The Paramedics

An Illustrated History of Paramedics in their First Decade in the U.S. 

(This could be considered history, both in the sense of the Haywood County Rescue Squad and Emergency Medical Services as we know it today)

          The Paramedics        

Haywood County spans the Great Smokies in North Carolina’s Appalachian region. Originally the area was home to the Cherokee tribe and later settled by Scotch-Irish immigrants fleeing the relative constraints of civilization in Pennsylvania and the northern colonies. Independence was so characteristic of these people that a serious effort at secession from North Carolina was undertaken between 1784 and 1788. Although the State of Franklin never became official, North Carolina’s western counties have remained separate in spirit. As late as the early 1970s, the local health-planning agency was officially named “The State of Franklin Health Planning Council.”This unlikely locale was one of the first areas in the United States to utilize non-physician paramedics in taking coronary care to the patient in a prehospital setting. Even more unlikely was the choice of personnel to serve as paramedics: local members of the volunteer Haywood County Rescue Squad.

The Haywood County Rescue Squad operated from locations in the towns of Canton and Waynesville. Many of the volunteers of the Canton unit worked for the Champion Paper Co., the benevolent provider of jobs and income for most residents of the little mountain community. Traditionally, the paper manufacturer and other employers of Haywood County volunteers would allow the rescuers to leave work to respond on calls. Likewise, there was a traditional tolerance toward other activities related to rescue squad activities by the volunteers.

Dr. Ralph Feichter, a native of Haywood County who had received his medical training in the north, practiced in Waynesville as an internist when he and his medical associates took note of Pantridge’s work. Concluding that such a system was possible in their mountains, they assembled 40 of the volunteers for basic training in 1968. At the same time, they applied to the North Carolina Regional Medical Program (RMP) for a grant to equip two mobile intensive care vehicles.

In April 1969 the volunteers reassembled for intensive training in cardiac pathophysiology, electrocardiography, arrhythmia recognition, pharmacology (cardio-active drugs) and CPR. Classes were conducted two nights per week for about twelve weeks. The course was then repeated in the fall of 1969.

Although the volunteer paramedics were ready to go into operation at the end of their training, “we had all kinds of problems trying to figure out how to run it,” explained Dr. Feichter. “When we applied for the RMP grant, the concept was that Dr. Goodwin [an associate] and I would carry radios and we would try to get to the scene of the coronary and come back with the ambulance.”

Feichter pointed out that the shortcomings in the planned approach quickly became obvious. “The rescue squad was so much better at getting there than we were, we had to figure out some way of allowing them to function,” he said. Alternatively, they considered having the volunteers pick up an ICU nurse at the local hospital on the way to the scene. “That didn’t work out because it was also a delaying factor. Finally, we got our telemetry system working and we got some standing orders from our doctors [signed by every member of the Haywood County Medical Society].”

Haywood County’s pioneering paramedic program went virtually unnoticed outside the mountains for several years. “Basically, we were just interested in doing the job,” explains Dr. Feichter, “and we never had plans to publish anything [about the program].”

The North Carolina General Assembly [legislature] did not legally authorize paramedics until 1974, but Haywood County’s mountaineers were not deterred by that fact. “Basically, we extended the [hospital’s] coronary care unit standing orders out to the rescue squad, and as soon as we had the telemetry, we considered the ambulance to be an extension of the hospital,” Dr. Feichter explained.

Over the years since 1969, the Waynesville Mountaineer (“The Most Widely-Read Daily Newspaper in Western North Carolina”) carried periodic reports of the work of the nation’s first volunteer paramedics, especially in cases where they had successfully resuscitated patients in cardiac arrest. But following enactment of legislation in 1974, the State Board of Medical Examiners established some comprehensive training standards for “Mobile Intensive Care Technicians (MICTs).” The education required for the new standards went beyond the earlier training of the Haywood County volunteers, which had concentrated on handling cardiac emergencies. Most of the original volunteers went back into training.

To Read the Entire History of Paramedics in thier first years Click Here!

By: James O. Page