Reviving the Doctor’s “House Call”

And saving thousands of lives doing it

BY 1967 the term “paramedics” was generally used in the United States to describe nonphysicians, usually fire fighters, trained to give advanced medical aid outside the hospital. Since then, more than 10 million people in the United States have called them for help. The paramedics​—it’s a story of people helping people.

Previous to the paramedics, emergency medical care was presumed to start when the patient arrived at the hospital. Ambulances careened through city streets, running red lights with sirens wailing, to get that care started as soon as possible. Many times it was not soon enough. Years ago many ambulance drivers and attendants were untrained even in elementary first aid. Various reports stressed the sorry picture of emergency care at that time in the U.S.

Europe moved more quickly to remedy inadequate prehospital emergency care. Prior to 1960 Russia dispatched ambulance crews having a doctor, a nurse and a special physician’s assistant. West Germany and France placed doctors in ambulances by 1961. The early mobile care units specialized in coronary emergencies.

The first such unit in the United States began in 1966, in New York City. It was staffed by medical personnel, not paramedics. In Miami, Florida, fire fighters were trained for use as “physician extenders”​—substitutes, or surrogates, guided by radio-transmitted orders from a physician located in a hospital. By 1967 Miami had developed equipment whereby their emerging paramedics could routinely transmit EKG’s (electrocardiograms) to hospital physicians and then be advised on what drugs to use or what other treatment to administer. The equipment was crude then compared to that used by paramedics today.

Keeping pace with the rapid developments, Ohio came out with a “rolling emergency room,” called the Heartmobile. It was put in service in April of 1969. In the same year Los Angeles introduced a similar mobile unit.

The activities of the Los Angeles paramedics were dramatized in the television series Emergency, which began in 1971 and lasted for six years. Its impact upon millions has been immeasurable in establishing paramedics as fast responders to calls for help in life-threatening emergencies. Millions of children who were emotionally stirred by the exciting adventures declared that they were going to be paramedics when they grew up.

Seattle’s program became widely known for a different reason: in addition to their use of paramedics, in 1971 they launched a program whose goal was to train 100,000 citizens in the CPR (cardiopulmonary resuscitation) technique. By 1973, 20 percent of resuscitations performed by paramedics were started by bystanders before the paramedics arrived at the scene of the emergency. By 1978 Seattle had trained 200,000 of its residents in CPR​—36 percent of its total population. Seattle became world famous as the “safest place to have a heart attack.”

During the 1970’s paramedics expanded their services until now, in addition to helping heart-attack victims, they respond to almost any life-threatening situation. Their equipment is sophisticated, their training is intensive, and doctors’ confidence in them has increased tremendously. Throughout the United States there are base-station hospitals that maintain physicians in the emergency rooms. Paramedics in the field talk to these doctors through portable radios, reporting on the condition of the sick or injured, even transmitting EKG’s to a screen in the hospital for the doctor to see. The doctor then tells the paramedic the treatment to use. The paramedic must do what the doctor orders. He is not the doctor; he is the doctor’s surrogate. It is the doctor who decides on the treatment.

It’s almost like the physician some 50 years ago who made house calls, only now the doctor does it through the use of radio frequency to the paramedic who is out in the field giving running reports on the patient’s condition. When the doctor says it’s time to bring the patient to the hospital, the paramedic brings him in.

In this way the paramedic has revived the doctor’s long-deceased house call, and has saved thousands of lives doing it. For interesting details, read in the following article the story of one paramedic’s experiences.

ONE Sunday morning a call came in to the paramedics stationed at the Huntington Beach Fire Department in California. A frantic voice on the other end of the telephone line screamed: “Come quick! My husband’s dying!” When my partner and I arrived blood was spattered over every room in the apartment, and a man was lying on the floor gripping his neck. With every heartbeat arterial blood spurted out. What had happened was: He had been out drinking, came in and beat his wife, and she ran a nine-inch butcher-knife blade through his neck. It had severed one of the carotid arteries that supplies blood to the brain. In panic he had run throughout the apartment.

Now he lay writhing on the floor. He was sure he was dying. I clamped off the neck, got two IV’s (intravenous feeding) started, one in each arm, replacing the blood volume with a substitute blood-volume expander called Ringer’s lactate. We then rushed him to the hospital. It being Sunday, few were there to assist the surgeon in the operating room, so I did. A vein removed from his leg was spliced onto the carotid artery. He lived.

It was at this time that the Huntington Beach Fire Department started a new program, the paramedic program. I joined up and spent the next eight months in intensive schooling at the University of California at Irvine Medical Center. Everything we were taught in these 16-hour days was geared to emergency medicine. Specially trained physicians, called traumatologists, instructed us on how to handle life-threatening situations not in sterile hospital operating rooms but out in burned-out houses, wrecked automobiles, dirty alleys, smoke-filled bars, vacant lots or wherever. I stood for countless hours with surgeons in emergency operating rooms, watching them perform open-heart surgery or open-lung surgery, or putting smashed bodies back into shape.