Some of the most profound world-changing medical discoveries in history occurred through happenstance, said Blair Bigham, MD, MSc, DTMH CCPf, during “The Next Medical Discovery Could Come From You!” on Wednesday Oct. 16 at EMS World Expo in New Orleans. And there are lessons for today's EMS clinicians written into their history.
Bigham, an emergency physician at McMaster University in Toronto, outlined five interesting facts discovered by non-researchers and how they revolutionized modern-day medical care.
Epidemiology is simply the study of diseases in people, began Bigham. It’s a systematic look at why people get diseases and how they can be limited or eliminated.
In the 1850s in England, an outbreak of cholera terrified the countryside and killed hundreds. No one knew the cause or how to stop it until an English physician named John Snow began tracking cholera deaths and found that the outbreak was concentrated in one particular area of London. On a hunch, Snow removed the handle from a water pump in the center of the outbreak, and deaths from the disease soon stopped. It was soon discovered that contaminated water was the source of the outbreak. Snow thus became the first researcher to establish a relationship between humans and disease. “That was the birth of epidemiology, how we formally study disease in people,” Bigham said. Even today, every EMT and medic who fills out a patient record participates in this process.
A Hungarian obstetrician named Ignaz Semmelweis is largely credited with introducing modern hygiene practices in healthcare. But he didn't set out to. In an attempt to comfort new mothers in his care, Semmelweis began to cover his hands in chlorine because he thought the smell would relieve stress. Almost immediately, the women in the ward stopped contracting fevers and hypotension, and newborn deaths plummeted. Still thinking that it was due to the comforting effects of the chemical, Semmelweis encouraged other providers to do the same.
However, his ideas were rejected by the medical community and he was committed to an asylum, where he died at age 47. Semmelweis's practice earned widespread acceptance only years after his death.
Now, hand hygiene is a staple of all healthcare protocols and is the best way in healthcare to stop infection and save lives, said Bigham. However, EMS and emergency departments can almost always improve in the area of hygiene and cleanliness, whether equipment or human, he added. While time and resources are strained in the emergency environment, it’s critical to maintain focus on proper hygiene practices.
A negligent lab tech accidentally discovered penicillin. When Alexander Fleming, professor of bacteriology at St. Mary's Hospital in London, returned from a holiday break on September 3, 1928, he began to sort through Petri dishes containing colonies of Staphylococcus bacteria. He noticed something unusual on one dish. It was dotted with colonies, except for one area where a blob of mold was growing. The zone immediately around the mold was clear, as if the mold had secreted something that inhibited bacterial growth.
Fleming found that his "mold juice" was capable of killing a wide range of harmful bacteria, such as streptococcus, meningococcus and the diphtheria bacillus, but he didn’t pursue the discovery further, said Bigham. It wasn’t until a decade later that scientists took up the cause and turned penicillin from a laboratory curiosity into a livesaving intervention. By 1942 it was the most common antibiotic in use. As a result, deaths—particularly in children—plummeted. “Ever since then we’ve had a meteoric rise in world population,” Bigham said. “People are just not dying of infection anymore.”
Among the most profound healthcare innovations in the world’s history has been the development of prehospital care, according to Bigham. Framing his talk around the 20th century, Bigham pointed out that mortality rates were high during the first two World Wars. People simply expected soldiers to die in battle.
That changed during the Vietnam War. Partly because of the nation’s sentiment about the conflict, as well as access to technologies such as helicopters, there was a new focus on no longer letting military personnel die in combat. Combat medics were trained to provide battlefield care. As a result, combat deaths plummeted.
Returning veterans with combat medical experience began to serve a stateside civilian population, and traumatic deaths began to decrease here as well.
“That was the birth of EMS as we know it, in the U.S. especially,” Bigham said. Coupled with the discoveries of the mobile defibrillator and CPR, millions of lives were being saved.
“We have this odd constellation of phenomena,” said Bigham of medical discoveries, transportation improvements, trained medical personnel and a groundbreaking Institute of Medicine report on death in America in the formative years of EMS. As a result, an emergency system was developed that revolutionized the care of the sick and injured in America.
Antiretrovirals have an interesting history. Those who practiced EMS in the 1980s recall the HIV scare, and the unknowns attached to it. “It really did change a lot of healthcare,” such as the widespread adoption of personal protective equipment, Bigham said.
Following the development of antiretroviral therapies, HIV/AIDS became a world movement. Every day people rose up and demanded access to these very expensive drugs, Bigham said. Politicians pressured drug companies to lower the costs of these lifesaving medicines. By the mid-2000s, if you had HIV you could access antiretrovirals without having to go bankrupt.
While people still die of AIDS, it’s not as common today in the civilized world. However, in Namibia, where Bigham teaches during the winter, people are still dying of AIDS every day. The reason? When AIDS cases began to drop because of access to antiretrovirals, government funding dried up. HIV incidence went up again. “Anybody who thought we were winning the battle, that’s not true anymore,” he said. “People have turned their eyes to other things, and HIV is making a resurgence everywhere.”
These accidental discoveries were produced through a combination of serendipity, idiocy and negligence, concluded Bigham. They have now saved millions of lives and transformed how society functions.
The take-home lesson for EMS? Looking to the future, all these practices are under threat, stressed Bigham. If we lose them, “we’re gong to be right back to where we started.” Pregnant women will again be at risk of dying of infection, drug companies could begin limiting access to lifesaving drugs, and organisms could begin killing masses of people.
In his practice, Bigham is encountering increasing numbers of patients with anti-medical perspectives, whether it's natural therapies, anti-vaccine stances, and more. He predicts EMS providers will be confronting the same trends. Because of this, don't hesitate to point out cases in which patient beliefs go against current scientific merit, he said.
A disregard of scientific evidence can lead to urgent healthcare concerns such as the recent measles outbreak, said Bigham. “This is a problem," he concluded. "Measles kills kids. As people who believe in medicine, we have to take this threat very very seriously. Science matters. We need to stand up for science.”