergencies. Accident victims were often
carried to a doctor's office rather than to a hospital. In any
case, improvisation was required when it came to transport
-- someone injured in an auto accident might be taken to
the hospital by the police or in the back seat of a passing
car. Except in large cities, no organized system or
authority existed to provide care. Rescue squads evolved
to address these deficiencies.
As I write I have on my desk a Motorola radio about the
size of a pack of cigarettes which silently monitors the
airwaves. On detecting a pair of tones designating the
Milan Rescue Squad it squawks an electronic alarm. A
dispatcher recites the type and location of the emergency.
A squad member for the past seven years, I carry in
my car a kit of supplies not all that different from what
Julian Wise's men used in 1928: a tank of oxygen, gauze
dressings, bandages, and a blanket. Since I maintain an
office in my home, I am available to help out on weekdays
when manpower is in short supply. Our district, in New
York's Hudson Valley, covers a township of more than 55
square miles with no central business district.
The squad consists of about thirty men and women
who are on call around the clock. We respond to auto
accidents and diabetic emergencies; to heart attacks, nose
bleeds, and sprained ankles; to the unexpected arrival of
the newborn and the last moments of the elderly. Today it
might be a man who's had a chain saw kick back on him,
tomorrow a widow suffering the vague malaise of terminal
loneliness.
The rescue squad idea was not entirely new when
Julian Wise's crew responded to their first call in 1928.
The volunteer Goodwill Fire Department in Pottstown,
Pennsylvania, had added a horse-drawn ambulance as
early as 1890 and had begun to offer first aid in 1911.
Wise's innovation was to combine rescue, first aid, and life
saving into one independent agency. The nine original
members of the crew all worked with Wise at the railroad.
Citizens were invited to call in alarms to a phone that rang
on the desk of chief clerk Harry Avis. Avis sent word to his
fellow crew members, who rushed to the scene of the
emergency. Only six calls were received during the first
year of operation and in most cases the crew arrived too
late to do any good.
“At that time, we could keep all our equipment in my
Reo,” Wise noted. The squad's first aid kit was a $3
fishing tackle box, stocked with supplies that included
poison ivy wash, tannic acid compound, ammonia inhalant
and tincture of merthiolate.
In 1931 Wise and his men were called out for a
drowning. They reached the scene in eleven minutes and
effectively revived a 16-year-old boy. The feat attracted
national publicity. Interest in the volunteer rescue
movement began to grow. Wise, a tireless promoter of his
cause, travelled to cities in Virginia, the Carolinas, and
elsewhere to help start squads, many of which cloned the
structure and philosophy of Wise's crew.
In Roanoke itself a group of volunteers under the
leadership of Alexander A. Terrell formed a squad a few
weeks after Pearl Harbor. The Hunton Life Saving and
First Aid Crew, the first all-black rescue squad in the
nation, served the city's predominantly African-American
northwest side.
“We made calls to people we knew personally,”
explains Lewis Peery, a soft-spoken man of 74 who served
on the Hunton Crew for more than 30 years beginning in
1955 and who currently sits on the board of the Roanoke
group. “It made it hard when you'd lose somebody. But
we knew we'd done all we could.”
To get to the scene, rescue squad members would
drive their own cars, or wait on the corner for another
member to pick them up. One of the original Roanoke
members remembered riding to a call on his brother's
bicycle.
In the days when doctors still made house calls, rescue
squads were seen as physicians' adjuncts. “We carried a
doctor's kit,” says Samuel Fralin, an 80-year-old former
postal worker who joined the Roanoke crew in the 1950s.
“We had an assortment of drugs, hypodermics and other
things a doctor would need in a sealed bag. If a doctor
showed up, we could break it out.” This was a common
practice on volunteer ambulances for many years.
Wise was the captain of the Roanoke squad for three
decades. “Julian was my hero,” Fralin says. “He was an
extraordinary man, an extreme extrovert, and somebody
who made his vision into reality. But you had to know your
stuff. Any time, he might ask you to give a demonstration,
say, of the Emerson resuscitator. You had to perform.”
The core of Wise's idea, and the essence of all
emergency work, is speed: to bring help to the injured or
critically ill as quickly as possible. “Save seconds and you
have a better chance of saving a life,” Wise said.
In this he echoed the sentiments of the man who is
known as “The Father of Ambulance Service.” Late in the
18th century, Dominique Jean Larrey, a surgeon in
Napoleon's army, observed that because military field
hospitals remained at least a league to the rear of the
fighting, the wounded did not reach them for 24 hours after
a battle. “Most of the wounded died from want of
assistance,” he observed. “This suggested to me the idea
of constructing an ambulance in such a manner that it
might afford a ready conveyance for the wounded during
the battle.”
Larrey invented the ambulance volante, a light two- or
four-wheeled carriage with room for a number of litters.
The vehicle carried into the battle zone a medical officer
and assistant who were able to treat wounded soldiers
where they fell.
Larrey wrote, “The first four hours are an isolated
period of calm which nature is able to maintain, and
advantage should be taken of this to administer the
appropriate remedy.” This advice rings true down to
today, when, as emergency medical technicians, we are
trained to heed the “golden hour” after a traumatic
accident, a window of opportunity to stabilize the patient
and transport him to an emergency facility.
While many of the developments of emergency
medicine would emerge from the military, civilian
volunteers have a long history of providing care. Perhaps
the oldest continuously active group of volunteers is the
Misericordia di Firenze, which was founded in 1240 to help
the sick and transport the dead of medieval Florence.
Hundreds of branches remain active in northern Italy.
Volunteers are still inducted into the group in elaborate
robed ceremonies.
In Britain the St. John Ambulance Association was
formed in 1878. Despite opposition from the medical
establishment, the organization trained volunteers in the
stop-gap treatment of wounds and illnesses, a practice for
which members invented the term “first aid.” Ten years
later, they began to offer ambulance service. The group's
roots go back to an order of knights who ran a Jerusalem
hospital during the crusades. Members still provide first
aid services in England.
The 1859 French, Italian and Austrian troops engaged
in a one-day bloodbath known as the Battle of Solferino, a
fight that left 36,000 wounded strewn across the
battlefield. A Swiss tourist on hand for the spectacle was
appalled. Jean-Henri Dunant later organized a conference
to establish humane rules of warfare. He set up a group to
coordinate civilian aid to wounded soldiers. To honor
Dunant the organization adopted the Swiss flag with its
colors reversed: a red cross on a white field. Dunant's
group became the International Red Cross, which in 1911
greatly expanded the training of laymen in the techniques
of first aid.
Civilian ambulance service began in large cities in the
second half of the 19th Century. In 1865 the Cincinnati
General Hospital established what was probably the first
regular ambulance operation in the United States. Four
years later Edward B. Dalton, a physician who had
organized medical evacuation during the Wilderness
Campaign of the Civil War, set up an ambulance service
for New York's Bellevue Hospital. That corps responded to
1401 calls in 1870. Snap harnesses suspended over the
horses enabled drivers to respond in as little as thirty
seconds, covering a mile through the city in about 6
minutes. Two physicians took turns accompanying the
ambulance. In addition to bandages and splints, the
ambulances' first aid kits always contained a quart flask of
brandy.
Most large cities developed some semblance of
organized ambulance service in the period before World
War I. Chicago saw the first motorized ambulance in 1899,
with St. Vincent's Hospital in New York introducing electric
vehicles a year later. An electric ambulance with hard
rubber tires rushed President McKinley to the Buffalo
Temple of Music Hospital after he was shot by an anarchist
in 1901.
Compared to its horse-drawn predecessor, the motor
ambulance, as Scientific American noted, “is capable of
greater sustained speed, and when the destination is
reached, no care has to be paid to the steaming horse.” It
offered the additional advantage of eliminating the need
for stables, and accompanying flies, on hospital grounds.
Despite the increased speed available, complaints
about dilatory service have been hurled at ambulances
from the earliest days. In 1905 a man was knocked down
by a cab a half mile from a New York hospital. During his
45-minute wait for an ambulance, a fire broke out in a near-
by building, the fire company arrived, and the blaze was
extinguished.
In many communities morticians possessed the only
vehicles capable of carrying recumbent patients. They
dominated the ambulance business for decades, usually
charging only a few dollars for a ride to a hospital or
doctor's office. For many operators the ambulance
business was a way to build goodwill, with an eye to the
more lucrative funeral business down the road. Some
maintained dedicated ambulances, others employed
hearses modified to accept a stretcher. Even Julian Wise's
resourceful squad in Roanoke deferred to the city's
undertakers until 1959, when the volunteers began to
provide transport as well as first aid.
For fifty years after World War I the manufacture of
ambulances was closely associated with the production of
hearses and funeral cars. Ambulances of the 1920s often
featured leaded glass windows and stained mahogany
interiors. Styles and horsepower changed over the years,
but the basic form of the ambulance as an enlarged
passenger car on a limousine frame remained constant.
