An illustrated history of paramedics in their first decade in the U.S.A.
By James O. Page
Founding of the Northwest Community EMS System
One of the most outspoken, prolific and influential of 1972's EMS activists was David R. Boyd, M.D., who served as chief of the EMS Division in the Illinois Department of Public Health. As a surgeon, Boyd's interests concentrated on trauma and in 1971 he established the Illinois Trauma Care System–"a system for the orderly method handling of patients with serious injuries through the best possible use of existing facilities and medical technology."36
Under Boyd's direction, the Illinois system had concentrated on the creation of a statewide network of trauma centers, a statewide communications network, a transportation system that would utilize state helicopters for interhospital transfers of critical patients, and a public information program to assist the public in accessing the system quickly and using it appropriately. Many of Boyd's EMS concepts would find their way into federal law and policy.
Meanwhile, in Boyd's own state, several unconnected events were producing an inspiration that eventually affected paramedic history. Those events would combine to produce some valuable lessons in citizen participation, as well as medical control of ALS programs.
It started with tragedy–August 1971. At about the time Jack Webb was struggling with NBC in Hollywood, an Illinois housewife was struggling to get an ambulance for her husband. He was gripped by the pain of a heart attack. The ambulance did not arrive. His wife finally got him into the family car and headed for a hospital. He died a mile from the emergency room.37
The victim of that fateful heart attack was too young to die. The tragedy affected family, friends and neighbors alike. One neighbor was particularly upset by the desperation of it all. Thus, when Mrs. Janet Schwettman tuned in to NBC's Today program on October 12th, she found herself especially interested in one of the interviews. The guest being interviewed was Dr. James Warren of Columbus.
Dr. Warren's Heartmobile had been serving Columbus residents for 2 1/2 years by the time he appeared on Today. The mobile coronary care unit (MCCU) had dispensed with its ride-along doctors and nurses several months earlier and Dr. Warren could proudly report that the system (using paramedics) was working well.
At home in Inverness (Illinois), Jan Schwettman listened intently as Warren reported that MCCUs had been proved practical and relatively inexpensive. Mrs. Schwettman was intrigued. Soon, she was researching the subject with missionary zeal.
From October to December, Schwettman became a frequent visitor at Northwest Community Hospital in nearby Arlington Heights. Her inquiries were directed inquiries to local physicians, private ambulance services, the American Heart Association and the American Medical Association. Little information was available, however. At the Arlington Heights Fire Department, she found Captain Jack Benson and learned that he had been trying without success to obtain additional emergency equipment and more complete emergency care training.
In her research, Mrs. Schwettman contacted many of the prehospital care programs that were springing up around the country. As she began to get a feel for what was required for such a program, she also began to survey the available resources in her own community. Jack Ryon, the public relations director at Northwest Community Hospital, suggested that the communities surrounding Mrs. Schwettman's town should be contacted. Thusly, the idea for a multi-community network of advanced prehospital care was born.
On December 14th, as the World Premiere of Emergency! was previewed in Los Angeles, Schwettman was making a preliminary presentation of her MCCU proposal to the Inverness Village Board in the suburbs of Chicago. A mere two months had passed since Dr. Warren had appeared on Today with his report on the Columbus paramedic program.
On January 4, 1972, an editorial appeared in northwest Chicago newspapers. It urged that the mobile coronary care concept be seriously considered for 15 communities in the area. The network was growing. The newspapers also carried a cartoon of a heartmobile with a tag on the wheel reading, "Proposed by Inverness Woman." Jan to become well known throughout the area as The Inverness Woman.
The publicity began to pay off. One woman showed up at the Schwettmans' front door in curlers and cold cream. It was 8:00 a.m. and she offered a check in the amount of $12.35 as a contribution to the project. She had lost her son an in automobile accident–he had bled to death in an automobile wreck.
In a matter of weeks, the tranquil suburban housewife routine of Janet Schwettman became a maelstrom of activity. Her mailbox bulged with encouraging notes and helpful articles. Among the information was a package of materials from the fledgling ACT Foundation in New Jersey.
On January l2th, The Inverness Woman met with Dr. Marjorie Smith, chairman of the board of a physician group that was providing emergency services to Northwest Community and several other area hospitals. During the meeting, an energetic young doctor whizzed by and was halted by Dr. Smith. "Doctor Stanley Zydlo, this is Jan Schwettman. She wants to set up a mobile coronary care unit," said the lady doctor. "Hi, Jan, so do I," Zydlo replied. Thus began a tenuous working relationship that would impact on people and places far behind the suburbs of Chicago.
