Me: When was the foundation started?
Jan Sprake: So you know Leonard Cobb’s name?
Me: Yes
Jan Sprake: And you know Chief Gordon Vickery’s name?
Me: Yes
Jan Sprake: So, when they started the project back in 1969, when they first started it was a research project that they put together to see if they could in fact, teach light people to do what a physician could do in the field. And that project you probably know was federally funded, it was a three year grant. And so halfway through, that grant was stopped. So they didn’t have enough money to complete the three year grant. So they went to the community in a really big way, Chief Vickery and Dr. Cobb. And it became just a huge grass roots effort. Kids your age were collecting coins, barber shops were giving haircut discounts for and raising money that way, but people just rallied tremendously because they knew that they were seeing results, that lives were being saved. So they wanted to keep it alive, the city wouldn’t pick it up. Actually the city wanted to bring in a private ambulance company. So the community raised more than they needed to keep the project going and actually the money kept coming in. So with that money, Dr. Cobb decided to set up a foundation, and do what he thought he hoped for and actually came to fruition would be to, through the private funding it keeps it out of the realm of a political decision how much money to spend on training or research or quality assurance, and it keeps it medically focused. So that would insure that it would always be a medical program and not a fire department driven program, or a political or private program. So that’s why he started the foundation. That was in 1974.
Me: How has the foundation impacted the progression of the Medic One program?
Jan Sprake: Tremendously. Probably what I could give you is the history, since when we first started doing research projects. The bulk of it has been in two areas or three areas. Research has had a tremendous impact, if you go back to the early 70s and even into the early 80s and look at what the foundation money was used to look at new and innovative ideas on how pre-hospital emergency care is delivered in the field. And it looked at a variety of things from different kinds of shock waves to whether or not firefighters could be taught how to defibrillate in the field and if that had any significant impact, what is the role of AED’s, we’ve become more sophisticated in our research as times have changed, to know funding, we were the ones that funded the pre hospital emergency care hypothermia. So this has been going on for the last 8-9 years and has just come to conclusion. And now looking at whether or not a device can be developed that when you do CPR on an individual and you have to stop the compression and for the defibrillator to be able to read the rhythm of the heart and this new devise is potential that it could read the rhythm of the devise while compressions continue. Because we found that, actually one of our research projects as well helped Dr. Cobb and his cohorts discover that if you limit the time you stop resuscitation compressions to less than ten seconds, then the survival rate goes up. So over the years we have had a tremendous impact not only locally but internationally through our published research. And that research has been funding faculty members from children’s hospitals in the University of Washington and Harvard. And then on the training side, we have through private funding, we provided the funding o allow us to demand more of our students than any other training programs in the country. Again it’s medically focused, it’s unlike any other program in literally the world. I don’t know, have you talked to anybody about the training program yet?
Me: I know a little bit about the training program, I learned about the hours from Dr. Eisenberg.
Jan Sprake: So that private funding allows them to have the number of those hours, you know two times the national average. Three times the number of patient contacts over the national recommendation. So without that private funding I think it would probably be like any other typical paramedic training program across the country, and so through that. And then you do the research you come up with innovative new ways to deliver care in the field, you train the students in the field how to deliver that innovative care, and then you review and look at how they are performing in the field, and that’s what we call quality assurance. So we have funded that through the Seattle Fire Department for the last 40 years as well. So it is an incredible circle of innovation and constantly improving. And that’s how I think the foundation has had such a significant impact both locally but I think you have to look beyond that because, did Dr. Eisenberg tell you about the resuscitation academy?
Me: He did.
Jan Sprake: We funded him to help him get that project as well, as a pilot project, up and running. The things we do here locally, now impact EMS systems around the world. By giving them toolkits that they can take to their communities. And implement it, they may not be able to implement everything, but they can implement part of our system. So we are having impact not only locally, but internationally.
Me: Where did the Medic One name come from?
Jan Sprake: So, you see engine one, engine two, engine 10. So they just have numbers engine one, engine two, engine three, engine four. So it was medic one, and it just stayed medic one. So everyone now there is medic one program at Bellevue Fire Department, Shortline fire department, I don’t know if Bainbridge is medic one, but that is how it started.
Me: My understanding is that the Medic One Foundation has funded some of the studies coming out of Medic One, what do you feel are the most important studies that the foundation has funded?
