June 7, 2013
by Audrey Fraizer
Jeff Clawson was in his second year of medical school at the University of Utah when he had his first brush with what would later become part of the Medical Priority Dispatch System (MPDS). It was close to midnight on April 9, 1972, and he and John Myers, attendants for Gold Cross Ambulance, were responding to a 9-1-1 call coming in from the west side of Salt Lake City.
The ambulance arrived just in time for Clawson to assist Mrs. Lureen Brock in the delivery of a 6-pound, 5-ounce girl in the hallway of her home. The delivery was normal in every other way, Myers told reporters but “Just a little faster than usual.” Mother and baby were taken to a local hospital, where both were reported to be in fine condition.
Six years later, Dr. Clawson took the same pre-hospital skills he provided in the field for application in the non-visual environment of a 9-1-1 communication center. Through the use of scripted protocol he developed, dispatchers could initiate care prior to paramedic arrival.
Protocol was not an instant success, no more so than the initial acceptance of paramedics providing on-scene emergency medical care.
In the case of paramedics, for example, a program in Los Angeles County, Calif., credited with saving the lives of about 2,400 victims of cardiac arrest in the first three years of operation did not win the hearts of the local ambulance service.
Despite (or due to) a success rate bettering the prediction of the county’s heart association for the number of lives saved if immediate care was provided, the local for-profit ambulance service condemned the fire department-affiliated paramedic service in its apparent attempt to destroy the business. There would be no incentive to pay for a service not offering pre-hospital emergency care.
The legislative sponsor of a bill to fund an expanded paramedic program in the state wasn’t concerned about the company’s unease.
“Our No. 1 concern is to provide the best emergency healthcare possible,” Kenneth Hahn told a Copley Press reporter. “Who goes out of business and who doesn’t is irrelevant.”1
The public responded enthusiastically to the new emergency medical services (EMS) fire departments from around the country were adding to diversify their jobs and remain relevant in a world with fewer fires to fight.
Training was rigorous and open, also, to individuals outside firefighting showing the aptitude for EMS. Not everyone worked within a department.
In a story hitting several newspapers in December 1973, 54-year-old Robert Hirsch finally achieved at least an inkling of his dream to become a medical doctor when he became the nation’s first paramedic certified while in the penitentiary.
A run of bad check writing while a pre-med freshman at Iowa University snowballed into more years behind bars during his adult years than on the street. He heard about the paramedic program Duke University was offering, convinced prison doctors that he’d be a great candidate for certification, and was paroled for his accomplishment. His first job out of prison was paramedic for the Travis County jail in Austin, Texas.
Travis County Sheriff Raymond Frank said Hirsch’s tenacity impressed him, despite a mile-long rap sheet (with no narcotic charges) that might have worked against him if looking for a career in law enforcement.
“I’m a firm believer in rehabilitation of people who can be and want to be,” the sheriff said.2
During 1973, 54% of the calls the Phoenix (Ariz.) Fire Department received were for EMS, while only 46% were concerned with fires. By the end of the year, the program had grown to an average of 1,627 EMS calls per month, and certification increased to include treatment for heart attacks, burns, seizures, wounds and severe bleeding, drowning and difficulty in breathing, injuries sustained in auto accidents and falls, swallowing of poisons, electric shock, and emergency childbirth. In 1973, Phoenix paramedics were credited with assisting in 23 births.3
Early “miraculous” saves, so reported the newspapers, included the life of four-year-old Billy Horton who accidentally shot a hole in his chest at close range with a .25-caliber pistol he retrieved from his mother’s purse. The paramedic arriving on scene provided CPR on the way to the hospital and following surgery to repair his wounds—a torn aorta and seven holes in his large and small intestines—Billy was expected to make a full recovery.
Paramedics gave the same phenomenal second chance to a 30-year-old abalone diver losing a large chunk of his thigh to a 12-foot shark off the coast of California in the summer of 1972. An unidentified Coast Guard paramedic who happened to be at the scene gave first aid while waiting for helicopter evacuation to the closest trauma center. The diver emerged from three hours of surgery in satisfactory condition.
The Medic One program earned Seattle, Wash., the reputation as the “best place to have a heart attack” because of services provided during its first decade of operations (1969–1979). The paramedics and emergency medical technicians—all were Seattle City firefighters—arrived on scene in a mobile intensive care unit and reported directly to Drs. Leonard A. Cobb and Michael K. Copass in medical matters.
The program followed a tiered response through an established chain of command, starting with the communication center. After the 9-1-1 call came in, one dispatcher ascertained the location and nature of the emergency, while another dispatcher, also monitoring the call, sent the nearest engine company, aid car, and paramedic unit to the scene.
The dispatcher’s job was a difficult one, according to the news article: [S]he had to determine the extent and acuteness of the emergency and whether or not a paramedic unit is needed. Dr. Copass described the dispatchers—all highly trained and some trained paramedics—as both “the strongest and weakest links” in the chain of operations.4
In 1978, Dr. Clawson, then medical consultant for the Salt Lake City Fire Department, took a first bold step in strengthening the dispatch link through the development of a set of 29 protocols employing Key Questions, Pre-Arrival Instructions (PAIs), and Determinant Descriptors (response codes) for a full range of medical emergencies. One year later, the first working MPDS Protocol prototype was introduced at the Salt Lake City Fire Department, and it went online just hours after the first training class ended on Sept. 14.
Over the past 35 years, Dr. Clawson has worked tirelessly to promote high standards in training and education and a universal emergency dispatch protocol, and, as a result, has impacted countless lives. He is commonly referred to as the father of modern emergency medical dispatch, responsible for recognizing the emergency dispatcher as a vital link in the emergency medical response chain.
Bringing babies into the world was just the start of things to come.
1Thomas Elias, Ambulance Firms Fear Paramedic Plans, Colorado Springs Gazette, Jan. 25, 1973, accessed Jan. 25, 2013
2Former Convict Turns Life Around, Denton Record Chronicle, Dec. 26, 1973, accessed Jan. 25, 2013
3Dave Spriggs, Frantic call to paramedic unit saves baby’s life, Arizona Republic, March 9, 1975, accessed Jan. 25, 2013
4 Grahame L. Jones, Here You Only Live Twice, Winnipeg Free Press, Aug. 22, 1979, accessed Jan. 25, 2013