Saving Lives in Seattle: The Story of Medic One

By Nicky M. | Arcadia Staff
In the 21st century, modern medicine can heal thousands of different wounds and diseases. But in the early-to-mid 1900s, medical caIe was still lacking throughout the United States, where people had trouble getting appropriate care even for the common cold. In Seattle, that all changed with the founding of Medic One, a paramedic service dedicated to improving people’s health before they even reached the ER. Seattle's Medic One: How We Don't Die divulges the history of this revolutionary foundation – read on for a sneak peek of the book, out Monday, August 5!
Eldon Holmes died early in the morning on February 29, 1972. His wife heard a loud crash when he fell over purple-faced because his heart had unaccountably stopped beating. Her call to 911 at 7:14 a.m. produced a Seattle Fire Department engine at their apartment by 7:16, and one of the brand-new Medic One rigs a minute later. The paramedics found a middle-aged man on the floor not breathing and pulseless.

Even a few years earlier, Mr. Holmes would have been pronounced dead in his apartment. The last thing he remembered of that Tuesday morning, the final leap year day in February, he was drinking coffee in his kitchen. But thanks to the medics who promptly put a breathing tube into his trachea and shocked his heart back to a normal rhythm, a few weeks later he walked out of the hospital.

Dr. Leonard CobbFrom after World War II until Lyndon Johnson signed Medicare/Medicaid into law on July 30, 1965, the emergency care provided by hospitals, doctors, and nurses hadn’t changed much since Abraham Flexner published his paradigm-changing report in 1910. In most hospitals, an emergency room was just that, a big room full of acutely ill people, some sitting up, some lying on gurneys divided into almost individual spaces. Patients might go—or be taken by ambulance—to a private hospital if they had means, but the ER itself was similar everywhere in America. Sick and injured patients either sat expectantly in a reception area or lay in curtained-off cubicles waiting until a junior house officer or a nurse got around to asking what was wrong, taking their vital signs, and examining them. Then they waited some more until a clerk appeared to find out if they had insurance, cash—or nothing. All of these activities were seldom hurried because, in truth, there wasn’t a lot to be done for them.

Almost all doctors and nurses then considered it a part of their professional obligation to provide care to poor, sick, and injured patients when they showed up for treatment regardless of their ability to pay. My father, a thoracic surgeon, claimed that at the first monthly meeting of his County Medical Society a dozen years before Medicare, the treasurer reported a total cost for treating unfunded patients admitted to that county hospital emergency room for the previous twelve months. The society president then added 2 percent for inflation and assessed each member an equal portion of the total to provide care for all of the patients anticipated in the ER during the coming year who would be unable to pay. The physicians each absorbed the loss of their professional fees in that setting as a responsibility.

Even so, only very basic techniques were available for diagnosing and treating the sick people who managed to get to a hospital in 1953. An intern on duty in the ER might have an x-ray taken, order an EKG or a blood count, sew up a wound, set a fracture, or treat an infection. The first antibiotics had then been available for little more than a decade, and bacteria had not yet acquired resistance. If the intern suspected appendicitis, he (there were few female doctors then) might consult a senior resident or attending, expecting that patient would undergo an exploratory laparotomy in the OR. The thinking then was that if you didn’t explore a few normal bellies you were missing a lot of appendicitis.

There were no CT scans, no MRIs, no ultrasound, no sophisticated angiography, no minimally invasive operations, no internal fixation of fractures, no cardioversion, and no CPR. There were a few effective drugs, most of them cheap, only relatively simple lab tests, and nothing but the local ambulance to get very sick people to the hospital in the first place. If the patient lacked breath and a pulse when the ambulance arrived to pick him or her up, the driver stopped in the ER only long enough for a doctor to pronounce the patient dead; the vehicle turned into a hearse and went straight to the morgue. There were few lawsuits but lots of room for improvement

And then things quickly began to change.

In Seattle, Dr. Leonard Cobb read the papers.

As a young cardiologist, Len Cobb had come in 1957 to the University of Washington faculty and worked mainly at the county hospital, Harborview. By 1963, he was the director of the Harborview Division of Cardiology. He exemplified the academic physician scientist and teacher of that era and quickly understood that the earlier treatment pioneered in Belfast increased possibilities for saving lives, and maybe increased those odds greatly. He also was a savvy enough pragmatist to know that a good idea is only as exceptional as its proof. There are always a lot of good ideas floating around an academic medical center competing both for attention and funding. Len Cobb quietly and systematically went in search of both.

Fire Chief Gordon Vickery.He needed help, and his first ally wasn’t a doctor. Sitting in his downtown office in 1968 beginning to ponder his budget for the upcoming year, Seattle Fire Chief Gordon Vickery had a call from Cobb, who knew of the chief only by reputation. Vickery had come up through the fire department ranks. He was strong-willed, politically astute, dedicated to the citizens he served, and a person to be taken seriously. In 1972, after the mayor appointed Mr. Vickery superintendent of the then troubled Seattle City Light, longtime newspaper columnist for both major Seattle papers Emmett Watson wrote that Vickery’s “controversial impact had to be measured on the Richter Scale.” However, as fire chief, Vickery was enormously popular, and when Len Cobb initially called him to discuss pre-hospital emergency care, he also clearly saw the possibilities.

His budget was one of them. By late 1969, the Seattle economic decline eventually known as the “Boeing Bust” had begun, and competing forces were after every cent that could be squeezed from the city budget. In addition, because of improved building codes, the practical use of home smoke alarms, better communications, and faster response times, fire crews departed their stations less frequently to actually fight big city fires. More and more calls to the firehouses concerned non-fire incidents, but the firefighters’ wages still had to be paid—at a time when they were vulnerable to cuts. So, when Chief Vickery heard from Dr. Cobb that the fire department might have a much-expanded role in providing treatment to victims of cardiac events before getting them to the emergency room, he had motivation to support the idea.

Cobb and Vickery soon discovered another collaborator in the director of a then still basic Harborview Emergency Room. For the next thirty-five years, the first thing anyone saw when they walked by the nurses’ station and into the primitive workroom just inside the double doors opening into the old Harborview ER was the balding head, black-rimmed glasses, and stocky body of Dr. Michael K. Copass.

For medical students, interns, and junior residents, this sight was at once both reassuring and terrifying. Reassuring because the students and house officers all understood that Dr. Copass was there to make absolutely certain that all patients, no matter what was wrong with them, where they came from, what shade of skin they had, what kind of insurance they had or didn’t, or what language they spoke, were cared for perfectly. That was also exactly what terrified the younger staff.

The last participant in this story of Medic One’s success occupied a general practice office in the middle of Washington State. William Henry, MD, was the only doctor in the small town of Twisp in the Methow Valley, a subalpine region in the Cascade Range of Central Washington. Bill Henry, his pregnant wife, Ann, and their two young children had arrived at this outpost in 1960 following his discharge from the U.S. Navy. He hung up a sign, opened his office on Glover Street, hired a nurse, then a receptionist, and Ann Henry paid the bills. Twisp had a new GP.

Chance brought all of these people together at a time when the technology was ripening, the fire department was diversifying, the emergency room was morphing into the emergency department, and the West Coast spirit of adventure and—perhaps more importantly—cooperation, came together to build Medic One in Seattle during those years when similar undertakings often faltered elsewhere.
 
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