Jan Sprake: I think, probably the study around community CPR in the beginning, so we helped to fund that. I think the one that has had the most recent impact is the high performance CPR. Again it goes back to doctor Cobb funding, it may have been Tom Ray, out of King County, I would have to look it up, looking at chest compression only CPR and limiting the number of minutes that you don’t do CPR and that has been, in the 14 years I have been here, that has resulted in the most significant increase in survival. Hypothermia, basically the result after that national study came back it showed that there was really no difference. So I guess that’s either good or bad. Dr. Cobb always points to amiodarone back, and now they’re doing a new study on amiodarone and I think they delivered it after the shock before and now they are trying to see what happens when giving it prior the shock, so I don’t know how that result will come, but probably around the CPR component. And way back when, and more recently that lead to the high performance CPR training. So they actually really shifted the way that the providers in the field did their CPR. A.A Chackie Mat a couple of years ago published a study saying that providers, first responders a majority of them actually weren’t doing chest compressions as well as they should have been doing chest compressions. The depth and the recoil part weren’t coming up high enough and a number, so we are now training both the firefighters and the paramedics with mannequins and we help to fund those mannequins for the paramedic program, actually the high CPR was the one most visible elements of the resuscitation academy that goes out to other communities in a really big way.
Me: Is there a way I could find any of those studies?
Jan Sprake: Yes. I will send you a list just basically what it has is the investigators name and the title and their study and the year that we funded them. And then you can go and do some research and if you find any information in particular that you are interested in just email me because I may have their reports that I can send you.
Me: How do you think Medic One has impacted the Seattle and King County area, and do you think it has impacted the EMS systems of other regions of the country or world?
Jan Sprake: It most definitely has and that’s why we have people come from all over the world to visit here and they come over and over and over again. We have a contingent from Japan that comes every couple of years. It’s, again, certainly through the research. There’s not a lot of places that are devoted to EMS research still, there is a lot of research given to cancer, certainly breast cancer, but there are a greater amount of cardiac arrest victims in the world, it’s one of the biggest killers. It’s huge, but there’s a real void of funding around research. And really the first line of defense for cardiac arrest is going to be in the field. So unfortunately they are not spending much money on doing that. I read this one article that said, and this has always stuck with me was; essentially the number of people that die every day from cardiac arrest is the same number that would be found on a 747. And it said; imagine the outrage of people if a 747 were crashing every day. To me that’s just so incredible. It’s just a huge visual, and I actually went back and I said “ok, how many people can fit on a 747?” And they were right, it’s like a 747 crashes every day! And so it’s unusual that as an organization, we do fund. We don’t spend a lot of money on it, but we provide that seed money support up and coming young researchers or investigators that have this idea that the kind of want to test so we give them a little money to test the idea and if they come away with data that looks sustainable or has value to it, then they can go to national funding for that. We are looking at possibly designing an innovation in pre-hospital emergency care research award that would go national for the first time so I’m excited about that. But certainly through our research. Now to answer your question, how do I think it impacted us? Yeah probably through the research and certainly through training. Because not only does it save more lives here, and it’s not just in cardiac arrest, there are skills that if you can bring someone back from being dead, then you’re probably going to be very skilled in trauma as well. So it’s just amazing, absolutely amazing. I don’t know if you’ve ever had a chance to see them, do a ride along or anything like that?
Me: I’ve been in an ambulance before, but I don’t think it was a medic one ambulance. And I was the patient, so it doesn’t really count. Where does the Medic One Foundation get their money, and what do they use it for?
Jan Sprake: Most of our money comes from individuals. They come from a group of individuals probably a lot of them have served at some point in time or their family members have been served and they are grateful for that. That’s probably our strongest supporter. I looked at it last night, about 4% comes from corporations and businesses which is typical of non-profit. Our individuals are probably 90% of our income, just from individuals in the community. We don’t get any federal funding, we don’t get any local funding as well, and we don’t have any program service were we get feedback for service. It’s just purely donations. We raise about $2,000,000 a year. And all of the goes back into the program, the research and training.
Me: What are the most funded or difficult to fund parts of Medic One?