The positive press committed Jan Schwettman to a much bigger task than she had originally tackled. Frequently reminded of her unfortunate neighbor, however, she pushed ahead. In late January and early February, she made contact with six area fire departments and made presentations to village boards representing nearly a quarter million residents. Momentum continued to build as the proposal was favorably received most everywhere. In the city of Rolling Meadows and in the village of Schaumburg, elected officials responded to Mrs. Schwettman's presentation by immediately voting to institute the program. In Rolling Meadows, the board took unprecedented action–necessary funds were immediately authorized.
Despite the enthusiasm of his board, RollingMeadows Fire Chief Thomas Fogarty felt the proposal might be moving too fast. Chief Fogarty tended to favor a five-year schedule for implementation. Later, on August 17, 1973, Tom Fogarty suffered a cardiac arrest in his home. After being clinically dead for approximately four minutes, he was successfully resuscitated by his Rolling Meadows Fire Department paramedics. His life had been spared by the prompt implementation of the program in Rolling Meadows. His gratitude for the program was captured later in a taped testimonial to the concept and the program. The tape was used throughout the nation by the ACT Foundation in promoting ALS programs. Chief Fogarty returned to active duty and retired after finishing his career in good health.
On January 19, 1972, Jan Schwettman met with Dr. Zydlo and gave him a progress report on the growing community support for the program. "Now it's time you hit hospital administration," the doctor advised. Within an hour, The Inverness Woman had a commitment from Malcolm MacCoun, president of Northwest Community Hospital. Two days later, the first of many meetings were held to expose Northwest's medical staff to the proposal. Although the doctors were willing to listen, their reaction was tainted by skepticism and predictions of problems.
February 13th found Jan Schwettman in Pittsburgh. A mere four months after her televised introduction to Dr. James Warren and emergency medical care, the Illinois housewife sat in the audience at a major medical conference. She hung on every word of the esteemed battery of speakers–even those she didn’t understand. One of the medical men impressed her foremost–Dr. Eugene Nagel.
Jan Schwettman had questions for Dr. Nagel. He had questions in return. "Is your unit to be a mobile coronary care unit or a mobile intensive care unit?" the doctor asked from the podium. Quickly, she turned to the person seated next to her, asking for an explanation. The answer: "Mobile intensive care covers all kinds of emergency situations, where mobile coronary care deals only with cardiac problems." "Our units will be mobile intensive care,'' The Inverness Woman replied. Many miles from home, in the midst of world-renowned medical superstars, only four months distant from a chance encounter with an experimental concept, fate had drawn Mrs. Janet Schwettman into a commitment of magnanimous proportions.
On her way back to Illinois, her head spun with the information she had assimilated in Pittsburgh. She was sure Zydlo would agree to the mobile intensive care concept. Or would he? It would mean a greater commitment from the physicians who would train the paramedics. But it would mean the delivery of more advanced medical knowledge to the field. Surely the doctors would agree. Or would they?
While Schwettman returned from Pittsburgh, another of the northwest Chicago suburbs considered the mobile coronary care proposal. The village trustees of Hoffman Estates debated the issue extensively. One of the trustees cast doubt on the proposal by pointing out that its principal proponent (The Inverness Woman) had no medical background. The proposal went down to defeat by a 7 to 5 vote.
Before the meeting had ended, however, the negative trustee began to feel ill. He complained of chest pains and was driven to his doctor. The problem was diagnosed as indigestion. He explained the probable source to his doctor. "Some damn fool woman is running around getting people to vote village money for some mobile heart thing," he told the physician. "How did you vote?" asked the doctor. "I voted no!'' replied the trustee adamantly. The doctor sighed before replying. "My friend, what you voted against might have been needed to save your life. Let me explain a few things to you."
The dyspeptic trustee called his fellow members just before their meeting ended. He asked to change his vote to yes.The vote thus tied, the mayor swung over, and the issue passed. Later, in discussing the series of events, Schwettman asked, "Whoever would have thought hot tamales would play a key role in determining whether a community would have mobile intensive care?"
