"Seattle: The best place in the world to have a heart attack."
A van carrying life support equipment and specially-trained medics speeds to the scene of a heart attack or accident. On the spot, the victim receives advanced care, which continues en route to the hospital. Meanwhile, in cooperation with the local fire department, university physicians train other paramedics who work out of strategically located fire stations, taking advantage of the expedited response and experience of fire departments. In that way, fire department and mobile intensive/coronary-care units can be at any emergency scene anywhere in the city within minutes.
That approach, developed and first implemented by University of Washington researchers in Seattle under the name Medic One, has become the model for emergency care services throughout the world.
Medic One was the product of a research program initiated in 1969 by UW professor Leonard Cobb and colleagues. Their goals were to determine if lives could be saved by means of major interventions outside the hospital and to see if non-physicians could provide high quality care under the remote guidance of physicians.
"We were able to develop a program of rapid response where patients themselves or bystanders could call for skilled help and receive it in a very few minutes," says Cobb, who is former director of Harborview Medical Center's Division of Cardiology. "We knew that 60 percent of heart attack patients who died did so instantaneously or within an hour of an out-of-hospital attack. We learned if CPR [cardiopulmonary resuscitation] is started within one minute after cardiac arrest, the patient has a good chance of recovery if paramedics arrive within five minutes."
An initial group of ten paramedics received training, and the first Medic One call was made on March 7, 1970. Shortly thereafter, the first patient was discharged home from the hospital in good condition following resuscitation from cardiac arrest by Medic One. A steady stream of successes followed in the first year, proving the success of the approach.
The Seattle Fire Department began in 1970 to provide all of its firefighters with CPR training and began dispatching engine companies simultaneously with Medic One vans. Since Cobb and the Seattle Fire Department initiated the program some 25 years ago, over 600,000 citizens in the greater Seattle area have been trained in CPR. These innovations have meant that many cardiac arrest patients can be saved in the critical few minutes after an attack.
The speed, precision, and effectiveness of Medic One are the fruit of interdisciplinary research in three key areas: geographical siting to select the optimal placement of response teams; cardiology research on the best treatments; and educational methods to train firefighters and citizens in the latest and most effective techniques.
By 1976, Medic One had saved the lives of 655 people who were clinically dead when paramedics arrived, and word had spread about the success of the program. Representatives from most major U.S. cities as well as from most European and many Asian countries have visited Seattle over the years and have adapted techniques from the program.
Since Medic One began, the program has continued to evolve. Colleagues of Cobb, working with programs in the suburban areas of Seattle, demonstrated that the most important factors predicting survival following cardiac arrest were the time intervals from collapse to CPR and collapse to defibrillation (an electric shock delivered across the chest to start a stilled heart). As a result, programs were established to shorten both of these intervals.
In 1979, UW professor Mickey Eisenberg, working with Cobb, trained and authorized emergency medical technicians (EMTs) to administer defibrillation treatment. Generally, EMTs are the first on the scene and precede paramedics by several minutes. In 1982, Eisenberg launched a program in which emergency dispatchers provide instant CPR instruction over the telephone for cases of cardiac arrest. And in 1984, automatic heart defibrillators were introduced, making it even easier for EMTs to defibrillate patients.