Mary Beth LaGoie (later Mary Beth Michos) was the head nurse of the Mobile Coronary Care Unit (MCCU) program for Montgomery County, Maryland. This initiative ffectively laid the foundation of Montgomery County’s later paramedic program. The 500 square-mile county is located on the northern edge of the District of Columbia and exceeds 600,000. As one of the most affluent counties in the U.S., Montgomery County is divided into numerous small communities and municipalities, each with its own identity.
For years, fire protection and ambulance services in Montgomery County was provided by 16 volunteer fire departments and two volunteer rescue squads. These services were supported by community fundraising campaigns.
In 1970, the Montgomery County chapter of the American Heart Association funded a mobile coronary care project. The project was similar to the Mobile Coronary Care Unit (MCCU) program which was started by Dr. William Grace at the Saint Vincents Hospital in Lower Manhattan and Harborview Medical Center in Los Angeles. It followed, even closer, the legendary ALS paramedic programs that had been started by both Dr. Luther Fortson between the Kennestone Hospital Coronary care Unit in Marietta (Northwest suburb of Atlanta, GA) and Metro Ambulance Service as well as the “Heartmobile” Project started by Dr. Lewis and Dr. Warren at Ohio State University Medical Center in Columbus, Ohio with the Columbus Fire Department. Both the Atlanta and Columbus ALS paramedic programs did not require that a physician or nurse be physically present on the scene to personally administer and ALS procedures and could therefore be administered by a highly trained paramedic. At the time, the Webster Dictionary defined the word “Paramedic” as “one trained to assist a physician.”. In the Montgomery County (MD) program, a Chevrolet step-van was designed as an ALS paramedic unit with coronary care nurses and driven by volunteer rescue squad personnel. The ranks of Mary Beth was also joined by Katy Sampson, RN who headed the paramedic training program for Dr. Lewis and Dr. Warren in Columbus as well as the late Jane Carter, RN who, as the Kennestone Hospital CCU head nurse in Marietta, coordinated all ALS paramedic training for Metro Ambulance Service, Inc. paramedics under the medical direction and supervision of Luther Fortson, MD.
As the growth of Montgomery County exploded, program changes produced a myriad of both career and volunteer staff. However, reflecting the cardiac emphasis of the original MCCU project, new county paramedics were actually classed as cardiac rescue technicians.
Between 1973 and 1977, seven paramedic-staffed MICUs were put in service under Michos’ continual direction and guidance. Four community hospitals were involved in the Montgomery County EMS system, and ED physicians provided medical direction for paramedics in specific cases. The EMS Committee of the County Medical Society provided medical protocols for the program, and were expanded as member physicians have gained experience and confidence in the program.
The program has been effective, with an average of 80 successful resuscitations per year. Key to that effectiveness, she suggests, has been uniform standards and policies.
Submitted to NEMSM June 2008, author unknown