“Those ambulances had the advantage of comfort,
speed, driveability, and a low center of gravity,” says
Myron Gitell, ambulance collector and publisher of a
history called The Ambulance. “They didn't have that
much room in back, but in those days patients rarely
received any treatment on the way to the hospital anyway.”
In the 1970s federal regulations and innovations in
emergency medical care dictated a switch to the use of the
vans and light trucks that are the standard ambulances
today.
Both motorized ambulances and emergency volunteers
played a role in World War I. When the guns roared in
1914, American expatriates began to aid the French war
effort by establishing ambulance services to transport the
wound back from the lines.
Two of the founders of this effort, Richard Norton and
Herman Harjes, had connections in high society -- Harjes
was the son of the House of Morgan's principal
representative in Europe. At a time when most army
ambulances were horse-drawn, Norton and Harjes were
able to assemble donated motor cars for conversion into
ambulances, and to make the idea of volunteer ambulance
driver fashionable.
One driver volunteered “with the object of seeing war
first hand and getting some excitement, as well as being of
some service.” This combination of humanitarianism and
adventure has motivated rescue volunteers through
history. It inspired many U.S. college students to sign up
as ambulance drivers in Europe; Harvard alone send 325
young men to the effort.
The duty was arduous and full of danger. “I am willing
to confess that it takes nerve of more than one variety to
handle unconscious boys and legless men all day long,”
one driver said. The volunteers would wrestle Model-T
Fords down shell-cratered roads, almost always at night
and without the benefit of lights, driving, as one man said,
“by instinct.”
A number of men who would become prominent writers
signed on for ambulance service during the war, including
John Dos Passos, Malcolm Cowley, and e.e. cummings.
The nineteen-year-old Ernest Hemingway was wounded by
a grenade and machine gun attack while serving as an
ambulance volunteer in Italy.
By 1940 the Roanoke squad had 58 members and
boasted of a carbon monoxide detector, field telephones,
an acetylene torch, and portable floodlights. That same
year the first of several serious polio epidemics hit
Roanoke. The volunteers arranged for the purchase of
iron lungs, 750-pound tanks that used negative air
pressure to breathe for paralyzed patients. During the
1944 epidemic, which involved more than 750 cases, area
rescue squads supplied 21 iron lungs. Julian Wise set up
a state-wide training program on how to use the unwieldy
devices.
The rescue squad movement continued to spread.
When the Hindenburg dirigible exploded in 1937, the New
Jersey First Aid Council was able to summon 29
ambulances to respond to the scene in Lakehurst. A 1945
Reader's Digest article featured Wise and his crew, with
the subtitle “An idea for your town.” That piece and a
follow-up article 11 years later boosted interest in rescue
squads around the country. Wise did his bit, helping to
form 25 squads in Virginia alone, and advising volunteers
from Michigan to Alabama, as well as in Canada and
Europe. He would phone squad captains across his state
monthly just to find out how things were going. By 1956
there were 26,000 members participating in 850 squads
around the world.
“The credit goes to the crews,” Wise insisted. “I was
only the pusher.”
Many squads were associated with volunteer fire
departments. During the 1920s fire departments in New
Jersey and Texas pioneered efforts to add rescue and first
aid capabilities. Legion posts were another common
sponsor of squads. Charles Myers remembers when his
group of veterans in the little upstate New York town of
Eldrid started a squad in 1946
“We handed out cards with our phone numbers on
them. When someone had an emergency, they called until
they reached a member who was home. That member
called the others and off we went. I still get calls -- people
have those old cards tacked on the wall.” Myers is
approaching his 50th year of active service with the squad.
In Roanoke, I spent some time with the volunteers who
carry on the tradition of Julian Wise's original crew. The
excitement of riding in a speeding ambulance, with lights
flashing and the siren screaming a passage through traffic,
is very real. One young EMT told me she joined the squad
“for the adrenaline rush and to be in the middle of the
action.” Certainly there is an element of “trauma junky” in
most volunteers, who are eager to go out on a “good” call
-- one involving sufficient life-and-death mayhem.
But the reality of the calls is often very different.
Tonight in one of Roanoke's poorer neighborhoods an old
lady has fallen in her home; she needs to go to the
hospital to be checked out. Pulse 74 and regular. On the
wall, a framed mother's day card. Patient is awake and
oriented. A needlepoint sampler: “What is life without
love?” Blood pressure 150 over 80. The stretcher is
wheeled in. A quiet ride to the hospital.
Later, an alarm goes out for a “code” at a nursing
home. It means a person whose heart has stopped
beating, a woman teetering on the edge of death. The
experienced crew of volunteers is unflappable throughout:
The driver Kathy Hagy is a mother of five, EMT Lena
Speck is studying pre-med at a local college, the crew
leader Luke Chambers is a respiratory therapist.
They are at the woman's bedside in minutes, following
a practiced routine: Begin cardiopulmonary resuscitation.
Insert an endotracheal tube, a clear passage for supplying
oxygen to the woman's lungs. Establish an intravenous
line to administer fluids and drugs. Connect a heart
monitor -- the green line shows the feeble quivering
motions of the woman's heart. Apply the paddles of the
defibrillator three times -- each time the woman stiffens as
if startled by a loud noise. No signs of life appear.
The crew wheels the patient to the ambulance, one
member astride the gurney to continue chest
compressions. As the ambulance rolls, more drugs are
administered: epinephrine, lidocaine. Another round of
shocks. For a moment a pulse returns, the woman's heart,
after 74 years of beating, doesn't want to give up. Stop
chest compressions. The patient's pupils remain fixed and
dilated.
As she's wheeled into the emergency room the line on
the monitor flattens, the patient “codes” again. Begin
CPR. The crew turns her over to waiting physicians and
nurses. They proceed with a similar round of efforts. To
no avail. A few minutes later the woman is pronounced
dead.
Resuscitation, the most heroic of the rescue squad's
storehouse of treatments, always involves swimming
against the tide. Something has caused the patient's heart
to stop, and the resulting oxygen starvation quickly
diminishes the person's ability to recover.
The ambulance crew retires to a corner of the
emergency ward to wash up and complete the paperwork
that will document their futile efforts to save this woman's
life. The ability to look at and accept death is one of the
first lessons that every rescue worker learns
Luke Chambers, 28, muses afterwards. “Sometimes,”
he says, “you meet somebody in the mall -- maybe you
don't even recognized them -- who you helped in an auto
accident. But they actually come up to you and say thank
you. Things like that really make it worthwhile.”
In spite of the steady spread of rescue squads,
ambulance service in the early 1960s still left much to be
desired. Morticians continued to provide emergency
transportation to half the country. In many places, even
large cities, ambulances ran with only a driver; the patient
rode alone in the back of the ambulance. Of 200,000
ambulance and rescue personnel, fewer than half were
trained to the level of Red Cross advanced first aid. Only
six states offered standard courses for rescuers, and only
four regulated ambulances.
Washtenaw County, Michigan, which includes the city
of Ann Arbor, provides a typical picture. In 1966, the 23
ambulances in the county were operated by 17 different
concerns, including hospitals, gas stations, taxi companies
and funeral homes. Service outside urban areas was
spotty at best. No standards of any kind were enforced.
The efficiency of emergency care advanced slowly in
the nearly four decades that passed since Wise founded
his squad in 1928. The reason can be traced in part to
the determination of the medical establishment to keep
laymen from trespassing on the territory of the physician.
Rescue volunteers, their duties only sketchily defined,
could be accused of practicing medicine without a license.
The American Red Cross, which supervised first aid
training, never took an active role in organizing or
supporting rescue squads. In fact Julian Wise came into
conflict with Red Cross bureaucrats who felt his approach
too progressive. Volunteers were willing to do more, but
the tools and skills were kept out of their reach.
“Doctors did have a tendency to get a little stinky when
it came to us doing too much,” says Sidney Robertson, a
veteran of rescue work in Roanoke and current president
of the volunteer squad there. “If one of the members
asked our medical advisor about a technique, his answer
often was, You don't want to get into that.”
The motto of rescue workers in those days was “load
and go.” “Prehospital care was limited solely to
transportation,” said a report of the American College of
Emergency Physicians. “Medical treatment didn't begin
until the patient arrived at the hospital.”
But the ten years between 1966 and 1976 would see a
transformation in emergency medical services (EMS) that
would affect volunteers profoundly, and would permanently
alter the public's expectations about ambulance service.
The changes were closely linked to that ubiquitous plague
of modern life: the auto accident.
Only four gasoline-powered automobiles existed in the
United States in 1885. Two of them encountered each
other on the streets of St. Louis that year and collided.