The program had begun to move. But uneasiness surfaced in the medical community and Schwettman found herself in toe-to-toe confrontation with some of the uneasy physicians. "This whole mobile medical thing is loaded with danger!" said one. "How would you like it if someone, after only a few weeks training, took over your husband's job ... a job he had earned by virtue of years of experience, training and work?" he asked. "But, doctor, no one is going to take over your job," the woman fired back. "And you can't be out in the field. We ask only that you to impart a tiny smidgen of your knowledge for use where it's needed at the scene of the incident.''
"You could be responsible for bringing socialized medicine to the Midwest," said another medical man. "And you're interfering with private enterprise; private ambulance companies are going to be in economic trouble over this.'' Schwettman spent day and night thinking of answers to such questions. She had been warned that they would come and she was ready. "If they meet the standards, they can be part of the system, too," she responded. "But everyone's going to have to face it--the days of you call we haul are over. The patient is not just a business item. He's a person with rights determined by the medical knowledge available today." Whew! Who could argue with such logic?
On February 19th, less than a week after the Pittsburgh conference, Schwettman got an argumentative phone call at home. "If this mobile intensive care system goes through, the coronary care unit at the hospital will be overloaded," the doctor on the line announced. "Only with patients who otherwise would die," she replied. The wisdom of Nagel, Lambrew and others at the Pittsburgh meeting still rang in her ears.
But logical arguments were not enough. Medical anxiety reached a fervor. On February 21st, Northwest Community's Department of Internal Medicine had a meeting to discuss the mobile intensive care program. A decision to participate was deferred.
Zydlo had readily accepted the expansion of the proposal to a mobile intensive care (MICU) concept. Two days after the internal medicine staff had caved in, Schwettman asked Zydlo if he would consider taking a leave of absence [from the emergency department corporation] to put together a complete mobile intensive care training program for paramedics. The never-reticent Zydlo replied: "Lemme think about it. …(Two second pause) Yes! ''
The following day, the medical staff at Northwest Community met again. Zydlo went into the meeting at 10:00 a.m. with a new level of commitment. At 2:00 p.m., MacCoun called Schwettman with a report: "The staff agrees the concept is good, but they feel the first logical step is a sound training program. Doctor "Z" had reversed the medical resistance, and The Inverness Woman was ecstatic.
MacCoun proved himself an unswerving supporter of the MICU program and a superb tactician as well. Within five days after the doctors had agreed to cooperate, MacCoun had assembled the area's fire chiefs to discuss their possible roles. They were an uneasy group.
More than four months had passed since Schwettman had begun her crusade. Her circle of friends and acquaintances had widened by the day. Her commitment to the ultimate success of the project never wavered. Through it all, her husband and daughters remained patient and supportive. On March 1st, Roy Schwettman asked his busy wife what she wanted for her birthday. "A Xerox machine," she responded.
Word of Schwettman's crusade had spread beyond the Chicago area. The American College of Cardiology held its annual meeting in Chicago and Schwettman was invited to attend as a guest of the College. Mobile coronary care pioneer, Dr. William Grace, invited her to join him for a breakfast meeting. The distinguished physician gave his time and advice generously. The meeting was an inspirational relief from the daily grind of pushing the project along.
Equipment and radio vendors had sniffed out the developments in Schwettman's territory. Their conflicting claims and advice seemed confusing and disturbing. One by one, they touted their own products while slandering their competitors. It was all distressing to one so new to the language and technical mystique. With his usual sense of good timing, Nagel called Schwettman on March 4th with some sage advice. Rejuvenated and freshly confident, Schwettman pushed ahead with final plans for the first public education meeting, held in Inverness on March 6th.
It was a capacity crowd. Speakers included a respiratory therapist and a nurse from Northwest Community Hospital who would help train the paramedics. The fire chief from Morton Grove attended and offered some loud negative opinions. A few weeks earlier, his remarks might have caused great concern. But on March 6th, his opinions represented only a stubborn minority. The project continued to move. The press and the public (and now, the medical community) got behind it. Besides, Schwettman knew that the Morton Grove chief's personnel supported the program and wanted to become part of it.
The March 12, 1972, issue of the Chicago Tribune carried an article about the project. The local suburban press provided abundant coverage, but this was the first major article by the big city press. Phone calls and letters began to pour in, mostly from people wanting to know how to get such a project started in their own areas.
