The first code I ever did I hadn’t been an EMT but a few months, and my partner had been an EMT but a few days. The man had collapsed in his kitchen. He had gasping respirations. We got him on a board and out to the ambulance, where my partner did compressions and bagged while I drove. This was in the late 1980’s, twenty years after this country had put a man on the moon. I don’t know what rhythm the man was in the field. He was asystole at the hospital — asystole, blue and with a bloated belly. Not only did we not have an AED and no paramedic intercept, we didn’t have any intercept. We were in fact trained to do two person CPR, not two person CPR like they teach in CPR class, but two person load the patient onto a stretcher and get him out to the ambulance, load him in the back and have one EMT do CPR while the other drove to the hospital kind of two man CPR. I remember shouting to my partner the whole way “15 and 2! 15 and 2!” Our small service couldn’t afford to tie two ambulances up for one patient.
Even later, when I worked as a paramedic for a larger service, while I had a Life Pack 5, our BLS crews didn’t have defibrillators nor did the police department who was the reluctant first responder. We considered it good form if a first responder was doing CPR when we showed up as opposed to standing in the doorway, saying “he don’t look too good.” For many years the only bystander CPR I saw was when someone dropped in sight of a volunteer EMT or a boy scout.
How different it is today. This year alone there have been five successful cardiac arrest resuscitations where the patient has walked out of our hospital with full neurological function. Four of those patients got bystander CPR from laypeople, three of them had pulses back before the medics even arrived thanks to the first responders’ defibrillators. The other two needed a shock from the medics before coming around after initial AED shocks. All of the five patients had pulses back before the medics intubated or put in an IV.
The 2nd most important change in EMS treatment in the last twenty years for me has been the introduction of defibrillators to all ambulances and to first responders, not to mention the widespread appearance of public access defibrillators. I wish I had one all those years ago.
16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic
3. STEMI Care
6. Termination of Rescusitation Guidelines
7. Decreased Use of Lights and Sirens
8. Selective Spinal Immobilization Guidelines
9. Alternative Airways
10. Chemical Restraint
11. No More Lasix
13. Permissive Hypotension
14.Expanded Medication Routes, Less IV Emphasis
15. Narrower Use of Narcan
16. Increased Standing Orders