Both drivers were injured, one seriously. That crash was a
harbinger of a coming slaughter on the highways, a record
of death and injury that would surpass all the casualties of
all the wars in the nation's history.
In the 1960 presidential campaign, candidate John F.
Kennedy labeled traffic accidents “the greatest of the
nation's health problems.” His choice of words was
significant. Researchers and policy makers were
beginning to change their perspective on accidents.
Instead of framing the problem as one involving random
acts of carelessness, they began to see an epidemic that
followed the pattern of a disease and offered opportunities
for prevention and cure.
The problem was a grave one. By 1965 annual
highway deaths had reached 49,000. Accidents of all
types killed 107,000 and permanently disabled nearly half
a million people every year. Accidents were the number
one cause of death up to the age of 35. Observers
routinely asserted in the late Sixties that a soldier wounded
in the jungles of Vietnam had a better chance of survival
than did a citizen hurt in a traffic accident back home.
In 1966 a seminal report from the National Academy of
Sciences catalogued the inadequacies of the country's
emergency medical services and recommended solutions
in terms of training and standards. The time for action had
come. Lyndon Johnson's Washington was a can-do place,
and the sea change that would sweep over the country's
ambulance service was a textbook case of big government
in action.
The Highway Traffic Safety Act of 1966 set federal
standards for training, equipment and procedures, which
states busied themselves implementing. While auto
accidents were the target, the legislation transformed EMS
across the board. The momentum of the changes was
maintained in the 1970s as “systems” became the rallying
cry. Emergency service began to become organized for
the first time.
Dr. Carol Gilbert, director of trauma at Roanoke
Memorial hospital and a longtime advisor to rescue
volunteers, points to systems as the real foundation of the
new approach to emergency medical aid. “A single person
doesn't save a life -- it's the response of an entire team.
What has altered in EMS is the realization that the system
is more important than any one component.”
As the states began to flesh out the concepts devised
in Washington, Congress picked up the tab. Hundreds of
millions of dollars were poured into demonstration projects,
pilot programs, and block grants to states. Government
funding in the 1970s essentially put EMS on its feet.
Communications and ambulance design were
enhanced as a result of federal involvement. The 911
telephone system spread, allowing for more efficient
dispatch. Ambulances acquired radios which attendants
could use to communicate with hospitals, a helpful link
when a serious case raised questions of treatment.
Standards for ambulances emphasized adequate room to
treat patients en route.
The development that would have the most direct
impact on volunteers was the new standard for training.
By the end of the 1960s the National Highway Traffic
Safety Administration had established a comprehensive 81-
hour course for Emergency Medical Technicians. In 1969,
200 people took the EMT course, the first emergency
responders to be trained to a national standard. The
course, which was later expanded to 110 hours, has
become a rite-of-passage for rescue volunteers.
The new training and testing represented a challenge,
but one to which volunteers adapted with enthusiasm. “All
our members, old and young, welcomed the EMT concept,”
says Sidney Robertson. “We wanted to learn more and we
were proud to call ourselves EMTs.”
Like every emergency tech, I've spent many hours
committing to memory the grievous effects of trauma on
the human body, with names like tension pneumothorax
and subdural hematoma. Where first aid training takes a
surface view of injury and illness, the EMT course gives an
in-depth view that helps us fully assess the patient's
condition before we act. We practice taking blood
pressures, using oxygen, and immobilizing the spine. We
learn how to extricate an injured person from a wreck, how
to stop arterial bleeding, how to apply a traction splint to a
broken femur. We cover everything from the complications
of childbirth to the best way to treat a nose bleed.
Another facet of modern EMS was initiated by Dr. J.
Frank Pantridge, who headed the cardiology department
of the Royal Victoria Hospital in Belfast, Northern Ireland.
Pantridge turned an ambulance into a mobile cardiac care
unit. In fifteen months he saved ten patients by bringing to
the scene of heart attacks the full arsenal of modern
resuscitation, including CPR and stimulative drugs like
epinephrine. He used two car batteries to build up the
current for the 7,000-volt jolt needed for electric
defibrillation.
By the late Sixties the idea was afloat to disseminate
Pantridge's concept by training EMTs to apply techniques
that were once the jealous preserve of physicians.
Technicians would learn to interpret electrocardiograms,
establish intravenous lines, administer drugs, and shock
patients in order to convert their hearts from the fatal
quivering of ventricular fibrillation. These “paramedic”
skills were officially recognized in 1969 by the American
College of Orthopedic Surgeons.
The first volunteer group to make use of these new
skills was the Haywood County Rescue Squad in the hills
of western North Carolina. A local internist, Dr. Ralph
Feitcher, noting Pantridge's work, brought together 40
volunteers for extensive training in 1968. The members
began applying their new skills a year later.
Many rescue squads now have added paramedic skills
to the services they offer their communities. The training
required is rigorous -- anywhere from 400 to 1500 hours,
plus additional hours of continuing education. But the
advanced life support that paramedics provide, nearly the
functional equivalent of a mobile emergency room, can
save lives.
Today's EMT's have at their disposal rescue tools that
Julian Wise would have envied back in 1928. In 1967 an
inventor named George Hurst designed an oversized
hydraulic can opener to help remove drivers from the
tangled metal of wrecked race cars. Dubbed the Jaws of
Life, this tool, which could generate five tons of force,
quickly found a market among rescue workers who were
faced with highway crashes just as severe as those on the
Indy track.
The biggest impact of the computer on emergency
volunteers has been in the development of automated
defibrillation. Battery-powered defibrillators became
available during the 1960s. They consisted of a monitor
and two metal paddles for applying current to a patient's
chest. But use of the units required an ability to interpret
the heart rhythm displayed on the screen. Once attached
to a patient, automated machines perform this analysis
internally, requiring the operator only to press a button if a
shock is indicated. This type of defibrillation is rapidly
becoming a standard EMT skill.
Air transport of patients represents the state of the art
in emergency medical services, taking Larrey's concept of
an ambulance volante to its literal limit. Again, the military
led the way. During the Korean conflict helicopters ferried
wounded soldiers to the Mobile Army Surgical Hospitals
made famous on the television show “M.A.S.H.” The
Vietnam war familiarized the nation with the “dust off”
helicopter that brought medical evacuation right into the
battle zone. The civilian version of the idea took off in the
1980s. Today hundreds of hospitals, police departments,
and private firms offer helicopter service.
The squad started by Julian Wise still operates out of a
large brick building constructed in 1957 near downtown
Roanoke. The headquarters houses a rescue truck, half a
dozen ambulances, a dormitory, meeting hall, and kitchen.
Rotating crews of six volunteers man the station for twelve-
hour shifts.
None of the members works for the railroad now. The
average age of members has dropped to the early
twenties. Kristine File, a new squad member, is one of
those who are very much aware of the crew's long history.
“It gets into your blood,” she says, talking over the drone
of the television in the squad lounge. “It's a rush for me to
stand where Julian Wise stood. I never met him, but I feel I
know him.”
But the world that File and the other Roanoke
volunteers contend with is far different than the one Wise
knew sixty years ago. Even in the late 1950s the crew was
handling only two or three calls a day. The city now
generates an average of more than 40 calls a day.
“We have some eighty names on the membership
roster,” says Sidney Robertson, who has been the group's
president since 1988, “But only about thirty-five are really
active.”
A bright-eyed man whose energy belies his 76 years,
Robertson is leading the organization through a time of
extensive change. During the 1980s paid city personnel
increasingly assumed responsibility for the burgeoning
load of calls. The Hunton crew, unable to recruit enough
members, folded. The Roanoke squad merged with the
other volunteer crew in the city to form the Roanoke
Emergency Medical System, Inc. And in 1989 financial
constraints required the squad to begin charging patients
for their service.
“People don't understand,” Robertson says, “how they
can be treated by two volunteers and then receive a bill for
$190.” But the group's annual operating budget has
climbed to more than $200,000. Additional assumption of
EMS responsibilities by the municipal authorities is
inevitable.
“It hurts,” Robertson admits, “to go under the city when
we've always had the freedom to do just as we wanted.
But our position has always been that the good of the
citizens comes first.”
Many of the Roanoke squad's problems are shared by
volunteers around the country. A single rescue truck can
cost $90,000, and automated defibrillation units run more
than $5,000 each. Baked food sales and fund raising
appeals don't always pay the bills. In Vermont, where 86%
of emergency medical services are provided by volunteers,
nearly three-quarters of squads bill those who use their
service.
“In the future you'll see a lot more hybrid squads, part
volunteer and part paid,” says Dan Manz, who heads up
EMS in Vermont and is president of the National
Association of State EMS Directors. “But volunteers are
still strong across the country.”
