Seattle's Medic One: How We Don't Die

by Richard Rapport

In 1968, Dr. Leonard Cobb, along with Seattle fire chief Gordon Vickery, began to implement something new and daring: one of the country's first pre-hospital coronary care systems. Along with Dr. Michael Copass, they started Medic One, an emergency service unlike any other. One year later, the first vehicle equipped with a defibrillator and ten highly trained Seattle firefighters took to the streets. Medic One has since trained hundreds of paramedics, added an emergency air transport service in four neighboring states, helped build a statewide emergency transfer system and saved countless lives. Dr. Richard Rapport delivers an inside look at one of the most influential medical programs in Washington State and the country.

194 pages, Hardcover

Published August 5, 2019

Reviews

[Raven · Rating 5 out of 5]

I read this immediately after "American Sirens", which gave me a ton of helpful context for understanding the development of civilian emergency medicine services in America. Seattle was reading the groundbreaking journal articles in the Lancet at the same time as Pittsburgh doctors, and was also bootstrapping a civic EMS program around the same time. This book is about what Seattle was doing, but there is a chapter about other cities all trying their own laboratories of mobile coronary care. The author gives props to Freedom House, if not to the City of Pittsburgh, and the story about Hawai'i causing an international incident with their EMS conference is pretty funny. Like Pittsburgh, there was a lot of local resistance from ambulance companies that were mostly transport-only, with desultory patient care, if that -- "sack of potatoes" style transport to definitive care. They correctly foresaw that trained, efficient medics would put them out of business. (Yep.) So they resisted it... to the detriment of the dying patients of Seattle. Fortunately, a combination of a data-driven Harborview Emergency Room, a determined doctor who supervised the paramedic calls, and a fire department eager to expand its remit and guarantee more good jobs for firemen as the number of actual fire calls decreased combined to get government behind Medic One.

My favorite parts of this book were the anecdotes about Dr. Copass, who for 35 years was medical control for the Medic One paramedics. He sounds amazing.

"At that time (1970), and for the next 35 years, Mike Copass read every patient chart and all the logs the paramedics kept of their runs for appropriateness, completeness, accuracy, and anything else he might want to argue about over what had happened to that patient. 'What I wanted to know was the chief complaint and did we work up everything completely. If we didn't, I marked the chart. And if we took too long, or goofed off, I marked the chart. I looked at the time in and out.' Everyone who worked in the ED or rotated through it remembers with dread finding, printed in orange wax x-ray film-marking crayon on top of a chart, the Copass note "SEE ME", or even worse, "WTF". This was long before texting."

Ahahahaha. But that is how you get excellence. (There were similar stories in "American Sirens" about the medical director's "reign of terror" ensuring that all her medics were fast, detail-oriented, and accurate.)

One of the things I took away from both "American Sirens" and "Medic One" was pretty similar to Thomas Kuhn's thesis from "The Structure of Scientific Revolutions"... many people vested in the current world order will resist progress, particularly if it threatens their bottom line, double particularly if the people in the vanguard are folks they don't like. You'd think scientists would want to see the field progress, that medical care providers would want the best care for the patient regardless of whether or not they were the ones providing it, and... not really. Sigh. There were also examples of government in both its supportive function (Freedom House in its later years got some federal grants for excellence in providing care to underserved neighborhoods) and in dysfunction (Pittsburgh's hostile takeover of EMS from Freedom House... and the pre-existing Seattle ambulance companies probably felt like this about Medic One, though I don't think that was particularly merited since they were measurably worse at their jobs than Medic One was). Very enlightening if you're a Seattle local, thought provoking regardless of who you are.