Jan Sprake: Quality assurance definitely. Pretend you’re talking to a donor. Couldn’t you describe paramedic training if you knew more about the program? Would it be easier to describe? And you could actually probably take them to a drill and show them. And you can also, there is skills in intubation, I think we have 98% intubation first time try, highest in the country. So you could show them your skills as tangibles, you could show them the equipment grants that we do. We do a modest number of equipment grants, and it’ mostly to communities, like your community would be a rural community that doesn’t have a large tax base, so we go through a funding cycle with grants and fire departments can submit for equipment when they need like a jaws of life, or stretchers or training mannequins. You can point to that to a donor and that would be something tangible. Research you can probably demonstrate pretty easily, but quality assurance is really a hard concept because people don’t really make the connection that if you don’t know how well you’re doing, then how can you improve. And quality assurance is about really the measurement of how well you’re doing, and so is our training resulting in higher survival rates. And that’s our only measurement on the quality of our EMS system other than survival rate for sudden cardiac arrest.
Me: Is it possible that medic one can improve on what is already a very well-oiled program and increase survival, and how could the foundation assist this even further?
Jan Sprake: Did mickey not tell you of his goal of 75%?
Me: I don’t think he did.
Jan Sprake: Probably through more research, and just continue to make sure that the paramedic training program remains intact, kind of the quality of that training program. And I think definitely through research. The other thing we are looking at is implementing, I don’t know if you know of or have heard of, pulse point?
Me: I haven’t heard of that.
Jan Sprake: So on your iPhone you can go to pulse point foundation and download an app. There is a pulse point app and an AED app that they have with it. It is being implemented all over the country, fire departments all over the country are using it. Let me back track, so how would it increase survival rate in the community. Higher citizen cpr rate, right now probably 60%, if it’s a witnessed cardiac arrest, then you have what 4 minutes before the first responders get there and then 6-8 minute before the paramedics get there. So within those 4 minutes, you need somebody doing cpr and if possible you need to do an AED. I think there’s about 4000 AED’s is what they said is in the Seattle King County Area, but that’s not public knowledge. There are registries, but they are registries that the health department and Seattle keep. But when a dispatch call come in, at this point we don’t have a mechanism that alerts somebody that an AED is one floor up or over or what-ever. So what pulse point does is it ties us in to the dispatch center’s computer system and it’s an app so if you downloaded the app, and opted in saying yes I would take a notification that if there’s a cardiac arrest I would respond and administer cpr. So when that cardiac arrest comes into the dispatch center, the minute the EMS team and the ALS team are notified then that goes out to those individuals that opted into the app within a quarter of a mile of the cardiac arrest victim. So you get an alert and it would tell you exactly where the patent was and it would also show you a photo of the AED and where the AED is. So that is something we are looking at, the foundation of implementing county-wide in the next 6 months. And hopefully that might bump up the survival rate as well.
Me: Is it possible to find the statistics of early Medic One through modern showing cardiac arrest survival and performance.
Jan Sprake: Showing survival rates?
Me: Yes.
Jan Sprake: I think I can dig them up for you. I have seen it in my 14 years bump from 46% up to 62%. Which is a pretty significant survival rate. I think I can find those.
Me: Does the foundation have an archive with picture or anything like that?
Jan Sprake: We do, kind of jumbled into a box. What are you looking for, old pictures?
Me: Just pictures to put on the website, data, just things I can include in my website.
Jan Sprake: When is your deadline?
Me: March
Jan Sprake: is it ok if I could get them to you two weeks from now? We are kind or in a big crunch right now. What kind of pictures are you looking at?
Me: A variety of things. Individuals certainly, Dr. Cobb, Dr. Copass some of the early leaders. Pictures of the early ambulances, early responders, trying to get a sense of the history. I think the way I’m setting it up is there’s going to be a history, then I will go into what is being practiced more modern, then the impact of Medic One worldwide. So anything along those lines will help significantly.
Jan Sprake: Ok, I will look around.
Me: Are there any cities that have come to Seattle and implemented what Seattle has as best they can in the nation?
Jan Sprake: San Francisco came up a few years before I was here and tried to create a foundation and the infrastructure that we have her, and they didn’t succeed at it. There are cities that have come up through the resuscitation academy that were starting to get reports of their survival rates improving. So you can talk to Dr. Eisenberg about that and he will be able to point you to couple of those examples to show you that we are having significant impact on other communities.