The types of calls are changing, too, especially in
cities. The urban poor often use the 911 system
indiscriminately. “Another taxi call,” one of the Roanoke
EMT's sneers after a non-emergency run. Abuse of
ambulance service is common. Like hospital emergency
rooms, rescue squads feel the strains that are affecting
the nation's medical system as a whole.
Recruiting is a perennial issue among volunteers.
Nationwide, turnover runs about 25% a year. A slew of
factors has made it hard for volunteer squads to maintain
coverage 24 hours a day. Employers are less agreeable
than in the past to letting workers take off from their jobs.
More people work away from the community. The time
demands of the rescue squad compete with second jobs
and family duties. The entry larger numbers of women
entering the work force has left fewer volunteers available
during weekdays.
Susan McHenry, the innovative director of Virginia's
EMS system, points to another issue: “One element that is
having an impact on manpower is that EMS has become a
much more attractive career in recent years. The result is
that some of the better, more committed volunteers move
into career positions and find they no longer have time to
volunteer.”
An EMS trade journal recently ran a feature article on
bullet-proof vests. Calls to domestic disputes, drug
overdoses or the aftermaths of shootings repeatedly
remind the volunteer of the possibility of violence. Adding
to the uneasiness is the peril of AIDS, hepatitis and
tuberculosis. EMTs are taught to assume that every
patient is a carrier, every drop of blood a danger.
In spite of all these drawbacks, unpaid providers
continue to play a major role in emergency medical
services. In rural areas, volunteers are still the ones who
arrive with the ambulance, who turn out at three in the
morning to help neighbors and strangers in distress.
“We're committed to keeping the volunteer tradition
alive in Roanoke,” Sidney Robertson told me. Indeed, as
an symbol of that commitment, the city is now the home of
the first museum dedicated to the story of volunteer rescue
squads. “To the Rescue” is a $1.2 million exhibit mounted
under the auspices of the Julian S. Wise Foundation.
Besides educating the public, it commemorates those
emergency responders who have lost their lives in the line
of duty.
One of the questions that those outside the field ask
rescue volunteers is “How do you handle the blood and
gore?” In practice, training and experience turn blood from
an emblem of horror into a sign that some action needs to
be taken.
“You have a bystander mentality that is purely
emotional,” says Pat Ivey, who has written two books about
her volunteer rescue experience. “But when you're the
one responsible, you shut that down and do what you
need to do. Only after a call does that bystander
perspective kick back in. Then you think about what all the
blood means. We've had some terrible calls, but I've never
seen an EMT who didn't do what needed to be done at the
time.”
Volunteers are a resilient lot who learn to walk a
narrow path between cynicism and sentimentality, between
callousness and tears. They are, in the end, humane
people who are pleasantly surprised when someone goes
out of his way to express appreciation.
“We were never seeking glory,” says Gordon Watson,
a longtime veteran of the Roanoke squad and colleague of
Julian Wise. “People took the crew for granted. And we
never tooted our own horn much because were always too
busy doing what had to be done.”
Still, the reason for enduring the countless hours of
training, drills and meetings, the frivolous calls and the
horrific calls, the danger and the drudgery, is clear. The
sense of fulfillment is worth more than any paycheck.
“I've never done anything that gave me the same self-
satisfaction,” Watson says. “It was an honor and a
privilege to serve with the squad.”
My radio breaks the silence at two in the afternoon, a
somber second day of deer hunting season. “Serious
injury auto accident.” A woman driving the highway that
cuts through our district has veered off the road. Maybe
she was distracted by one of her two young children in the
back seat. The car has careened down an embankment,
flipping over, throwing the driver out. The four-year-old
has crawled from the battered vehicle and is found
bleeding nearby. The two-year-old, rescued from his car
seat, sits on the lap of a passer-by, gloomily surveying the
activity around him.
Squad officers direct our members as they arrive. We
strap the mother to a plywood backboard -- critically
injured, she will prove to have suffered fractured
vertebrae. Because we offer only basic life support, we
summon a paid crew of paramedics to supply the woman
with needed advanced life support on the way to the
hospital. We bandage the older son's lacerations and
send him off in a different ambulance along with his
uninjured brother.
It is an ordinary call. We've done what we could. For a
few minutes the crew members who haven't gone with the
ambulance stand around speculating about the cause of
the mishap, trading a few jokes and some gossip,
unwinding. Then we remove our protective turn-out gear,
stash oxygen and first aid kits back in our cars, and go
home.
“This was like all other fine adventures,” Julian Wise
said, looking back on his life in volunteer rescue. “All we
need to do is reach out and there are people to respond.”
Wise died on a July afternoon in 1985, not unlike the
one during which he'd watched two men drown 76 years
earlier. In one of those dreamy coincidences, five hours
after Julian took his last breath, a call came into Roanoke's
911 system about a 13-year-old boy who'd gone down in
the river. Volunteers rushed to the scene, found the boy
unconscious, and in minutes had him breathing again.
And that, as every volunteer will tell you, is what it's all
about.
SAVING LIVES, CHANGING LIVES
A rescue squad is a visible institution that can give a
community a sense of self as well as a sense of security.
In 1988 Julian Wise's idea was picked up by James
“Rocky” Robinson in the Bedford-Stuyvesant section of
Brooklyn. Bed-Stuy, one of the oldest African-American
communities in New York City, had been hit hard by
poverty and drug violence. Fed up with twenty and thirty
minute response times on the part of the city EMS system,
Robinson, himself an EMS supervisor, launched the
Bedford-Stuyvesant Volunteer Ambulance Corps.
Big city rescue volunteers are not new. Though we
often picture the movement as a rural or suburban
phenomenon, there are 46 squads in New York City. The
oldest, in the College Point section of Queens, dates back
to 1942. The squads supplement the municipal EMS
system, which receives more than 4,000 calls on a busy
day. Volunteers may serve clients with special language
and cultural needs, as does the large and well-organized
squad Hatzolah, which ministers to the community of
Hasidic Jews.
Like many squads, Robinson's started without even an
ambulance. Members monitored radio scanners and
hurried off to calls in their own cars, hefting tanks of
oxygen and first aid kits. A couple of years later, after
publicity on the ABC television show “20/20,” the squad
managed to acquire an ambulance and a 50-foot mobile
home as a headquarters.
“Everyone was skeptical at first,” Robinson says.
“Even the people in the neighborhood didn't know if we
could cut it. But gradually they came over to our side.”
Training became a big part of the squad's operation.
Working with the city, the Bed-Stuy group has been
instrumental in training more than 500 EMTs. Previously,
minorities had rarely had the opportunity to acquire the
experience they needed in order to move into EMS as a
career, Robinson points out. Now many of the program's
alumni are working as career EMS employees.
“We started out to save lives and ended up changing
lives,” says Robinson, a burly man of 54.
The squad helped welfare recipients and gang
members to gain a direction in their lives. Robinson is
particularly proud of his “Trauma Troopers,” children who
learn CPR and first aid in after-school classes. They are
encouraged to spend time at the squad's headquarters in
order to expose them to positive role models. Recently,
Robinson's partner Joe Perez moved to southern
California, where he is working on starting a similar squad
in that South Central Los Angeles.
Deborah Crawford is a 41-year-old BSVAC veteran
who lives near the squad's quarters. “I volunteered just to
help out as a secretary,” she says. “Then I took some
training and went on a call, then another call. I liked it. I
became a tech, learned to drive.”
She now works for the city emergency medical system
as an EMT. Her seven-year-old son Vischon is one of the
Trauma Troopers. He spends time with the squad, helps
out with supplies, learns by watching.
“Maybe someday,” his mother says, “he'll be a doctor.”
# # #
(American Heritage Magazine – May/June 1996)
A warm May afternoon in 1909 -- the quiet along the
river in Roanoke, Virginia, is broken by cries for help. Two
canoeists have capsized. Bystanders rush to the banks,
throw branches toward the foundering men. In vain -- the
swift current carries them under; they drown. A nine-year-
old boy watches them perish.
This childhood memory, not just the watery death but
the utter helplessness of those on shore, would haunt
Julian Stanley Wise into adulthood. “Right then I resolved
that I was going to become a life saver,” he said. “Never
again would I watch a man die when he could be saved.”
His resolve would lead Wise to a lifetime of organizing
ordinary citizens to respond to emergencies. Today
450,000 volunteers, organized into squads modelled on
Wise's idea, provide ambulance and rescue service to
more than two thirds of the United States.
Wise grew to a slender, highly energetic young man,
with big jug ears and a quick wit. During the Roaring
Twenties he formed a dance band and strummed
Charlestons on his mandolin in Myrtle Beach resorts. He
held a day job as a lifeguard and a life saving instructor.
In 1927 he returned to his native Roanoke, a railroad
town in western Virginia tucked between the Allegheny and
Blue Ridge Mountains. He married and went to work as a
clerk for the Norfolk and Western Railroad. In the following
year he formed the Roanoke Life Saving and First Aid
Crew: ten volunteers intent on bringing emergency care to
those in need.
