Prior to 1969, there were an alarming high number of deaths from cardiac arrest in the Los Angeles metropolitan area. So studies were instituted to help reduce the mortality and morbidity of these patients. From the early 60’s, the Soviet Union had already demonstrated that a dispatched ambulance, staffed with a physician, a nurse and a “Felcher” (a physician’s assistant), could greatly increase the survival rates of both trauma and cardiac victims alike. In 1966, the first scientific study defining a Mobile Coronary Care Unit (MCCU) operation in Belfast, Northern Ireland was published by Dr. Frank Pantridge in the British medical journal "Lancet.". This program concept was then mirrored by Dr. William Grace at New York City’s Saint Vincent Hospital in Manhattan starting in 1968.
At about this same time, Walter Graf, MD was President of the Los Angeles County Heart Association,and also chaired a MCCU development program in the Inglewood-Centinella region of Los Angeles County. He had studied the success of the Belfast, Northern Ireland, St. Vincent's Hospital and Miami Fire Department mobile coronary care programs and was convinced that such a program could save lives in the area served by Daniel Freedman Hospital (DFH). Dr. Graf instituted a MCCU program that used a 1969 white Chevrolet "stepvan" which had been fully equipped as a "hospital coronary care unit on wheels." This was instituted in conjunction with McCormick Ambulance Service, Inc. which provided ambulance personnel who were allowed to undergo MCCU training. This vehicle was designated as the “Heart Car” and was very successful in response to coronary emergency calls within the hospital's service area.
This same year, Dr. J. Michael Criley proposed a paramedic training program for Los Angeles County. Dr. Walter Graf agreed with the concept of using specially trained firemen to deliver emergency pre-hospital coronary treatment. Based on the proven success of early MCCU programs, LA County Board of Supervisor Kenneth Hahn, the medical community and others met to consider the most effective emergency care delivery system for the future. It was decided that fire personnel could best be trained as paramedics. On September 12, 1969, a small group of carefully selected Los Angeles County firemen were selected to join LA City firemen, 30 RN’s and Inglewood Fire rescue members to begin “Mobile Intensive Care Paramedic (MICP) training at Harbor General Hospital. The course consisted of over 1000 hours of classroom, 180 hours of clinical and 480 hours of internship at Harbor General Hospital (HGH) under the guidance of Dr. Michael Criley, Dr. James Lewis and Critical Care Unit Nurse Carol Bebout.
On December 8, 1969, Squad 59’s “Rescue Heart Unit”, became the first official Los Angeles County Fire Rescue Unit placed into service. It was based Fire Station 59 on the grounds of Harbor General Hospital (HGH). L.A. City Fire Department Rescue Ambulance (RA) 53 was also placed in service as the city's first paramedic unit. Los Angeles City RA's units actually transported the patient whereas the L.A. County Squad would call for a basic life support (BLS) private or hospital based ambulance to transport.
When a “cardiac call” was received, Squad 59 would depart the bays of the fire station. At the rear of the hospital, the two paramedics would then be joined by a coronary care unit (CCU) who had been paged. This required that the nurse transverse many flights of stairs and hallways in order to meet up with the rescue unit as it were preparing to depart the hospital’s back door. The nurse would ride in the back seat along with the paramedics. This was due to a California law requirement that only allowed state licensed physicians and registered nurses (RN) to administer invasive medical procedures. Within the year, this strategy proved to be difficult at best, due to constantly reducing the critical CCU staffing to satisfy this requirement. Officials then realized that specific medical legislation would have to pass the California legislature in order to allow paramedics to legally administer invasive coronary care invasive procedures without requiring that a nurse be present.
In January of 1970, the Board of Supervisors approved two formal study programs on the training and use of Mobile Intensive Care Paramedics, however, there was still no formal legislation that permitted paramedics to administer invasive coronary care treatment procedures. That same month, Senator James Q. Wedworth and Assemblyman Larry Townsend jointly introduced the bill into both houses of the California State Legislature. On July 14, 1970, The Wedworth-Townsend Paramedic Act was signed into law by then Governor Ronald Reagan and California became the first state to adopt legislation defining “certification” and permitting paramedics to provide advanced medical life support. The Wedworth-Townsend Paramedic Act defined the role of the Mobile Intensive Care Paramedic (MICP), the Mobile Intensive Care Nurse (MICN), defined the paramedic practice and allowed paramedics to function without the presence of a physician or nurse. Once the nurse requirement was removed, L.A. County Squad 36 began covering Squad 59’s basic response area with Squad 59 serving as back-up. The City of Inglewood also began operating a paramedic level rescue unit using a slight variation from that of the county.
Today, Los Angeles County has one of the largest and most diverse EMS systems in the country. It serves over 10 million residents in 88 cities, covers over 4,000 square miles of mountains, deserts, beaches and valleys in myriad patchwork of urban, rural, and remote wilderness areas.
Keywords: Los Angeles, LA County, Wedworth-Townsend Act, MICP, Walter Graf
Last Revision Date: 7/31/11 - 5:51 PM