Jan Sprake: So you know Leonard Cobb’s name?
Me: Yes
Jan Sprake: And you know Chief Gordon Vickery’s name?
Me: Yes
Jan Sprake: So, when they started the project back in 1969, when they first started it was a research project that they put together to see if they could in fact, teach light people to do what a physician could do in the field. And that project you probably know was federally funded, it was a three year grant. And so halfway through, that grant was stopped. So they didn’t have enough money to complete the three year grant. So they went to the community in a really big way, Chief Vickery and Dr. Cobb. And it became just a huge grass roots effort. Kids your age were collecting coins, barber shops were giving haircut discounts for and raising money that way, but people just rallied tremendously because they knew that they were seeing results, that lives were being saved. So they wanted to keep it alive, the city wouldn’t pick it up. Actually the city wanted to bring in a private ambulance company. So the community raised more than they needed to keep the project going and actually the money kept coming in. So with that money, Dr. Cobb decided to set up a foundation, and do what he thought he hoped for and actually came to fruition would be to, through the private funding it keeps it out of the realm of a political decision how much money to spend on training or research or quality assurance, and it keeps it medically focused. So that would insure that it would always be a medical program and not a fire department driven program, or a political or private program. So that’s why he started the foundation. That was in 1974.
Me: How has the foundation impacted the progression of the Medic One program?
Jan Sprake: Tremendously. Probably what I could give you is the history, since when we first started doing research projects. The bulk of it has been in two areas or three areas. Research has had a tremendous impact, if you go back to the early 70s and even into the early 80s and look at what the foundation money was used to look at new and innovative ideas on how pre-hospital emergency care is delivered in the field. And it looked at a variety of things from different kinds of shock waves to whether or not firefighters could be taught how to defibrillate in the field and if that had any significant impact, what is the role of AED’s, we’ve become more sophisticated in our research as times have changed, to know funding, we were the ones that funded the pre hospital emergency care hypothermia. So this has been going on for the last 8-9 years and has just come to conclusion. And now looking at whether or not a device can be developed that when you do CPR on an individual and you have to stop the compression and for the defibrillator to be able to read the rhythm of the heart and this new devise is potential that it could read the rhythm of the devise while compressions continue. Because we found that, actually one of our research projects as well helped Dr. Cobb and his cohorts discover that if you limit the time you stop resuscitation compressions to less than ten seconds, then the survival rate goes up. So over the years we have had a tremendous impact not only locally but internationally through our published research. And that research has been funding faculty members from children’s hospitals in the University of Washington and Harvard. And then on the training side, we have through private funding, we provided the funding o allow us to demand more of our students than any other training programs in the country. Again it’s medically focused, it’s unlike any other program in literally the world. I don’t know, have you talked to anybody about the training program yet?
Me: I know a little bit about the training program, I learned about the hours from Dr. Eisenberg.
Jan Sprake: So that private funding allows them to have the number of those hours, you know two times the national average. Three times the number of patient contacts over the national recommendation. So without that private funding I think it would probably be like any other typical paramedic training program across the country, and so through that. And then you do the research you come up with innovative new ways to deliver care in the field, you train the students in the field how to deliver that innovative care, and then you review and look at how they are performing in the field, and that’s what we call quality assurance. So we have funded that through the Seattle Fire Department for the last 40 years as well. So it is an incredible circle of innovation and constantly improving. And that’s how I think the foundation has had such a significant impact both locally but I think you have to look beyond that because, did Dr. Eisenberg tell you about the resuscitation academy?
Me: He did.
Jan Sprake: We funded him to help him get that project as well, as a pilot project, up and running. The things we do here locally, now impact EMS systems around the world. By giving them toolkits that they can take to their communities. And implement it, they may not be able to implement everything, but they can implement part of our system. So we are having impact not only locally, but internationally.
Me: Where did the Medic One name come from?
Jan Sprake: So, you see engine one, engine two, engine 10. So they just have numbers engine one, engine two, engine three, engine four. So it was medic one, and it just stayed medic one. So everyone now there is medic one program at Bellevue Fire Department, Shortline fire department, I don’t know if Bainbridge is medic one, but that is how it started.
Me: My understanding is that the Medic One Foundation has funded some of the studies coming out of Medic One, what do you feel are the most important studies that the foundation has funded?