Today we take ambulance service for granted. But
unlike volunteer fire departments, which date to colonial
times, rescue squads developed relatively recently in
American life. Before modern emergency medical services
were established, a person who was injured or gravely ill
faced a grim ordeal.
Frederick R. Johnson, of White Township, New Jersey,
remembered breaking his leg as a young boy. He fell from
a ladder during the winter of 1914. Because his father was
away, his mother had to carry him through the snow to a
neighbor's house. Lacking a phone, the neighbor rode a
horse six miles to town. The doctor came out at noon the
next day, confirmed that the bone was fractured, and
advised Johnson's mother to get him to the hospital in
Easton, Pennsylvania, about 15 miles away.
Johnson remembered making the trip to town on an
iron bed mounted on a buckboard. “I hollered all the way
as the bumps sent pain shooting into my leg.”
After a twenty-minute wait, the bed was placed on the
baggage car of a southbound train to the city. A horse-
drawn ambulance carried the boy to Easton Hospital,
where his leg was finally set.
Johnson's experience reflected the type of emergency
medical care that was to change only slowly during the first
65 years of this century. Physicians attended patients at
the scene of emergencies. Accident victims were often
carried to a doctor's office rather than to a hospital. In any
case, improvisation was required when it came to transport
-- someone injured in an auto accident might be taken to
the hospital by the police or in the back seat of a passing
car. Except in large cities, no organized system or
authority existed to provide care. Rescue squads evolved
to address these deficiencies.
As I write I have on my desk a Motorola radio about the
size of a pack of cigarettes which silently monitors the
airwaves. On detecting a pair of tones designating the
Milan Rescue Squad it squawks an electronic alarm. A
dispatcher recites the type and location of the emergency.
A squad member for the past seven years, I carry in
my car a kit of supplies not all that different from what
Julian Wise's men used in 1928: a tank of oxygen, gauze
dressings, bandages, and a blanket. Since I maintain an
office in my home, I am available to help out on weekdays
when manpower is in short supply. Our district, in New
York's Hudson Valley, covers a township of more than 55
square miles with no central business district.
The squad consists of about thirty men and women
who are on call around the clock. We respond to auto
accidents and diabetic emergencies; to heart attacks, nose
bleeds, and sprained ankles; to the unexpected arrival of
the newborn and the last moments of the elderly. Today it
might be a man who's had a chain saw kick back on him,
tomorrow a widow suffering the vague malaise of terminal
loneliness.
The rescue squad idea was not entirely new when
Julian Wise's crew responded to their first call in 1928.
The volunteer Goodwill Fire Department in Pottstown,
Pennsylvania, had added a horse-drawn ambulance as
early as 1890 and had begun to offer first aid in 1911.
Wise's innovation was to combine rescue, first aid, and life
saving into one independent agency. The nine original
members of the crew all worked with Wise at the railroad.
Citizens were invited to call in alarms to a phone that rang
on the desk of chief clerk Harry Avis. Avis sent word to his
fellow crew members, who rushed to the scene of the
emergency. Only six calls were received during the first
year of operation and in most cases the crew arrived too
late to do any good.
“At that time, we could keep all our equipment in my
Reo,” Wise noted. The squad's first aid kit was a $3
fishing tackle box, stocked with supplies that included
poison ivy wash, tannic acid compound, ammonia inhalant
and tincture of merthiolate.
In 1931 Wise and his men were called out for a
drowning. They reached the scene in eleven minutes and
effectively revived a 16-year-old boy. The feat attracted
national publicity. Interest in the volunteer rescue
movement began to grow. Wise, a tireless promoter of his
cause, travelled to cities in Virginia, the Carolinas, and
elsewhere to help start squads, many of which cloned the
structure and philosophy of Wise's crew.
In Roanoke itself a group of volunteers under the
leadership of Alexander A. Terrell formed a squad a few
weeks after Pearl Harbor. The Hunton Life Saving and
First Aid Crew, the first all-black rescue squad in the
nation, served the city's predominantly African-American
northwest side.
“We made calls to people we knew personally,”
explains Lewis Peery, a soft-spoken man of 74 who served
on the Hunton Crew for more than 30 years beginning in
1955 and who currently sits on the board of the Roanoke
group. “It made it hard when you'd lose somebody. But
we knew we'd done all we could.”
To get to the scene, rescue squad members would
drive their own cars, or wait on the corner for another
member to pick them up. One of the original Roanoke
members remembered riding to a call on his brother's
bicycle.
In the days when doctors still made house calls, rescue
squads were seen as physicians' adjuncts. “We carried a
doctor's kit,” says Samuel Fralin, an 80-year-old former
postal worker who joined the Roanoke crew in the 1950s.
“We had an assortment of drugs, hypodermics and other
things a doctor would need in a sealed bag. If a doctor
showed up, we could break it out.” This was a common
practice on volunteer ambulances for many years.
Wise was the captain of the Roanoke squad for three
decades. “Julian was my hero,” Fralin says. “He was an
extraordinary man, an extreme extrovert, and somebody
who made his vision into reality. But you had to know your
stuff. Any time, he might ask you to give a demonstration,
say, of the Emerson resuscitator. You had to perform.”
The core of Wise's idea, and the essence of all
emergency work, is speed: to bring help to the injured or
critically ill as quickly as possible. “Save seconds and you
have a better chance of saving a life,” Wise said.
In this he echoed the sentiments of the man who is
known as “The Father of Ambulance Service.” Late in the
18th century, Dominique Jean Larrey, a surgeon in
Napoleon's army, observed that because military field
hospitals remained at least a league to the rear of the
fighting, the wounded did not reach them for 24 hours after
a battle. “Most of the wounded died from want of
assistance,” he observed. “This suggested to me the idea
of constructing an ambulance in such a manner that it
might afford a ready conveyance for the wounded during
the battle.”
Larrey invented the ambulance volante, a light two- or
four-wheeled carriage with room for a number of litters.
The vehicle carried into the battle zone a medical officer
and assistant who were able to treat wounded soldiers
where they fell.
Larrey wrote, “The first four hours are an isolated
period of calm which nature is able to maintain, and
advantage should be taken of this to administer the
appropriate remedy.” This advice rings true down to
today, when, as emergency medical technicians, we are
trained to heed the “golden hour” after a traumatic
accident, a window of opportunity to stabilize the patient
and transport him to an emergency facility.
While many of the developments of emergency
medicine would emerge from the military, civilian
volunteers have a long history of providing care. Perhaps
the oldest continuously active group of volunteers is the
Misericordia di Firenze, which was founded in 1240 to help
the sick and transport the dead of medieval Florence.
Hundreds of branches remain active in northern Italy.
Volunteers are still inducted into the group in elaborate
robed ceremonies.
In Britain the St. John Ambulance Association was
formed in 1878. Despite opposition from the medical
establishment, the organization trained volunteers in the
stop-gap treatment of wounds and illnesses, a practice for
which members invented the term “first aid.” Ten years
later, they began to offer ambulance service. The group's
roots go back to an order of knights who ran a Jerusalem
hospital during the crusades. Members still provide first
aid services in England.
The 1859 French, Italian and Austrian troops engaged
in a one-day bloodbath known as the Battle of Solferino, a
fight that left 36,000 wounded strewn across the
battlefield. A Swiss tourist on hand for the spectacle was
appalled. Jean-Henri Dunant later organized a conference
to establish humane rules of warfare. He set up a group to
coordinate civilian aid to wounded soldiers. To honor
Dunant the organization adopted the Swiss flag with its
colors reversed: a red cross on a white field. Dunant's
group became the International Red Cross, which in 1911
greatly expanded the training of laymen in the techniques
of first aid.
Civilian ambulance service began in large cities in the
second half of the 19th Century. In 1865 the Cincinnati
General Hospital established what was probably the first
regular ambulance operation in the United States. Four
years later Edward B. Dalton, a physician who had
organized medical evacuation during the Wilderness
Campaign of the Civil War, set up an ambulance service
for New York's Bellevue Hospital. That corps responded to
1401 calls in 1870. Snap harnesses suspended over the
horses enabled drivers to respond in as little as thirty
seconds, covering a mile through the city in about 6
minutes. Two physicians took turns accompanying the
ambulance. In addition to bandages and splints, the
ambulances' first aid kits always contained a quart flask of
brandy.
Most large cities developed some semblance of
organized ambulance service in the period before World
War I. Chicago saw the first motorized ambulance in 1899,
with St. Vincent's Hospital in New York introducing electric
vehicles a year later. An electric ambulance with hard
rubber tires rushed President McKinley to the Buffalo
Temple of Music Hospital after he was shot by an anarchist
in 1901.
