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EMS Hall of Fame: The Pioneers of Prehospital Care—Pantridge, Safar

The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This new series honors these trailblazers. 

Frank Pantridge, MD

Inventor of the portable defibrillator

It weighed more than 150 lbs. and was powered by car batteries, but the first portable defibrillator, invented in 1965, has grown into the compact signature tool that helps EMS providers all over the world stop cardiac arrests and save their sufferers today. For that we can thank Dr. Frank Pantridge. 

James Francis Pantridge, born in Northern Ireland in 1916, was a consultant physician at the Royal Victoria Infirmary in Belfast when he produced the device (with the assistance of technician Alfred Mawhinney and senior house officer John Geddes). When they put it in an ambulance in 1966, they created prehospital coronary care, a concept that quickly spread to the U.S. 

American hospitals had been developing coronary-care units since earlier in the ’60s, but Pantridge knew most coronary deaths occurred elsewhere and that ventricular fibrillation could best be treated where it occurred. He believed anyone who could perform CPR could operate a defibrillator and preached that one should be alongside every fire extinguisher. 

Pantridge became a physician in 1939, then went to war, where he was captured by the Japanese. As a POW slave laborer, he survived beriberi and the notorious “death camp” at Tanbaya in Burma. Afterward he worked at the University of Michigan with electrocardiography expert F.N. Wilson, then returned to Belfast’s Royal Victoria Hospital, where he helped establish a world-renowned cardiology unit. 

By 1968, using a miniature capacitor built for NASA, he’d shrunk portable defibrillators down to less than 7 lbs. But in the face of concerns that lay rescuers might shock people who had just fainted or were drunk, Pantridge envisioned a safety mechanism that would prevent inappropriate shocks. Implanted defibrillators had that, but their inventor, Polish physician Michel Mirowski, was skeptical about adapting the technology. “Frank persisted,” a biography notes, and the AED ultimately emerged.1 Pantridge died in 2004 at age 88. 

Peter Safar, MD

The father of CPR

Even more essential to saving cardiac arrest victims than defibrillation is chest compressions and perhaps an occasional rescue breath—the modern-day incarnation of cardiopulmonary resuscitation. CPR was largely conceived by Dr. Peter Safar. 

Born in Vienna in 1924, Safar earned his MD in 1948. Two years later he came to the U.S., studying at Yale New Haven Hospital and the University of Pennsylvania—at the latter, anesthesiology. He ended up at Baltimore City Hospital, where he conducted airway and breathing research, including investigating mouth-to-mouth breathing and tilting the head back with the mouth open to control the airway. When he added closed-chest cardiac massage to the equation, it became CPR. 

Though loath to take credit for “inventing” CPR, Safar worked hard to popularize it, including helping develop Laerdal’s Resusci Anne manikin. “The way he saw it,” one biography says, “he merely brought to light effective procedures humans had already discovered, putting them together into what he called ‘the ABCs’—maintaining a patient’s airway, breathing, and circulation.”2 

In 1961 Safar led a new anesthesiology department at the University of Pittsburgh that’s since become the largest academic anesthesiology department in the nation. He also developed the U.S.’ first intensive care unit and initiated the legendary Freedom House.

A personal tragedy was key to this work: In 1966 Safar’s 11-year-old daughter suffered an asthma attack, fell into a coma, and died. Doctors revived her heart and lungs but not her brain. This helped convince Safar that early intervention was the initial key to successful resuscitation and led him to help develop and implement Freedom House the next year.3,4 He and Nancy Caroline subsequently developed standards for EMT education and training. Safar also began researching methods of cardiopulmonary-cerebral resuscitation and experimenting with therapeutic hypothermia.2  Safar was nominated three times for the Nobel Prize in medicine. 

References

1. Evans A. Frank Pantridge. BMJ, 2005 Apr 2; 330(7,494): 793.

2. Lemelson-MIT Program. Peter Safar, https://lemelson.mit.edu/resources/peter-safar.

3. Cadogan M. Peter Safar. Life in the Fastlane, https://litfl.com/peter-safar/.

4. Wikipedia. Peter Safar, https://en.wikipedia.org/wiki/Peter_Safar.

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