40 Years & Counting—Part 2: Show Me the Equipment

Mike Smith is a featured speaker at EMS World Expo, October 29–November 2, in New Orleans, LA.

In my mind, the most significant development in prehospital care is the evolution of "industry specific" equipment.

When the National Academy of Sciences published the landmark document Accidental Death and Disability: The Neglected Disease of Modern Society in 1966, aka “The White Paper,” EMS was born. Alas, we were born into a world with no tools of the trade that we could call our own.

That auspicious beginning left no real choice other than to seek out equipment from other sources. The Thomas half-ring splint, Hare traction splint and military anti-shock trousers (MAST) came to us from the military. Our first transport vehicles and gurneys morphed from the funeral industry. The space program shared with us the ability to capture ECGs and transmit them via bio-telemetry. Hospitals ponied up dressings, bandages, IV catheters and IV bottles.

With no real control over the development and implementation of equipment, we embarked on a trial and error process to expand the contents of our toolbox. One of those tools was the E&J Resuscitator—literally a hard shell suitcase with about 50 pounds of ventilator inside that you unceremoniously humped in to your patient. Once applied, it overventilated patients almost instantly—to the point of inflating the stomach—resulting in the patient vomiting, which the E&J then blew down into the patient’s lungs. As an old-dog physician once told me, “For patients who were going to die from a cardiac problem anyway, the E&J Resuscitator shortened the period of suffering, bringing about the patient’s demise quickly.”

Another loser was the HLR, or the heart and lung resuscitator. You placed this plastic wedge under a cardiac arrest victim and strapped it over their shoulders, fixing the straps onto little pegs. When you turned it on, the first two or three compressions blew out the costochondral cartilage and then the HLR really got going. If you weren’t smart enough to stop and retighten the straps securing the device, the HLR would bounce around and pretty much thump all over the anterior chest.

Yet another total dog was the Throat-E-Vac. It looked like a water pistol with a long kind of anteater snout. You inserted it into the mouth of a victim of airway obstruction, sealed it around the patient’s lips and started squeezing the trigger, which in theory created enough suction to magically cause the obstruction to pop out. First off, you had to make sure the nose was pinched shut or it was useless from the get-go. Even with the nose sealed, I never once saw it work or even heard of it working. After about two minutes of squeezing the trigger, you were much closer to needing carpal tunnel surgery than you were actually clearing the obstruction.

Thankfully, we have long since moved on and now enjoy an extraordinary number of industry specific choices when it comes to prehospital care. Here’s my list of what I consider some of the greatest innovations to have come our way in the last 40 years: Power-lift gurneys (my back says thanks); stair crawlers (my back says thanks, again); AEDs; CPAP (our CHF patients say thanks for not intubating them); waveform capnography; the gum bougie (elegant simplicity); patient transfer sheets (how slick can slick get?); the Spider Strap (if put away and stored properly; if not, yikes!); speed clip straps and longboards; the Stifneck cervical collar; the Kendrick Extrication Device; self-blunting IV catheters; needleless injection systems; disposable troponin I measurement; transport ventilators; adult and pediatric intraosseous devices; bleeding control compounds/dressings; and one-hand application tourniquets.

The exponential growth and development of our equipment choices has allowed us to meet our patient care needs more efficiently and effectively. To all those really smart folks out there who continue to think up really smart things, thanks for all the innovative equipment choices.