A day earlier, in the Miami Herald, an article reported on a meeting of nurses in that city. The article expressed the satisfaction of the Florida Nurses Association over the defeat of certain health-related legislation and also reported that the Association would pursue defeat of the Hollander-Fincher Bill. That proposed legislation would have provided legal authority for paramedics in Florida. Five years had passed since Nagel's first paramedics had gone to work in Miami, and they still operated without legislative authority.
Nagel penned a lengthy and educational letter to the nurses, with copies to every significant political figure in Florida. Nagel's instincts suggested that Schwettman would soon face similar problems. He mailed her a copy of the letter.
Slightly more than five months after her campaign had begun, The Inverness Woman's phone bill skyrocketed as she called around the United States for information. Nonetheless, she placed a call to the Federal Communications Commission in Washington, D.C. on March 20th. She learned that a new set of EMS radio frequencies were to be released within three weeks. The manufacturer who won the contract would make application for the frequencies.
Within 24 hours, the conference room at Northwest Community Hospital filled with interested people. MacCoun formally and publicly committed the hospital to all-out support for the program. Zydlo was formally appointed director of training. Details of the training program were revealed to the fire chiefs and private ambulance owners in attendance. Two days later, MacCoun appointed an ad hoc steering committee for the training program. It consisted of MacCoun, Zydlo and Schwettman. The program was affiliated with the Life Science Division of Harper College (Chicago), although most of the training would occur at Northwest Community.
On March 24th, a letter went out with information concerning the pending training program. Fire chiefs and private ambulance providers were advised to contact the hospital immediately with numbers of personnel to be trained. Within days, 218 trainees from seventeen communities had committed to the program.
On March 27th, Schwettman drove into Chicago to attend the Electronics in Medicine Conference at the Drake Hotel. At the door, she learned that she would need to pay a $100 registration fee. After months of stretching the family budget, such an expense was out of the question. Before turning to leave, however, she spotted Nagel. Learning of her dilemma, Nagel instructed her to stand fast for a few minutes. He disappeared and then returned with a press pass. "Try to look official," he told her. To Schwettman, looking official behind her press pass meant frowning a lot, taking copious notes and walking fast. No one challenged her and, in the process, she gained new familiarity with the megahertz, millivolts and subcarrier frequencies of medical electronics.
That night, Nagel Joined Zydlo and Schwettman for dinner. He suggested that the dynamic duo commit their experience to writing. He was impressed by the speed with which the Northwest MICU program had developed. It had happened in a manner different from most others across the nation. The do-it-yourself approach could appeal to citizens who wanted better emergency care but might remain unaware of the important role they could play in bringing it to fruition.38
April 3, 1972, saw the first 64 trainees arrive for orientation at the Arlington Heights fire station. Apprehension was apparent among the neophytes. They had personal and collective concern about their ability to handle their prospective role and the training that must precede it. Zydlo prepped them with typical candor. He stressed his functional approach. "If you learn by thinking out what you're doing and why you're doing it, you won't panic under stress. I don't just want textbook answers fed back to me. I want you to reason out why youdo what youdo."
On April 4th, Northwest Community Hospital, acting as agent for the participating communities, advertised for equipment bids. Competition among hungry vendors had intensified to a fever pitch and the remarkable skills of MacCoun would prove a critical factor in managing the temptation of peddlers to promise more than was possible.
Obviously, Northwest Community was not the only hospital in the network of cities, towns and villages that joined the MICU project. In other parts of the country, the "other hospital" problem had been ignored, only to produce festering problems in the aftermath of implementation. Northwest Community had staked a claim as the focal point of the new system. But it was clearly recognized that other hospitals in the region must be involved.
On April 5th, Alexian Brothers Medical Center and Lutheran General Hospital were contacted about possible involvement. Little did anyone realize that the resulting arrangement would establish a national model for regional medical control of ALS operations. The labels had not yet been devised, but Northwest Community was tagged the "resource" hospital and its participating neighbors were to become known as "associate" hospitals. Five years later, these distinctive tags would find their way to permanence in federal EMS program directives.
Also, on April 5th, Schwettman knocked on doors at Illinois Bell Telephone. Her goal: a single emergency telephone number, such as 9-1-1. "Too expensive, and too many technical problems,'' they told her. She countered with a request that future telephone directories distinguish MICU ambulance services. Ma Bell's Illinois sibling said such a listing would not be possible without a recommendation from the American Medical Association.
