THE HEARTMOBILE – COLUMBUS FIRE DEPARTMENT’S ROLE IN THE DEVELOPMENT OF AMERICA’S EMS SYSTEM

BY WILLIAM T. HALL

PRESIDENT, CENTRAL OHIO FIRE MUSEUM

COLUMBUS DIVISION OF FIRE HISTORIAN

Ohio has played a pivotal role in the development of Emergency Medical Service (EMS) in America over the last eighty years. Many fire departments developed medical care for their own firefighters, which gradually grew to include delivery of medical care to their respective communities. In Central Ohio that care advanced past basic first aid common throughout the state to delivery of pre-hospital heart care at the scene of a heart attack.

In the period following World War I, and as motorized fire apparatus came into service, fire departments in major cities added an ambulance to their equipment roster and added first-aid kits to apparatus. This medical care capability was provided for the firefighters and civilian victims of an emergency.

In 1931 a Lyons Pulmotor (resuscitator) was added to the Columbus, Ohio Fire Chief’s vehicle to help resuscitate overcome firefighters. In 1933 Chief Edward Welch recommended the formation of an Emergency Squad in his first annual report. However, the event that affected the birth of a squad service was the electrocution of a lineman working on a pole in 1934. Chief Welch and two firefighters responded to the scene with the Pulmotor, but all attempts at resuscitation were futile. However newspaper coverage of the fire department’s efforts resulted in citizens calling the fire department for aid in a medical emergency. Late in 1934, a hose wagon equipped with supplies donated by the Red Cross, along with an H & H Inhalator, was placed in service for the public; thus the Columbus Fire Department became one of the first fire departments in the country to offer this service. The number of responses for out-of-hospital emergency care increased every year as the city grew and the public became more aware of this valuable service. The number of emergency squad vehicles increased and more advanced first-aid training was provided for the firefighters.

In the early 1960’s, Emergency Medical Care began to receive national attention. Columbus had a highly trained fire department Emergency Squad which arrived at the scene on an average of four minutes after a call for help.  Yet, nationally, mobile emergency medical teams arrived at an average response time of over 40 minutes with inadequately equipped and trained crews. Primarily, as a result of concern over highway safety, specifications were developed at a national level covering ambulance attendant training and equipment requirements as well as the design of the emergency vehicle itself. How many of you remember funeral home ambulances, hearses or private ambulances responding to a call with lights and siren? Basically it was a load-and-go operation.  How would you like that level of care today?

Also in the early 1960’s the leading cause of death in America was recognized as ‘heart attacks’ and the first Coronary Care Units (CCU) were opening in hospitals across the nation. The Ohio State University Hospital opened its first Coronary Care Unit in 1964 to specifically address coronary care. Physicians were also looking for a way to stabilize heart attack victims at emergency scenes to increase the likelihood of their survival to the hospital.

In 1966 in Belfast, Northern Ireland, Doctor Frank Pantridge proposed a system of ‘flying squads’ to provide the world’s first mobile coronary care. Staffed by doctors and nurses, these special coronary care vehicles would go out to treat heart attack victims at the scene. Their ability to stabilize patients at the scene prior to transport had dramatic results and aroused interest in the USA.

Doctors James Warren and Richard Lewis of Ohio State University Hospitals were following the efforts of Doctor Pantridge in mobile coronary care.  With the assistance of a 1968 Federal Highway Grant awarded to Columbus, Seattle, and Los Angeles, they began to develop a plan to provide mobile coronary care to the citizens of Columbus.

The result was the Heartmobile: the first vehicle specifically designed as a Mobile Coronary Care Unit in the United States. The Heartmobile was designed and built locally, and was staffed by three specially trained Columbus Firefighters and an Ohio State University Hospital physician. The Columbus Fire Department was chosen as the source for the newly created ‘paramedics’, based on its existing EMS system and the more than 30 years of experience in providing pre-hospital medical care. Launched in April of 1969, the Heartmobile served as the basis of an investigational study to examine the effectiveness of mobile emergency coronary care.  

Patient emergency care was initiated with a call to the fire department, which dispatched an emergency squad staffed by first-aid trained firefighters. If a cardiac related medical problem was suspected, the squad called for the Heartmobile to respond. The Heartmobile was housed in a building next to the hospital Emergency Room entrance affectionately nicknamed the ‘Heart Shack’. It provided garage space for the vehicle and living quarters for the three paramedics who worked a 24-hour shift. Upon receiving a call to respond, the medics paged the on-duty physician who then met them at the Emergency Room door and the Heartmobile responded to the emergency.

Today, the Heartmobile is credited with the successful beginnings of onsite resuscitation of cardiac arrest and heart attack patients. It was soon apparent that firefighters were capable of providing advanced medical care without the direct supervision of a physician. On July 1, 1971, the Heartmobile was incorporated into the Columbus Division of Fire Emergency Squad system. Today the highly trained paramedics in Columbus and across the nation operate without direct physician supervision as a direct result of the Heartmobile and similar programs across the country.

As Columbus’ success drew national attention other local fire departments such as Upper Arlington and Worthington (formerly Sharon Twp) began to implement their own pre-hospital cardiac care programs. Utilizing specialized cardiac training provided by Ohio State University Hospital and the Heartmobile model for successful delivery of this care, central Ohio helped launch a new era of EMS care.  Today emergency care for heart attack victims is still provided by firefighter paramedics in mobile coronary care units with very little change to the initial concepts of 45 years ago.

Submitted to NEMSM July 2014