Seattle & King County Emergency Medical Services System

Patient being loaded into a Seattle Medic One ambulance circa 1970

Seattle Paramedic Unit

King County Paramedic Unit

In 1968, motivated by the work of Frank Pantridge, cardiologist Leonard Cobb proposed to the chief of the Seattle Fire Department, Gordon Vickery, training firefighters to treat cardiac arrest. The department was attractive to Cobb because it already provided first aid and tracked its performance electronically.[6]

In 1969, they trained fifteen firefighters and used a grant from the Washington/Alaska Regional Medical Program to convert a large motor home into a Mobile Coronary Care Unit nicknamed "Moby Pig", which would respond to calls with both the firefighter paramedics and a physician on board.

The first Medic One call was on March 7, 1970. During the program's first year, 31 lives were saved.[7] The following year the program was changed, replacing the on-board doctors with fire department paramedics given advanced special training and remote access to the doctors.

In 1974, the TV news-magazine 60 Minutes profiled the success of Medic One, lauding the high standards of training and education provided by the Seattle training program. Correspondent Morley Safer declared, "If you have to have a heart attack, have it in Seattle". The phrase is still used frequently in conjunction with Medic One, due to its continued success which is reflected in the area's high survival rate for heart attacks and their comprehensive CPR training program.[8][9]

That same year Medic One incorporated as a privately held, non-profit organization and established the Medic One Foundation, which works on behalf of both fund raising and the expansion of the program. The program is financed by local property tax levies, which are voted on by the public every six years, along with private and corporate donations.[9]

Medic One had saved 655 patients from cardiac arrest by 1976 and this success was gaining national and international attention.[10] Medic One service was expanded into the rest of King County in 1976,[11] and in conjunction with the Medic One Foundation, other counties in Washington State began paramedic programs to serve their communities.

In 1979, Cobb and UW professor Mickey Eisenberg began training fire department emergency medical technician - Basics (EMT-Bs) to perform the administration of defibrillation for patients in cardiac arrest since the EMTs were usually at the patient's side several minutes before the paramedics. Eisenberg began training 9-1-1 dispatchers to provide instructions to lay-persons on how to perform CPR in 1982. With the introduction of automatic external defibrillators (AEDs) in 1984, EMTs were able to defibrillate patients in cardiac arrest even more quickly.[10]

There are five paramedic programs in the Medic One system.

King County Medic One

Logo of King County Medic One

King County Medic One is the paramedic service serving all of South King County provided by Public Health - Seattle & King County.[18] Its medical director is Peter Kudenchuk.

Founded on strong physician leadership Medic One is structured around response, training, and quality improvement.

One of the primary components to the success of Medic One is their “Tiered Response System” which begins with the citizen call to the 9-1-1 center. Emergency Medical Dispatchers are trained to rapidly triage the call to dispatch the appropriate level of assistance, while providing pre-arrival instruction of CPR. Firefighters, with EMT training, respond first to deliver immediate Basic Life Support (BLS), pending the arrival of the paramedics. Specially trained paramedics arrive within minutes to provide Advanced Life Support (ALS) and, if needed, can provide transportation to the nearest appropriate Medical Center.[23]

The system is successful due to the blended cooperation between the fire department and paramedic/ambulance services, as well as, a strict policy of meticulous measurement of system performance and cardiac arrest survival information. Strong leadership and regional programs promote uniformity in medical care and response, regardless of jurisdiction.[7]

Another critical element to the Medic One program is the comprehensive training program for the paramedics, one of the most stringent anywhere, making their paramedics some of the most thoroughly trained in the world. Only paramedics with at least three years of prior firefighter or EMT experience may enter the program. Medic One paramedics receive 2,000 hours of instruction, using both “book” studies and hands on field and clinical application through both the University of Washington and Harborview Medical Center. The national standard for paramedic training is just 1,100 hours. Medic One paramedics will have more than 700 patient contacts during their training, which is three times the national standard. Upon completion of training Medic One paramedics are considered to be an extension of the ER doctors and may perform advanced medical care, open airways and administer a variety of medications.[8]

The final component is an emphasis on community based CPR training, called Medic Two. The Seattle/King County area has the highest per capita number of citizens that are trained in the administration of CPR techniques, approximately 50% of its residents.[24]

Education

Break down of training[27]

All paramedics in King County are graduates of the University of Washington Paramedic Training Program regardless of previous training. The training is 1,866 total hours consisting of 380 lecture hours, 120 lab hours, 466 clinical hours in the operating room and emergency department at Harborview Medical Center and critical care unit and labor and delivery at Seattle Children's Hospital, and 900 field internship hours with Seattle Medic One.[28] Students see an average of 700 patient contacts.

Medic One paramedic programs are funded by a property tax levy. Basic life support services receive partial funding from the levy. The levy passed in 1979, 1985, 1991, 1998, 2001, and 2008.[29] The levy did not pass in 1997.[30]

The Medic One Foundation is a nonprofit charitable foundation supporting paramedic training, research, medical oversight and quality review, and the purchasing of emergency medical equipment.[31]

• Cardiac Arrest Blood Study (CABS)
• AutoPulse Assisted Prehospital International Resuscitation (ASPIRE) Trial [40]
• Transthoracic Incremental Monophasic Versus Biphasic by Emergency Responders (TIMBER)
• Dispatcher-Assisted Resuscitation Trial (DART)[41]
• Emergency Medical Technician Treatment of Hypoglycemia in the Field
• Induced Hypothermia for Cardiac Arrest Patients
• Resuscitation Outcomes Consortium
• SPHERE Hypertension Intervention Study
• At-Home Automated External Defibrillator (AED) Training Study