Kip Cohen, publisher of Medical Opinion magazine, and an early promoter of the ACT Foundation, had got wind of the Chicago-area developments. On April l3th, he flew west from his New York City base to have lunch with Schwettman. On the way to a restaurant, the two came across an automobile accident with a seriously injured victim. Schwettman had spent the prior two weeks sitting in on Zydlo's lectures. The housewife-activist had a little fresh knowledge about emergency care and, when the ambulance arrived 45 minutes later, it came in handy.
The injured woman had been thrown from her vehicle by the impact. The two ambulance attendants began to lift her by the feet and under her arms. "Hey, don't you guys have a backboard?" The Inverness Woman asked. "Yeah, but it's too much trouble to use," replied the attendant. "Get it!'' Schwettman demanded. "OK, Doc, but it's gonna delay getting her to the hospital." Later, the injured woman was found to have a lower spinal fracture. Cohen, having witnessed the whole event, flew back to New York City and put together a special issue on the need for improved prehospital care.39
On April 20th, an Illinois meeting was held with a state official to determine the availability of federal funds for use in training, purchasing equipment, etc. It was learned that the Northwest Community project was ineligible because it was already underway. In order to be eligible for funds, a work program had to be submitted before the project got underway, according to the bureaucrat. "This doesn't make sense," said Schwettman. "If an ongoing program meets the criteria of excellence, it surely would be a better risk for taxpayer's money than a paper program."
Of course, she was right. But she was also learning that being right is not always enough in seeking federal funding assistance. From that day on, the Northwest Community project proudly pursued its goals without federal funds. Pride turned to irony in later years as the federal program borrowed from the experience of the Northwest Community project in setting standards for the nation.40
By early May, a new problem surfaced. A newspaper article had pointed out that the Illinois Medical Practice Act limited the use of defibrillators and the administration of drugs. That law did not authorize paramedics. Several of the area fire chiefs had called to report that they might pull their men out of the program unless they were legally covered.
Any timidity that Schwettman may have felt as she began her crusade in October was but a memory in May. She put in a call to Governor Richard Ogilvie in Springfield. The governor's administrative assistant put her in contact with Senator John Graham's office. Graham's aide was intrigued by the possibility of providing legislative authority for the paramedics, but considered it improbable because the legislature was scheduled for adjournment in June. "The only way it could be done would be to get the backing of the State Medical Society, the Illinois Nurses Association, the State Hospital Association, the Chicago Board of Health, and Doctor Dave Boyd at the Illinois Department of Public Health," said the aide.
A major advantage of inexperience lies in not knowing what is impossible. Before the end of the day, Schwettman had made contact with every group and individual whose support she needed. California's Wedworth-Townsend Act
was deemed an acceptable model to use for the proposed Illinois legislation, largely because it contained a liability immunity provision for pilot program personnel.
Within a week, Senator Graham had agreed to be the Senate sponsor of the paramedic legislation. The Board of Trustees of the State Medical Society pushed the proposal through three committees in a weekend meeting. The Chicago Tribune and suburban newspapers did a remarkable job of reporting the issue accurately. But then there was the Nurses Association.
Dr. Gene Nagel's sharing of his experience with Florida's nurses had been timely. A May 12th meeting with the president of the Illinois Nurses Association was courteous, but cold. "Until Monday when I talked to you, we knew nothing of your program. You can't just all of a sudden ask us to support legislation like this," a representative announced. As expected, the resistance had its roots in anxiety over creation of a new category of health-care worker: the paramedic. In summary, after much selling and diplomacy, the nurses acknowledged that they might go along with legal coverage for certified personnel in the program, "…if you don't call them anything."
A meeting with Boyd later in the afternoon offset the chilly greeting from the nurses. Schwettman described the encounter: "Such a tiger! There is a rumor that he's got a built-in rocket because he zooms around the state faster than Ozark Airlines could possibly take him. He tells us he is delighted with the progress we've made and has some new information about legislation in Washington, D.C. that could affect EMS nationwide. Most gratifying interview. Dave Boyd is likable, easy to know and obviously a mover. He sits with his shoes off on an old-fashioned steam radiator like it was a feather pillow ... a most dedicated and unique person."38
Dr. Boyd's support for the paramedic legislation seemed a sure thing.
On May 16th, Governor Ogilvie, at the urging of Dr. Boyd and Senator Graham, agreed to make the paramedic bill a part of his administrative program. It would have been too late in the legislative session to get the bill introduced any other way.
