How have paramedic techniques changed since the TV series 'Emergency!'?

Check it out and add your own thoughts in the comments


A question posted recently on Quora asked, “In what ways have paramedic techniques changed from how they were portrayed in the 1970s TV series Emergency?” Anderson Moorer, an EMT-P, gave his opinion on the topic below. Check it out and add your own thoughts in the comments.

The television show "Emergency!" did a great job of chronicling the evolution of emergency medical services. 

The first episodes touched on the overall idea of a "paramedic" and the concerns doctors had as to whether firefighters could actually administer emergency care in the field. The role of communications and telemetry and the concept of a paramedic as an extension of a medical doctor's eyes and hands into the field is covered.

Over the first few seasons and amidst a lot of sappy skits and chintzy dialogue, you see a remarkably accurate record of how the gear evolved, the role of the medics broaden, techniques getting adapted to field conditions, and an overall system forming to handle emergencies of all kinds.

So what are things like now? 

Totally different, yet fundamentally the same

By this I mean the core concepts remain: A paramedic is an extension of the medical doctor's decisions, and much of the gear is similar but refined variants on what was in play back then... IVs, cardioversion, drug administration, etc. Most of the drugs mentioned are still used, but dosages and circumstances of use have been greatly refined, plus there are many, many more drugs in use today. 

"Emergency!" was set in a time where emergency medicine was rapidly developing, from the Korean-war MASH style surgeries being a wartime phenomena and an ambulance essentially being a hearse you were thrown in the back of to a specialized field of medicine encompassing not only surgical but other medical intervention. A lot of the care shown on the show as being cutting edge is now routine, and some of it seems laughably primitive by today's standards. Some big changes have occurred in this time frame, that of a single career.

In the TV show, a paramedic and an "ambulance driver" were still very different. Today, the paramedics drive the ambulances, with one of the team of two driving and the other in the back with the patient, and this role switching for each call. In cases where more medical personnel are needed for a single patient, firefighters or additional medics do the driving.

You see the hearse-like station wagon ambulances of the 1970's replaced today by the boxy emergency vehicle which essentially blends an ER room on the inside and the gear truck the medics drive in the TV show on the outside.

The iconic image of the medical doctor pondering concernedly at an EKG strip radioed by the medics is now redundant. The medics read the strips themselves. And the medics giving care while things explode nearby shows a lesson yet to be learned at the time of the series....putting medics too deeply in harms way simply means more critically injured patients and nobody left to care for them.

Specializations

In "Emergency," the two paramedics were rescue specialists. Today, they are separate but overlapping fields, and there are more kinds of rescue specialists. One person may have several specializations, and most do, and all paramedics have a required basic knowledge of a variety of rescue scenarios. It is no longer typical if it ever really was for two individuals to have pretty much all specialized rescue and medical care fall on them alone. Plus as suggested before, it's not good planning to have your medical specialists be the ones who are most likely to be hurt.

There is a third player today, the EMT-B (emergency medical technician - basic). A paramedic (EMT-P) has advanced skills which can be consider "invasive care:" IV therapy, drug administration, cardioversion, emergency surgical techniques, etc. The EMT-B has a more limited skillset intended to provide basic care prior to arrival of paramedics or which is sufficient in itself, as is the case with a majority of calls. In "Emergency!" this role is shown developing (the firefighter with the striking mustache and comic relief role begins to act as a defacto EMT as the series evolves).

And of course, there are plenty of small differences. "Ambu bags" replaced pressurized O2 shortly after the series ended and intubation is routine for unconscious patients. 

Paramedics now use "standing orders" that give them great leeway to act without direct communication with an M.D. based on a document written by their chief medical director and subject to regular review. (One episode in "Emergency" covers the development of this concept, in fact).

And frankly, paramedics have much greater medical knowledge in general than is portrayed in "Emergency!" Similarly, call volumes are hugely higher, and in the show the sheer space (HUGE hospital rooms) and the amount of time spent on a single patient, in and out of the E.R. is completely alien to the world I knew as a medic 10 years ago.

Communication and camaraderie

In "Emergency!," the paramedics get to know patients and worry about them. I don't know if this was ever the case, when I was a medic you went from call to call, half the time you were lucky to find out if the patient lived or died.

And most notably, in "Emergency!" a critical aspect of the system was still in place: The regular communication, camaraderie and training between ER physicians and paramedics. This has become fleetingly rare over time, but it's still at the very heart of what a paramedic is. 

Medical doctors specializing in emergency medicine should be required to watch a few episodes of "Emergency!" simply to hit home the fact that paramedics existed, and still do, to act as agents of emergency physicians. 

The best of them today still realize this and save a tremendous number of lives as well as alleviate stressors on the ED by using paramedics wisely. But it has been a trend over time for the distance between paramedics and M.D.s to widen, and in doing so, for there to be a loss of a certain magic of human care which this remarkable 1970's show somehow manages to capture.

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