Jan Sprake: I think, probably the study around community CPR in the beginning, so we helped to fund that. I think the one that has had the most recent impact is the high performance CPR. Again it goes back to doctor Cobb funding, it may have been Tom Ray, out of King County, I would have to look it up, looking at chest compression only CPR and limiting the number of minutes that you don’t do CPR and that has been, in the 14 years I have been here, that has resulted in the most significant increase in survival. Hypothermia, basically the result after that national study came back it showed that there was really no difference. So I guess that’s either good or bad. Dr. Cobb always points to amiodarone back, and now they’re doing a new study on amiodarone and I think they delivered it after the shock before and now they are trying to see what happens when giving it prior the shock, so I don’t know how that result will come, but probably around the CPR component. And way back when, and more recently that lead to the high performance CPR training. So they actually really shifted the way that the providers in the field did their CPR. A.A Chackie Mat a couple of years ago published a study saying that providers, first responders a majority of them actually weren’t doing chest compressions as well as they should have been doing chest compressions. The depth and the recoil part weren’t coming up high enough and a number, so we are now training both the firefighters and the paramedics with mannequins and we help to fund those mannequins for the paramedic program, actually the high CPR was the one most visible elements of the resuscitation academy that goes out to other communities in a really big way.
Me: Is there a way I could find any of those studies?
Jan Sprake: Yes. I will send you a list just basically what it has is the investigators name and the title and their study and the year that we funded them. And then you can go and do some research and if you find any information in particular that you are interested in just email me because I may have their reports that I can send you.
Me: How do you think Medic One has impacted the Seattle and King County area, and do you think it has impacted the EMS systems of other regions of the country or world?
Jan Sprake: It most definitely has and that’s why we have people come from all over the world to visit here and they come over and over and over again. We have a contingent from Japan that comes every couple of years. It’s, again, certainly through the research. There’s not a lot of places that are devoted to EMS research still, there is a lot of research given to cancer, certainly breast cancer, but there are a greater amount of cardiac arrest victims in the world, it’s one of the biggest killers. It’s huge, but there’s a real void of funding around research. And really the first line of defense for cardiac arrest is going to be in the field. So unfortunately they are not spending much money on doing that. I read this one article that said, and this has always stuck with me was; essentially the number of people that die every day from cardiac arrest is the same number that would be found on a 747. And it said; imagine the outrage of people if a 747 were crashing every day. To me that’s just so incredible. It’s just a huge visual, and I actually went back and I said “ok, how many people can fit on a 747?” And they were right, it’s like a 747 crashes every day! And so it’s unusual that as an organization, we do fund. We don’t spend a lot of money on it, but we provide that seed money support up and coming young researchers or investigators that have this idea that the kind of want to test so we give them a little money to test the idea and if they come away with data that looks sustainable or has value to it, then they can go to national funding for that. We are looking at possibly designing an innovation in pre-hospital emergency care research award that would go national for the first time so I’m excited about that. But certainly through our research. Now to answer your question, how do I think it impacted us? Yeah probably through the research and certainly through training. Because not only does it save more lives here, and it’s not just in cardiac arrest, there are skills that if you can bring someone back from being dead, then you’re probably going to be very skilled in trauma as well. So it’s just amazing, absolutely amazing. I don’t know if you’ve ever had a chance to see them, do a ride along or anything like that?
Me: I’ve been in an ambulance before, but I don’t think it was a medic one ambulance. And I was the patient, so it doesn’t really count. Where does the Medic One Foundation get their money, and what do they use it for?
Jan Sprake: Most of our money comes from individuals. They come from a group of individuals probably a lot of them have served at some point in time or their family members have been served and they are grateful for that. That’s probably our strongest supporter. I looked at it last night, about 4% comes from corporations and businesses which is typical of non-profit. Our individuals are probably 90% of our income, just from individuals in the community. We don’t get any federal funding, we don’t get any local funding as well, and we don’t have any program service were we get feedback for service. It’s just purely donations. We raise about $2,000,000 a year. And all of the goes back into the program, the research and training.
Me: What are the most funded or difficult to fund parts of Medic One?