On the 17th, the chairman of the Chicago Board of Health reversed his earlier position. Earlier signs of support had disappeared. "We can't give you an answer today. And, we won't meet for another month. People have been dying for years. We can't rush a decision to back this (proposed legislation)."
On the 22nd, Jan wrote to Dr. Nagel: "Learned today from Springfield that the 'nurses are furious' and are planning lobbying action. Your letter to the Florida Nurses Association may come in handy. I am testifying in Springfield on Tuesday.
"May 30. Decided to see what kind of support was available from various nurses and lo and behold, seems there may be a mini-rebellion brewing!"
THE QUEEN OF PALATINE
Itwas one of the coldest days in Illinois history. The paramedic ambulance hurtled across icy streets enroute to a reported diabetic coma. Arriving at the dismal overgrown bungalow, paramedics Dale Collier, Dave Riddle and Steve Zimmerman bailed out of the ambulance with armloads of equipment and bounded through the deep snow into the sagging abode.
The interior of the house seemed a nightmare. Heavy black soot had stained everything, including a frightened dog that raced for the door. A soot-covered liquid filled the kitchen sink, and a filthy cat languished on the counter, watching the scene with little obvious concern. A defective oil furnace belched smoke into the putrid dwelling. Seated in a chair was Margaret. ''Let's get her out of here," Collier commanded.
Margaret presented a surreal image as the paramedics escorted her carefully through the snow. Her exposed skin was dark as coal. Her hair was a matted black tangle. She was wrapped in several layers of filthy winter garments. On her feet she wore a pair of ill-fitting men's shoes. The paramedics didn't notice the filth as they clutched her firmly on the short passage to the ambulance.
Inside the warm vehicle, the stench of clothing soaked with body wastes was almost overpowering. But no one seemed to notice. Margaret objected briefly as Collier commenced to peel off the layers of rags, among her few possessions.
Collier was authoritative, but sensitive, demanding, but comforting. His credentials did not need to be displayed on his uniform. Margaret instantly believed in him. She was lowered to the gurney and urged to lie back. The stench of excrement regenerated with her movements.
A symphony of well-practiced movements began as the paramedics went to work. Margaret was preoccupied with Collier's questions. "Do you take any medications? Are you a diabetic? Do you have a headache? Have you been nauseated?" Her answers disclosed that she was alert and probably well educated. She hardly noticed that Collier had lifted her soiled undershirt and was applying patches.
Collier called for an IV. Riddle had anticipated it. The hospital was contacted. A strip was running and the quick rhythmic squiggle broken irregularly by premature ventricular contractions. As Collier told Margaret about the pending IV, he rechecked heart and breathing sounds, pulling at a grubby stocking to check for swelling ankles. Riddle hit the brittle diabetic vein on the first try. The hospital authorized transport.
Underway, Zimmerman drove; Collier and Riddle remained in perpetual motion. Collier standing, half-bent over the patient, braced himself with every bump and turn of the vehicle. Riddle sent another strip. Collier checked breathing sounds, adjusted oxygen flow, replaced a nasal cannula with a mask and kept talking. "Are you comfortable, Margaret? Do you know who I am?" ("You're a par-a-medic," she responded.) "Don't go to sleep now. ... Take a deep breath, dear; like this" (demonstrating).
As they pulled into the hospital driveway, Margaret vomited. Collier and Riddle grabbed to get her upright. A pan appeared from a cabinet. The odor of vomit had no visible impact on their sensitive concern for this wretched human being. At 9:00 a.m., Margaret had been alone, miserable and on the brink of death--a victim of age, poverty, pride, loneliness, the coldest winter in a hundred years, and an oil furnace that had poisoned her for days. But at 11:00 a.m. on a January day in 1977, she was the Queen of Palatine, the sole object of the concern and skill of three young paramedics.
Seventy-three years of life and some tough breaks couldput most of us in a similar situation of misery and despair. Let's hope we will have the security of emergency medical services personnel who really care, who will treat without concern for ability to pay, who won't judge a patient by appearances or odors, who will respond without question, delay or red tape.
On the 26th, Schwettman was in Chicago, testifying before an HEW site review committee. Illinois was being considered for one of the federal EMS demonstration projects and Boyd had asked her to report on the Northwest Community project. "Just tell what you've done in the suburbs, where the program now stands and why it's needed ... an honest, complete, three-minute presentation as a community representative."