Compared to its horse-drawn predecessor, the motor
ambulance, as Scientific American noted, “is capable of
greater sustained speed, and when the destination is
reached, no care has to be paid to the steaming horse.” It
offered the additional advantage of eliminating the need
for stables, and accompanying flies, on hospital grounds.
Despite the increased speed available, complaints
about dilatory service have been hurled at ambulances
from the earliest days. In 1905 a man was knocked down
by a cab a half mile from a New York hospital. During his
45-minute wait for an ambulance, a fire broke out in a near-
by building, the fire company arrived, and the blaze was
extinguished.
In many communities morticians possessed the only
vehicles capable of carrying recumbent patients. They
dominated the ambulance business for decades, usually
charging only a few dollars for a ride to a hospital or
doctor's office. For many operators the ambulance
business was a way to build goodwill, with an eye to the
more lucrative funeral business down the road. Some
maintained dedicated ambulances, others employed
hearses modified to accept a stretcher. Even Julian Wise's
resourceful squad in Roanoke deferred to the city's
undertakers until 1959, when the volunteers began to
provide transport as well as first aid.
For fifty years after World War I the manufacture of
ambulances was closely associated with the production of
hearses and funeral cars. Ambulances of the 1920s often
featured leaded glass windows and stained mahogany
interiors. Styles and horsepower changed over the years,
but the basic form of the ambulance as an enlarged
passenger car on a limousine frame remained constant.
“Those ambulances had the advantage of comfort,
speed, driveability, and a low center of gravity,” says
Myron Gitell, ambulance collector and publisher of a
history called The Ambulance. “They didn't have that
much room in back, but in those days patients rarely
received any treatment on the way to the hospital anyway.”
In the 1970s federal regulations and innovations in
emergency medical care dictated a switch to the use of the
vans and light trucks that are the standard ambulances
today.
Both motorized ambulances and emergency volunteers
played a role in World War I. When the guns roared in
1914, American expatriates began to aid the French war
effort by establishing ambulance services to transport the
wound back from the lines.
Two of the founders of this effort, Richard Norton and
Herman Harjes, had connections in high society -- Harjes
was the son of the House of Morgan's principal
representative in Europe. At a time when most army
ambulances were horse-drawn, Norton and Harjes were
able to assemble donated motor cars for conversion into
ambulances, and to make the idea of volunteer ambulance
driver fashionable.
One driver volunteered “with the object of seeing war
first hand and getting some excitement, as well as being of
some service.” This combination of humanitarianism and
adventure has motivated rescue volunteers through
history. It inspired many U.S. college students to sign up
as ambulance drivers in Europe; Harvard alone send 325
young men to the effort.
The duty was arduous and full of danger. “I am willing
to confess that it takes nerve of more than one variety to
handle unconscious boys and legless men all day long,”
one driver said. The volunteers would wrestle Model-T
Fords down shell-cratered roads, almost always at night
and without the benefit of lights, driving, as one man said,
“by instinct.”
A number of men who would become prominent writers
signed on for ambulance service during the war, including
John Dos Passos, Malcolm Cowley, and e.e. cummings.
The nineteen-year-old Ernest Hemingway was wounded by
a grenade and machine gun attack while serving as an
ambulance volunteer in Italy.
By 1940 the Roanoke squad had 58 members and
boasted of a carbon monoxide detector, field telephones,
an acetylene torch, and portable floodlights. That same
year the first of several serious polio epidemics hit
Roanoke. The volunteers arranged for the purchase of
iron lungs, 750-pound tanks that used negative air
pressure to breathe for paralyzed patients. During the
1944 epidemic, which involved more than 750 cases, area
rescue squads supplied 21 iron lungs. Julian Wise set up
a state-wide training program on how to use the unwieldy
devices.
The rescue squad movement continued to spread.
When the Hindenburg dirigible exploded in 1937, the New
Jersey First Aid Council was able to summon 29
ambulances to respond to the scene in Lakehurst. A 1945
Reader's Digest article featured Wise and his crew, with
the subtitle “An idea for your town.” That piece and a
follow-up article 11 years later boosted interest in rescue
squads around the country. Wise did his bit, helping to
form 25 squads in Virginia alone, and advising volunteers
from Michigan to Alabama, as well as in Canada and
Europe. He would phone squad captains across his state
monthly just to find out how things were going. By 1956
there were 26,000 members participating in 850 squads
around the world.
“The credit goes to the crews,” Wise insisted. “I was
only the pusher.”
Many squads were associated with volunteer fire
departments. During the 1920s fire departments in New
Jersey and Texas pioneered efforts to add rescue and first
aid capabilities. Legion posts were another common
sponsor of squads. Charles Myers remembers when his
group of veterans in the little upstate New York town of
Eldrid started a squad in 1946
“We handed out cards with our phone numbers on
them. When someone had an emergency, they called until
they reached a member who was home. That member
called the others and off we went. I still get calls -- people
have those old cards tacked on the wall.” Myers is
approaching his 50th year of active service with the squad.
In Roanoke, I spent some time with the volunteers who
carry on the tradition of Julian Wise's original crew. The
excitement of riding in a speeding ambulance, with lights
flashing and the siren screaming a passage through traffic,
is very real. One young EMT told me she joined the squad
“for the adrenaline rush and to be in the middle of the
action.” Certainly there is an element of “trauma junky” in
most volunteers, who are eager to go out on a “good” call
-- one involving sufficient life-and-death mayhem.
But the reality of the calls is often very different.
Tonight in one of Roanoke's poorer neighborhoods an old
lady has fallen in her home; she needs to go to the
hospital to be checked out. Pulse 74 and regular. On the
wall, a framed mother's day card. Patient is awake and
oriented. A needlepoint sampler: “What is life without
love?” Blood pressure 150 over 80. The stretcher is
wheeled in. A quiet ride to the hospital.
Later, an alarm goes out for a “code” at a nursing
home. It means a person whose heart has stopped
beating, a woman teetering on the edge of death. The
experienced crew of volunteers is unflappable throughout:
The driver Kathy Hagy is a mother of five, EMT Lena
Speck is studying pre-med at a local college, the crew
leader Luke Chambers is a respiratory therapist.
They are at the woman's bedside in minutes, following
a practiced routine: Begin cardiopulmonary resuscitation.
Insert an endotracheal tube, a clear passage for supplying
oxygen to the woman's lungs. Establish an intravenous
line to administer fluids and drugs. Connect a heart
monitor -- the green line shows the feeble quivering
motions of the woman's heart. Apply the paddles of the
defibrillator three times -- each time the woman stiffens as
if startled by a loud noise. No signs of life appear.
The crew wheels the patient to the ambulance, one
member astride the gurney to continue chest
compressions. As the ambulance rolls, more drugs are
administered: epinephrine, lidocaine. Another round of
shocks. For a moment a pulse returns, the woman's heart,
after 74 years of beating, doesn't want to give up. Stop
chest compressions. The patient's pupils remain fixed and
dilated.
As she's wheeled into the emergency room the line on
the monitor flattens, the patient “codes” again. Begin
CPR. The crew turns her over to waiting physicians and
nurses. They proceed with a similar round of efforts. To
no avail. A few minutes later the woman is pronounced
dead.
Resuscitation, the most heroic of the rescue squad's
storehouse of treatments, always involves swimming
against the tide. Something has caused the patient's heart
to stop, and the resulting oxygen starvation quickly
diminishes the person's ability to recover.
The ambulance crew retires to a corner of the
emergency ward to wash up and complete the paperwork
that will document their futile efforts to save this woman's
life. The ability to look at and accept death is one of the
first lessons that every rescue worker learns
Luke Chambers, 28, muses afterwards. “Sometimes,”
he says, “you meet somebody in the mall -- maybe you
don't even recognized them -- who you helped in an auto
accident. But they actually come up to you and say thank
you. Things like that really make it worthwhile.”
In spite of the steady spread of rescue squads,
ambulance service in the early 1960s still left much to be
desired. Morticians continued to provide emergency
transportation to half the country. In many places, even
large cities, ambulances ran with only a driver; the patient
rode alone in the back of the ambulance. Of 200,000
ambulance and rescue personnel, fewer than half were
trained to the level of Red Cross advanced first aid. Only
six states offered standard courses for rescuers, and only
four regulated ambulances.
Washtenaw County, Michigan, which includes the city
of Ann Arbor, provides a typical picture. In 1966, the 23
ambulances in the county were operated by 17 different
concerns, including hospitals, gas stations, taxi companies
and funeral homes. Service outside urban areas was
spotty at best. No standards of any kind were enforced.
The efficiency of emergency care advanced slowly in
the nearly four decades that passed since Wise founded
his squad in 1928. The reason can be traced in part to
the determination of the medical establishment to keep
laymen from trespassing on the territory of the physician.
