Evolution of out-of-hospital emergency cardiac care: Heart attack therapy for a retired president helped modernize American emergency medical services

Abstract

In the late 1960s, American emergency medical services (EMS) began to upgrade from mere Red Cross first aid to systems that now provide sophisticated advanced life support. This revolution in EMS stemmed from two pioneering Belfast reports in The Lancet that described how early out-of-hospital coronary care saved lives. Inspired, a handful of American physicians implemented avant-garde programs in the USA. One such physician, Richard Crampton of the University of Virginia, supported by the university and by Charlottesville-Albemarle Rescue Squad staffs, led an early effort to provide out-of-hospital drug treatment and defibrillation via a mobile coronary care unit (MCCU) ambulance. Half a dozen high-profile local cases, including successful treatment of retired President Lyndon B. Johnson, demonstrated MCCU efficacy to the Virginia and American public via local and national press coverage. The economic feasibility of the MCCU system was established. With two Virginia colleagues, Crampton successfully lobbied for a bill to permit trained nonphysicians to render out-of-hospital cardiac care with no on-site physician. This MCCU-augmented EMS system reduced coronary deaths in Charlottesville and Albemarle County, Virginia. It also stimulated nationwide progress in care by EMS systems that yielded countless lives saved in the succeeding half-century.

Keywords: Charlottesville; Lyndon Baines Johnson; University of Virginia; emergency medicine; mobile coronary care unit.

Figure 1.

A staged event raised public awareness of mobile coronary care units. Charlottesville–Albemarle Rescue Squad and University of Virginia staff demonstrated use of a portable defibrillator carried by a resident physician to a collapsed construction worker. Photo courtesy of The Daily Progress.

Figure 2.

Bedside home electrocardiogram showing acute anterior myocardial infarction, with new anterior Q waves in leads V2–V4; elevated ST segments of acute anterior myocardial injury in leads I, aVL, and V2–V6; and reciprocal depression in leads III and aVF.

Figure 3.

Yearly coronary deaths from 1971 to 1973. Mobile coronary care units lowered age-specific deaths outside the hospital. Community age-specific and total deaths fell also. By contrast, coronary mortality rose 6% in areas of Virginia not served by a mobile coronary care unit.