More than seven months of head-spinning developments were boiled down to a three-minute presentation for the visitors from Washington.
May 30, 1972, found Zydlo and Schwettman in Springfield. Senate Bill 1571 was up for consideration by the Illinois Senate Health and Welfare Committee. The hot and cramped hearing room was wall-to-wall with interested parties, including representatives of the nurses association. The aged and unpredictable committee chairman opened with a suggestion that the vote be taken without testimony. Fellow senators rebuffed his suggestion. As the parliamentary turmoil began to look like anarchy, Jan looked about the room for a sergeant-at-arms. Seeing none, she sprung to her feet and began to testify loudly (to overcome the noise of the room and her own knocking knees). The surprised senators forgot what they had been arguing about and turned to listen to the earnest woman as she leveled an emotional appeal, complete with tears rolling down her cheeks.
The committee voted 13 to 2 in favor of the bill. On June 1, the amended legislation got through its second reading in the Senate. On June 5th, it ran into trouble on its third and final reading. The trial lawyers did not like the liability immunity provisions. Schwettman enlisted her neighbor, Judge Daniel Covelli, to help. The judge was a friend of the president pro tern of the State Senate. On June 7th, the Senate voted 35 to 2 in favor of the bill. Six days later, with the enthusiastic support of Senator Graham, Senate Bill 1571 had its first reading in the House and was assigned to the Public Welfare Committee.
Next day, word came from Springfield that the bill was in trouble again. The State Hospital Association actively lobbied against it; and, a lawyer-legislator had offered an amendment that would do away with the liability immunity for doctors and nurses. With that gone, support from the State Medical Society would probably disappear. In the nature of politics, however, another call a day later suggested that Schwettman get in touch with the governor's office to set up a bill signing ceremony.
On June 17th, 93 of the trainees were examined for the EMT portion of their training. The National Registry of EMTs conducted the test and there were the usual gripes from the test takers. But the complaints were forgotten after the test as Schwettman and Zydlo provided a keg of beer for celebration. A week later, another 103 took the examination, with 100 passing. All of the successful trainees then progressed into their ALS program. Meanwhile, questions hung over the fate of their commitment as all pretense of goodwill was shed at the state Capitol. The battles over Senate Bill 1571 had become desperate and an amendment had been offered that was calculated to be the kiss of death.
On June 26th, the paramedic legislation came before the Illinois House for a second reading. The proposed amendments were defeated 87 to 31. On the 28th, it was brought up for a third reading and the opposition came out of the woodwork. But largely influenced by a dramatic appeal by Chicago Representative Ray Ewell, the House passed the bill by a vote of 108 to 21. Eight weeks earlier, such an event had been viewed by the political pros as highly unlikely. Support from five major health groups was deemed essential to success. In the end, only one had provided unequivocal support.
July was an opportunity to wind down from the frenetic uncertainty of politics. Training continued and a contract was awarded for the communications equipment. An unsuccessful vendor stirred the waters for awhile but, in time, that disturbance passed. After the battles at Springfield, little crises back home seemed tame by comparison.
Governor Ogilvie chose to sign the paramedic law in Cook County. The ceremony was held on a hot August 13th in Rolling Meadows. It was a euphoric occasion, but the good feelings were almost topped by events on the following day. The village of Morton Grove voted to join the MICU system and to appropriate necessary funds. Just three months earlier, Morton Grove's fire chief had loudly opposed the program at a public education meeting in Inverness.
A formal dedication of the system was planned for September 23rd. On September 15th, Schwettman proposed to MacCoun that the United States president's wife, Pat Nixon, be invited. "Oh, sure, Jan,'' MacCoun replied. Three days later, slightly more than eleven months after Dr. James Warren's fateful appearance on the Today program, The Inverness Woman got a call from the White House. It was Dr. James Cavanaugh: "Mrs. Schwettman, your invitation to Mrs. Nixon has been received, and she is sorry she can't make it, but wonders if you'd like to have [her daughter] Tricia in her place?"
Hosting a member of the First Family turned out to involve more detail than anticipated. But the dedication occurred as planned and it was an inspirational day--for one housewife turned activist in particular.
With the passage of the paramedic law, the State Department of Public Health suddenly had responsibility for testing and certifying the paramedics--and it did not have a system for examining candidates. Days of delay stretched to weeks and, finally, December 1, 1972, was set as kick-off day. At 8:00 a.m., the switch was thrown on the radio-receiving module at Northwest Community Hospital.
