Portland, Ore., isn’t always considered among the short list of municipalities that developed the first wave of American EMS systems. But the city made some early contributions to the field that were both unique and lasting, and they’re chronicled in a new film by Oregon paramedic Denise O’Halloran, The Rose City Experiment.
The project—basically a two-person job from O’Halloran and videographer Pat McAbery, a firefighter/paramedic in Gresham, a neighboring city in Multnomah County—was six years in the making. With a couple of technical upgrades, they hope to air it on Oregon Public Broadcasting. Its public debut came October 10, when AMR hosted a screening for an enthusiastic packed house at Portland’s Kennedy School.
“This is a raw story,” says O’Halloran, a veteran of EMS in the city since 1980. “These folks sat in my garage and were real. Maybe it was the environment—they realized Pat and I weren’t fancy, and they all knew us. But I don’t think you’re going to find storytelling anywhere that’s quite this raw.”
What primarily distinguished Portland from other trailblazing jurisdictions like Seattle, Los Angeles, and Miami was that where those cities built their EMS capacity onto their fire departments, Portland let its private services drive. Its lead players during the 1968–1980 period examined in the film were companies like Buck Ambulance, Care Ambulance, and A.A. Ambulance. (Service names of the pre-9-1-1 period started with the early letters of the alphabet so callers would find them before competitors in the phone listings.)
Compared to the more restrictive systems elsewhere, Portland providers had a lot of latitude. And if this fostered a kind of cowboy mentality, it’s because the docs calling the shots were pretty progressive too. Foremost among them were Buck’s Don McNeill and the better known Leonard Rose, MD, Portland’s contemporary to early EMS physician-giants like Eugene Nagel and Leonard Cobb. A cardiologist and combat veteran, Rose came to Portland in 1955 to practice at Good Samaritan Hospital, where he placed the first pacemaker in a patient in 1958 and developed a mobile resuscitation cart that brought defibrillation to patients in 1961.
Aware of the work of Frank Pantridge and others, Rose wanted to train ambulance attendants to use portable defibrillators. Buck had its own history of innovation; its vehicles had carried oxygen since 1943 and two-way radios since 1948. In 1969 they joined forces for the Oregon Coronary Ambulance Project, which trained Buck personnel in ECG interpretation, CPR, and defibrillation and equipped them to take the care to the field.
The program started slowly but found initial success and took off. Portland subsequently had the first out-of-hospital cardiac save by a nonphysician crew (which included Roger Fox, later the first president of NAEMT), and of 14 patients cited in a 1972 JAMA review of the project, fully half survived to hospital discharge. Concluded authors Rose and Edward Press, “The feasibility of incorporating this service on a practical basis into the community medical system with conservation of medical manpower and at a low cost to the patient was demonstrated.”1
The Rose City Experiment notes that one of Buck’s “heart cars” responded in 1970 when the company’s owner had a cardiac arrest. Despite a lengthy response time in a system not yet concerned with them, he was saved and made a full neurological recovery. Then, two years later, the same thing happened to Portland Mayor Terry Schrunk. Schrunk’s distaste for sirens downtown, the film observes, was much reduced thereafter.
Portland kept pushing the envelope in other ways too, including allowing prehospital IVs, and had among the first female paramedics in the U.S. This is a main subject of the film, and several of those pioneers share their stories. While they were greeted with hostility in some quarters—they were ignored, rebuffed, and had their access blocked on scenes; on more than one occasion they were met with physical aggression—the advanced integration of women in Portland’s private services ultimately helped ensure AMR, which had absorbed Buck, got the exclusive city contract over Portland Fire & Rescue when the city went to a single ambulance provider in the early 1990s.
The film also examines responses to a pair of early local mass-casualty incidents, a 1972 tornado in suburban Vancouver, Wash., and the 1978 crash of United flight #173 in an east Portland neighborhood.
Ultimately, when Portland Fire & Rescue fully expanded into the EMS business, Buck crews trained its firefighters—some of whom then did their best to drive the privates out of the picture. The city’s basic model still survives, however, with firefighters providing first response and AMR—which acquired Buck in 1992, A.A. in 1994, and Care in 1997—still the exclusive ambulance provider.
“It’s an amazing story,” says O’Halloran. “We’ve talked about OPB, and we’d love to have it recognized by state of Oregon on some level, as an Oregon story and part of the state’s history.
“The history of EMS in the United States has been such an amazing story, and a story developed in part by each city, each community, and each state. It wasn’t a united effort for a long time. I guess I’d like someone to see the effect Portland had.”
1. Rose LB, Press E. Cardiac defibrillation by ambulance attendants. JAMA, 1972 Jan 3; 219(1): 63–8.