Rescue volunteers, their duties only sketchily defined,
could be accused of practicing medicine without a license.
The American Red Cross, which supervised first aid
training, never took an active role in organizing or
supporting rescue squads. In fact Julian Wise came into
conflict with Red Cross bureaucrats who felt his approach
too progressive. Volunteers were willing to do more, but
the tools and skills were kept out of their reach.
“Doctors did have a tendency to get a little stinky when
it came to us doing too much,” says Sidney Robertson, a
veteran of rescue work in Roanoke and current president
of the volunteer squad there. “If one of the members
asked our medical advisor about a technique, his answer
often was, You don't want to get into that.”
The motto of rescue workers in those days was “load
and go.” “Prehospital care was limited solely to
transportation,” said a report of the American College of
Emergency Physicians. “Medical treatment didn't begin
until the patient arrived at the hospital.”
But the ten years between 1966 and 1976 would see a
transformation in emergency medical services (EMS) that
would affect volunteers profoundly, and would permanently
alter the public's expectations about ambulance service.
The changes were closely linked to that ubiquitous plague
of modern life: the auto accident.
Only four gasoline-powered automobiles existed in the
United States in 1885. Two of them encountered each
other on the streets of St. Louis that year and collided.
Both drivers were injured, one seriously. That crash was a
harbinger of a coming slaughter on the highways, a record
of death and injury that would surpass all the casualties of
all the wars in the nation's history.
In the 1960 presidential campaign, candidate John F.
Kennedy labeled traffic accidents “the greatest of the
nation's health problems.” His choice of words was
significant. Researchers and policy makers were
beginning to change their perspective on accidents.
Instead of framing the problem as one involving random
acts of carelessness, they began to see an epidemic that
followed the pattern of a disease and offered opportunities
for prevention and cure.
The problem was a grave one. By 1965 annual
highway deaths had reached 49,000. Accidents of all
types killed 107,000 and permanently disabled nearly half
a million people every year. Accidents were the number
one cause of death up to the age of 35. Observers
routinely asserted in the late Sixties that a soldier wounded
in the jungles of Vietnam had a better chance of survival
than did a citizen hurt in a traffic accident back home.
In 1966 a seminal report from the National Academy of
Sciences catalogued the inadequacies of the country's
emergency medical services and recommended solutions
in terms of training and standards. The time for action had
come. Lyndon Johnson's Washington was a can-do place,
and the sea change that would sweep over the country's
ambulance service was a textbook case of big government
in action.
The Highway Traffic Safety Act of 1966 set federal
standards for training, equipment and procedures, which
states busied themselves implementing. While auto
accidents were the target, the legislation transformed EMS
across the board. The momentum of the changes was
maintained in the 1970s as “systems” became the rallying
cry. Emergency service began to become organized for
the first time.
Dr. Carol Gilbert, director of trauma at Roanoke
Memorial hospital and a longtime advisor to rescue
volunteers, points to systems as the real foundation of the
new approach to emergency medical aid. “A single person
doesn't save a life -- it's the response of an entire team.
What has altered in EMS is the realization that the system
is more important than any one component.”
As the states began to flesh out the concepts devised
in Washington, Congress picked up the tab. Hundreds of
millions of dollars were poured into demonstration projects,
pilot programs, and block grants to states. Government
funding in the 1970s essentially put EMS on its feet.
Communications and ambulance design were
enhanced as a result of federal involvement. The 911
telephone system spread, allowing for more efficient
dispatch. Ambulances acquired radios which attendants
could use to communicate with hospitals, a helpful link
when a serious case raised questions of treatment.
Standards for ambulances emphasized adequate room to
treat patients en route.
The development that would have the most direct
impact on volunteers was the new standard for training.
By the end of the 1960s the National Highway Traffic
Safety Administration had established a comprehensive 81-
hour course for Emergency Medical Technicians. In 1969,
200 people took the EMT course, the first emergency
responders to be trained to a national standard. The
course, which was later expanded to 110 hours, has
become a rite-of-passage for rescue volunteers.
The new training and testing represented a challenge,
but one to which volunteers adapted with enthusiasm. “All
our members, old and young, welcomed the EMT concept,”
says Sidney Robertson. “We wanted to learn more and we
were proud to call ourselves EMTs.”
Like every emergency tech, I've spent many hours
committing to memory the grievous effects of trauma on
the human body, with names like tension pneumothorax
and subdural hematoma. Where first aid training takes a
surface view of injury and illness, the EMT course gives an
in-depth view that helps us fully assess the patient's
condition before we act. We practice taking blood
pressures, using oxygen, and immobilizing the spine. We
learn how to extricate an injured person from a wreck, how
to stop arterial bleeding, how to apply a traction splint to a
broken femur. We cover everything from the complications
of childbirth to the best way to treat a nose bleed.
Another facet of modern EMS was initiated by Dr. J.
Frank Pantridge, who headed the cardiology department
of the Royal Victoria Hospital in Belfast, Northern Ireland.
Pantridge turned an ambulance into a mobile cardiac care
unit. In fifteen months he saved ten patients by bringing to
the scene of heart attacks the full arsenal of modern
resuscitation, including CPR and stimulative drugs like
epinephrine. He used two car batteries to build up the
current for the 7,000-volt jolt needed for electric
defibrillation.
By the late Sixties the idea was afloat to disseminate
Pantridge's concept by training EMTs to apply techniques
that were once the jealous preserve of physicians.
Technicians would learn to interpret electrocardiograms,
establish intravenous lines, administer drugs, and shock
patients in order to convert their hearts from the fatal
quivering of ventricular fibrillation. These “paramedic”
skills were officially recognized in 1969 by the American
College of Orthopedic Surgeons.
The first volunteer group to make use of these new
skills was the Haywood County Rescue Squad in the hills
of western North Carolina. A local internist, Dr. Ralph
Feitcher, noting Pantridge's work, brought together 40
volunteers for extensive training in 1968. The members
began applying their new skills a year later.
Many rescue squads now have added paramedic skills
to the services they offer their communities. The training
required is rigorous -- anywhere from 400 to 1500 hours,
plus additional hours of continuing education. But the
advanced life support that paramedics provide, nearly the
functional equivalent of a mobile emergency room, can
save lives.
Today's EMT's have at their disposal rescue tools that
Julian Wise would have envied back in 1928. In 1967 an
inventor named George Hurst designed an oversized
hydraulic can opener to help remove drivers from the
tangled metal of wrecked race cars. Dubbed the Jaws of
Life, this tool, which could generate five tons of force,
quickly found a market among rescue workers who were
faced with highway crashes just as severe as those on the
Indy track.
The biggest impact of the computer on emergency
volunteers has been in the development of automated
defibrillation. Battery-powered defibrillators became
available during the 1960s. They consisted of a monitor
and two metal paddles for applying current to a patient's
chest. But use of the units required an ability to interpret
the heart rhythm displayed on the screen. Once attached
to a patient, automated machines perform this analysis
internally, requiring the operator only to press a button if a
shock is indicated. This type of defibrillation is rapidly
becoming a standard EMT skill.
Air transport of patients represents the state of the art
in emergency medical services, taking Larrey's concept of
an ambulance volante to its literal limit. Again, the military
led the way. During the Korean conflict helicopters ferried
wounded soldiers to the Mobile Army Surgical Hospitals
made famous on the television show “M.A.S.H.” The
Vietnam war familiarized the nation with the “dust off”
helicopter that brought medical evacuation right into the
battle zone. The civilian version of the idea took off in the
1980s. Today hundreds of hospitals, police departments,
and private firms offer helicopter service.
The squad started by Julian Wise still operates out of a
large brick building constructed in 1957 near downtown
Roanoke. The headquarters houses a rescue truck, half a
dozen ambulances, a dormitory, meeting hall, and kitchen.
Rotating crews of six volunteers man the station for twelve-
hour shifts.
None of the members works for the railroad now. The
average age of members has dropped to the early
twenties. Kristine File, a new squad member, is one of
those who are very much aware of the crew's long history.
“It gets into your blood,” she says, talking over the drone
of the television in the squad lounge. “It's a rush for me to
stand where Julian Wise stood. I never met him, but I feel I
know him.”
But the world that File and the other Roanoke
volunteers contend with is far different than the one Wise
knew sixty years ago. Even in the late 1950s the crew was
handling only two or three calls a day. The city now
generates an average of more than 40 calls a day.
“We have some eighty names on the membership
roster,” says Sidney Robertson, who has been the group's
president since 1988, “But only about thirty-five are really
active.”
A bright-eyed man whose energy belies his 76 years,
Robertson is leading the organization through a time of
extensive change. During the 1980s paid city personnel
increasingly assumed responsibility for the burgeoning
load of calls. The Hunton crew, unable to recruit enough
members, folded. The Roanoke squad merged with the
other volunteer crew in the city to form the Roanoke
Emergency Medical System, Inc. And in 1989 financial
constraints required the squad to begin charging patients
for their service.
