EMS Revisited: Down the Rabbit Hole and Through the Looking Glass

As part of EMS Magazine's 10th Anniversary Celebrations, Ronald D. Stewart, MD, founding medical director of the Los Angeles County paramedic program and, at that time, assistant professor of medicine, anesthesiology and critical care medicine at the University of Pittsburgh, PA, described his first encounter with a paramedic during a crazy night in the ED at USC Medical Center, which was to change his career forever. This essay is reprinted from the Jan/Feb 1982 issue.

It was a far cry from a Nova Scotian fishing village. From the cold winds that swept across the north Atlantic ice and chilled every one of us to the very bone, I had fled in 1972 to the Santa Ana winds of Southern California to take up a Residency in Emergency Medicine in the newly created Department at the University of Los Angeles. Packing all my worldly possessions in a Volvo station wagon, I drove across the continent, across cultural borders and--almost as though through time--arrived in the megalopolis of L.A. with not a small dose of fear and trembling. As one of two physicians covering the northern coast of Nova Scotia I had served for two years as doctor, counselor, dentist, physician-to-sick-mariners, village vet, county coroner and church organist. Our outpost hospital of 13 beds, described as "quaint" by most tourists who happened by, had set a record of 1,000 patients that year in the Emergency "Room." I had chosen to train in a hospital, LAC/USC Medical Center, which saw the same number--in one day!

During my mostly happy stay in the Nova Scotia Highlands, we were pressed to set up what amounted to a rural EMS system. Many of our patients had to be referred out to a regional hospital 130 miles over twisting, snow-choked roads in winter and along a frequently fogbound coast in summer. House calls were part of the fare; 30-40 miles to visit a family was expected of us, and at any hour of the day or night. It was clear we needed an ambulance service, and we developed a relatively progressive one with the capability of rapid response, cardiac monitoring during transport, and lay first aid and BLS training. Our very efficient system of locating the doctor was by means of a cooperative telephone operator and several elderly ladies at key windows along our crank-phone single-line telephone system.

Similar progressive steps in developing a modern EMS system were taking place a world and era away--in Los Angeles. Little did I know at the time that these worlds would meet, and I would be in the middle of the crash.

I began at USC as a junior resident in the Emergency Medicine Department of Los Angeles County/USC Medical Center--the largest general hospital in the world and famous as the General Hospital of the TV soaps. We called it "the trenches," and it was precisely that. Critically ill patients--"red blankets," as we called them--would roll in one after another on a busy night with problems I had only read about in medical journals and texts in the North country--overdose, stabbings ("cuttings" in street lingo), gunshot wounds, beatings, freeway accidents and a multitude of the destitute, poor and losers of the world.

We were having a particularly bad Saturday night one weekend, with more than our share of "knife-and-gun-club" victims. Our staff was on edge, overworked and tired. The critical care area was crowded; nurses, doctors, aides, physicians' assistants and others were all clamoring to keep up with a seizing patient here, a young girl with PCP on board there, a gunshot victim with M.A.S.T. in place, and a young man with too many "reds" who needed a nasotracheal intubation before going up to ICU. In the midst of this organized chaos, two clean-cut young men stood somewhat apart from the rest of us haggard excuses for humanity. They appeared pretty cool under the pressure of it all, and not a part of the regular staff: they looked too "neat" and untouched by it all.