At 8:13 a.m., the hospital received its first contact from one of the MICUs. The wife of a volunteer fireman had suffered an accidental overdose. Icy roads made the transport to the hospital exceptionally slow. Without the ALS services of the new paramedics, the patient would probably have expired. Case concluded, the Buffalo Grove, Illinois, paramedics wore broad smiles. The system had worked!
Mrs. Janet L. Schwettman provides the following epilogue to her story:
"In the first year of mobile intensive care in the Northwest Community Hospital area, 26 persons were saved from death by prehospital application of skills and equipment. Countless others were spared the anguish of temporary and permanent disability.
"The ensuing years have brought a sharpening of all aspects of system components, continued dedication to excellence, firm medical control, huge public support, and the incomparable feeling of satisfaction on the part of the hospital, physicians, nurses and emergency medical technicians. They know they are now doing everything possible for the victim of a medical emergency. It's the kind of happening that gives meaning to one's life."
Cook County, Illinois, rivals Los Angeles, Pittsburgh and Washington state in its proliferation of small suburban cities, towns and villages spreading out from its urban heart. The multitude of boundary lines, political prerogatives and territorial imperatives make development of a countywide or regional health delivery system nearly impossible in such an environment of parochialism and special interest. By sheer accident--not to mention the untiring efforts of some dedicated people--such a system unfolded in Cook County.
As he strongly asserted his responsibility for the paramedics, Dr. Stan Zydlo molded the role that has come to be known as "Project Medical Director.'' Because the Northwest Community mobile intensive care program was established before it could be mandated by political or government officials, it evolved as a medical program. By using the employees of fire departments and private ambulance operators as paramedics, the project revived a modern version of the ancient legal concept of the "borrowed servant."41
By asserting itself as the focal point of a regional system, Northwest Community Hospital planted the seeds of the resource hospital' concept. As it embraced other hospitals in the region into a cooperative (albeit limited) role, the status of associate hospital was molded.42
Limiting the system to a workable territory (rather than the entire county) avoided span-of-control problems.
Before long, similar systems developed in the Chicago area. Ingalls Memorial Hospital in Harvey became the resource hospital for the South Cook County Mobile Intensive Care System. Highland Park Hospital became the resource facility for the North County system. The McGaw Hospital of Loyola University took on the medical control role in another region of the county.
In 1974, Dr. Dave Boyd, guru of the Illinois Trauma System, was appointed director of the Division of Emergency Medical Services at HEW in Washington, DC. His responsibility included blanketing the nation with regional EMS projects that would ultimately produce regional EMS systems. Included within those systems were ALS programs using paramedic personnel. As Boyd traveled throughout the land, his most oft-repeated preachments were on the topic of medical control. Hot on his trail as a living testament to the concept was Stan Zydlo. Seated in the audience were hundreds of hungry grant writers, hanging on every word, who realized that medical control was a non-negotiable price of getting funded by the feds.
36 Hearings before the Subcommittee on Health of the Committee on Labor and Public Welfare, United States Senate, Ninety-Third Congress, First Session, on S. 504 and S. 654, March 9, 1973, p. 500.
37 1 Love You Frank, an award-winning film produced by the American Medical Association is based on this experience. The film is available for loan or purchase through the AMA Film Library or Associated Sterling Films at the following addresses: 600 Grand Ave., Ridgefield, NJ 07657; 512 Burlington Ave., La Grange, Ill. 60525; 6644 Sierra Lane, Dublin, CA 94566
38 "Journal of a Happening," an unpublished manuscript by Janet L. Schwettman (copyright 1977).
39 "The Suburbs Caught Fire..." Medical Opinion magazine, June 1972.
40 "Special Terms and Conditions for EMS Grants." Working draft document issued June 1, 1977 by the Division of EMS, U.S. Department of Health, Education and Welfare.
41 "A servant directed or permitted by his master to perform services for another may become the servant of such other in performing the services. He may become the other's servant as to some acts and not as to others. ... " American Law Institute's Restatement of Agency, sec. 227.
42 Page J0: "Pilgrimage to Palatine." Paramedics international magazine, winter 1977.
43 Page, J0: "Paramedic Promotions." Paramedics international magazine, fall 1977.