“People don't understand,” Robertson says, “how they
can be treated by two volunteers and then receive a bill for
$190.” But the group's annual operating budget has
climbed to more than $200,000. Additional assumption of
EMS responsibilities by the municipal authorities is
inevitable.
“It hurts,” Robertson admits, “to go under the city when
we've always had the freedom to do just as we wanted.
But our position has always been that the good of the
citizens comes first.”
Many of the Roanoke squad's problems are shared by
volunteers around the country. A single rescue truck can
cost $90,000, and automated defibrillation units run more
than $5,000 each. Baked food sales and fund raising
appeals don't always pay the bills. In Vermont, where 86%
of emergency medical services are provided by volunteers,
nearly three-quarters of squads bill those who use their
service.
“In the future you'll see a lot more hybrid squads, part
volunteer and part paid,” says Dan Manz, who heads up
EMS in Vermont and is president of the National
Association of State EMS Directors. “But volunteers are
still strong across the country.”
The types of calls are changing, too, especially in
cities. The urban poor often use the 911 system
indiscriminately. “Another taxi call,” one of the Roanoke
EMT's sneers after a non-emergency run. Abuse of
ambulance service is common. Like hospital emergency
rooms, rescue squads feel the strains that are affecting
the nation's medical system as a whole.
Recruiting is a perennial issue among volunteers.
Nationwide, turnover runs about 25% a year. A slew of
factors has made it hard for volunteer squads to maintain
coverage 24 hours a day. Employers are less agreeable
than in the past to letting workers take off from their jobs.
More people work away from the community. The time
demands of the rescue squad compete with second jobs
and family duties. The entry larger numbers of women
entering the work force has left fewer volunteers available
during weekdays.
Susan McHenry, the innovative director of Virginia's
EMS system, points to another issue: “One element that is
having an impact on manpower is that EMS has become a
much more attractive career in recent years. The result is
that some of the better, more committed volunteers move
into career positions and find they no longer have time to
volunteer.”
An EMS trade journal recently ran a feature article on
bullet-proof vests. Calls to domestic disputes, drug
overdoses or the aftermaths of shootings repeatedly
remind the volunteer of the possibility of violence. Adding
to the uneasiness is the peril of AIDS, hepatitis and
tuberculosis. EMTs are taught to assume that every
patient is a carrier, every drop of blood a danger.
In spite of all these drawbacks, unpaid providers
continue to play a major role in emergency medical
services. In rural areas, volunteers are still the ones who
arrive with the ambulance, who turn out at three in the
morning to help neighbors and strangers in distress.
“We're committed to keeping the volunteer tradition
alive in Roanoke,” Sidney Robertson told me. Indeed, as
an symbol of that commitment, the city is now the home of
the first museum dedicated to the story of volunteer rescue
squads. “To the Rescue” is a $1.2 million exhibit mounted
under the auspices of the Julian S. Wise Foundation.
Besides educating the public, it commemorates those
emergency responders who have lost their lives in the line
of duty.
One of the questions that those outside the field ask
rescue volunteers is “How do you handle the blood and
gore?” In practice, training and experience turn blood from
an emblem of horror into a sign that some action needs to
be taken.
“You have a bystander mentality that is purely
emotional,” says Pat Ivey, who has written two books about
her volunteer rescue experience. “But when you're the
one responsible, you shut that down and do what you
need to do. Only after a call does that bystander
perspective kick back in. Then you think about what all the
blood means. We've had some terrible calls, but I've never
seen an EMT who didn't do what needed to be done at the
time.”
Volunteers are a resilient lot who learn to walk a
narrow path between cynicism and sentimentality, between
callousness and tears. They are, in the end, humane
people who are pleasantly surprised when someone goes
out of his way to express appreciation.
“We were never seeking glory,” says Gordon Watson,
a longtime veteran of the Roanoke squad and colleague of
Julian Wise. “People took the crew for granted. And we
never tooted our own horn much because were always too
busy doing what had to be done.”
Still, the reason for enduring the countless hours of
training, drills and meetings, the frivolous calls and the
horrific calls, the danger and the drudgery, is clear. The
sense of fulfillment is worth more than any paycheck.
“I've never done anything that gave me the same self-
satisfaction,” Watson says. “It was an honor and a
privilege to serve with the squad.”
My radio breaks the silence at two in the afternoon, a
somber second day of deer hunting season. “Serious
injury auto accident.” A woman driving the highway that
cuts through our district has veered off the road. Maybe
she was distracted by one of her two young children in the
back seat. The car has careened down an embankment,
flipping over, throwing the driver out. The four-year-old
has crawled from the battered vehicle and is found
bleeding nearby. The two-year-old, rescued from his car
seat, sits on the lap of a passer-by, gloomily surveying the
activity around him.
Squad officers direct our members as they arrive. We
strap the mother to a plywood backboard -- critically
injured, she will prove to have suffered fractured
vertebrae. Because we offer only basic life support, we
summon a paid crew of paramedics to supply the woman
with needed advanced life support on the way to the
hospital. We bandage the older son's lacerations and
send him off in a different ambulance along with his
uninjured brother.
It is an ordinary call. We've done what we could. For a
few minutes the crew members who haven't gone with the
ambulance stand around speculating about the cause of
the mishap, trading a few jokes and some gossip,
unwinding. Then we remove our protective turn-out gear,
stash oxygen and first aid kits back in our cars, and go
home.
“This was like all other fine adventures,” Julian Wise
said, looking back on his life in volunteer rescue. “All we
need to do is reach out and there are people to respond.”
Wise died on a July afternoon in 1985, not unlike the
one during which he'd watched two men drown 76 years
earlier. In one of those dreamy coincidences, five hours
after Julian took his last breath, a call came into Roanoke's
911 system about a 13-year-old boy who'd gone down in
the river. Volunteers rushed to the scene, found the boy
unconscious, and in minutes had him breathing again.
And that, as every volunteer will tell you, is what it's all
about.
SAVING LIVES, CHANGING LIVES
A rescue squad is a visible institution that can give a
community a sense of self as well as a sense of security.
In 1988 Julian Wise's idea was picked up by James
“Rocky” Robinson in the Bedford-Stuyvesant section of
Brooklyn. Bed-Stuy, one of the oldest African-American
communities in New York City, had been hit hard by
poverty and drug violence. Fed up with twenty and thirty
minute response times on the part of the city EMS system,
Robinson, himself an EMS supervisor, launched the
Bedford-Stuyvesant Volunteer Ambulance Corps.
Big city rescue volunteers are not new. Though we
often picture the movement as a rural or suburban
phenomenon, there are 46 squads in New York City. The
oldest, in the College Point section of Queens, dates back
to 1942. The squads supplement the municipal EMS
system, which receives more than 4,000 calls on a busy
day. Volunteers may serve clients with special language
and cultural needs, as does the large and well-organized
squad Hatzolah, which ministers to the community of
Hasidic Jews.
Like many squads, Robinson's started without even an
ambulance. Members monitored radio scanners and
hurried off to calls in their own cars, hefting tanks of
oxygen and first aid kits. A couple of years later, after
publicity on the ABC television show “20/20,” the squad
managed to acquire an ambulance and a 50-foot mobile
home as a headquarters.
“Everyone was skeptical at first,” Robinson says.
“Even the people in the neighborhood didn't know if we
could cut it. But gradually they came over to our side.”
Training became a big part of the squad's operation.
Working with the city, the Bed-Stuy group has been
instrumental in training more than 500 EMTs. Previously,
minorities had rarely had the opportunity to acquire the
experience they needed in order to move into EMS as a
career, Robinson points out. Now many of the program's
alumni are working as career EMS employees.
“We started out to save lives and ended up changing
lives,” says Robinson, a burly man of 54.
The squad helped welfare recipients and gang
members to gain a direction in their lives. Robinson is
particularly proud of his “Trauma Troopers,” children who
learn CPR and first aid in after-school classes. They are
encouraged to spend time at the squad's headquarters in
order to expose them to positive role models. Recently,
Robinson's partner Joe Perez moved to southern
California, where he is working on starting a similar squad
in that South Central Los Angeles.
Deborah Crawford is a 41-year-old BSVAC veteran
who lives near the squad's quarters. “I volunteered just to
help out as a secretary,” she says. “Then I took some
training and went on a call, then another call. I liked it. I
became a tech, learned to drive.”
She now works for the city emergency medical system
as an EMT. Her seven-year-old son Vischon is one of the
Trauma Troopers. He spends time with the squad, helps
out with supplies, learns by watching.
“Maybe someday,” his mother says, “he'll be a doctor.”
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