Jan Sprake: Quality assurance definitely. Pretend you’re talking to a donor. Couldn’t you describe paramedic training if you knew more about the program? Would it be easier to describe? And you could actually probably take them to a drill and show them. And you can also, there is skills in intubation, I think we have 98% intubation first time try, highest in the country. So you could show them your skills as tangibles, you could show them the equipment grants that we do. We do a modest number of equipment grants, and it’ mostly to communities, like your community would be a rural community that doesn’t have a large tax base, so we go through a funding cycle with grants and fire departments can submit for equipment when they need like a jaws of life, or stretchers or training mannequins. You can point to that to a donor and that would be something tangible. Research you can probably demonstrate pretty easily, but quality assurance is really a hard concept because people don’t really make the connection that if you don’t know how well you’re doing, then how can you improve. And quality assurance is about really the measurement of how well you’re doing, and so is our training resulting in higher survival rates. And that’s our only measurement on the quality of our EMS system other than survival rate for sudden cardiac arrest.
Me: Is it possible that medic one can improve on what is already a very well-oiled program and increase survival, and how could the foundation assist this even further?
Jan Sprake: Did mickey not tell you of his goal of 75%?
Me: I don’t think he did.
Jan Sprake: Probably through more research, and just continue to make sure that the paramedic training program remains intact, kind of the quality of that training program. And I think definitely through research. The other thing we are looking at is implementing, I don’t know if you know of or have heard of, pulse point?
Me: I haven’t heard of that.
Jan Sprake: So on your iPhone you can go to pulse point foundation and download an app. There is a pulse point app and an AED app that they have with it. It is being implemented all over the country, fire departments all over the country are using it. Let me back track, so how would it increase survival rate in the community. Higher citizen cpr rate, right now probably 60%, if it’s a witnessed cardiac arrest, then you have what 4 minutes before the first responders get there and then 6-8 minute before the paramedics get there. So within those 4 minutes, you need somebody doing cpr and if possible you need to do an AED. I think there’s about 4000 AED’s is what they said is in the Seattle King County Area, but that’s not public knowledge. There are registries, but they are registries that the health department and Seattle keep. But when a dispatch call come in, at this point we don’t have a mechanism that alerts somebody that an AED is one floor up or over or what-ever. So what pulse point does is it ties us in to the dispatch center’s computer system and it’s an app so if you downloaded the app, and opted in saying yes I would take a notification that if there’s a cardiac arrest I would respond and administer cpr. So when that cardiac arrest comes into the dispatch center, the minute the EMS team and the ALS team are notified then that goes out to those individuals that opted into the app within a quarter of a mile of the cardiac arrest victim. So you get an alert and it would tell you exactly where the patent was and it would also show you a photo of the AED and where the AED is. So that is something we are looking at, the foundation of implementing county-wide in the next 6 months. And hopefully that might bump up the survival rate as well.
Me: Is it possible to find the statistics of early Medic One through modern showing cardiac arrest survival and performance.
Jan Sprake: Showing survival rates?
Me: Yes.
Jan Sprake: I think I can dig them up for you. I have seen it in my 14 years bump from 46% up to 62%. Which is a pretty significant survival rate. I think I can find those.
Me: Does the foundation have an archive with picture or anything like that?
Jan Sprake: We do, kind of jumbled into a box. What are you looking for, old pictures?
Me: Just pictures to put on the website, data, just things I can include in my website.
Jan Sprake: When is your deadline?
Me: March
Jan Sprake: is it ok if I could get them to you two weeks from now? We are kind or in a big crunch right now. What kind of pictures are you looking at?
Me: A variety of things. Individuals certainly, Dr. Cobb, Dr. Copass some of the early leaders. Pictures of the early ambulances, early responders, trying to get a sense of the history. I think the way I’m setting it up is there’s going to be a history, then I will go into what is being practiced more modern, then the impact of Medic One worldwide. So anything along those lines will help significantly.
Jan Sprake: Ok, I will look around.
Me: Are there any cities that have come to Seattle and implemented what Seattle has as best they can in the nation?
Jan Sprake: San Francisco came up a few years before I was here and tried to create a foundation and the infrastructure that we have her, and they didn’t succeed at it. There are cities that have come up through the resuscitation academy that were starting to get reports of their survival rates improving. So you can talk to Dr. Eisenberg about that and he will be able to point you to couple of those examples to show you that we are having significant impact on other communities.