Me:
Could you please state your full name and title?
Captain Larsen: Jonathan Larsen, I am the captain for Medic One for the Seattle Fire Department. I manage several supervisors and about 70 paramedics.
Me: How long have you been with Medic One?
Captain Larsen: About 30 years in Seattle, but I was trained here a long time ago. And I worked in Thurston County by Olympia for about ten years.
Me: Why do you think Medic One is so successful?
Captain Larsen: Why do I think Medic One is so successful? I would say because of strong leadership an essentially community support and involvement.
Me: What do you think have been the most significant changes over the years that have aided its success?
Captain Larsen: I think careful evaluation and measurement and willingness to try new approaches. So essentially we look very carefully at ourselves, primarily at cardiac arrest, and we measure very carefully, try new things and measure them carefully. We made, not huge leaps, but incremental improvement every year for the past 40 years.
Me: Where are the statistics kept for cardiac arrest?
Captain Larsen: So we have records of every cardiac arrest that has occurred in the city of Seattle outside the hospital since 1970. And those records were originally paper, eventually summarized and put into the databases which is maintained jointly between the University of Washington, who does quality assurance work, and the Seattle Fire Department. So all those records now are essentially in the paper archives or the electronic records and servers.
Me: Who are some contacts I could talk to at the University of Washington I might be able to get those?
Captain Larsen: What are you looking for specifically?
Me: I am just looking for survival of cardiac arrest and what Medic One focusses on, and the changes in survival over the years.
Captain Larsen: So you want longitudinal, or just starting back 40 years ago. It is probably best summarized by a survival curve. We can send that to you, I think so.
Me: Perfect! I am aware that Seattle paramedics have more intense training than any others in the country. Could you describe this training and tell me what they go through?
Captain Larsen: I think you could probably say that our training is more intense, more concentrated, and longer than most places. I don’t know that we could necessarily say that it is more than anybody else. It is essentially a 10-11 month immersion training program. So people who participate in the training program, are assigned from the fire department or EMS agency, they are given to the paramedic training program, and they are trained sort of the way doctors are trained. They are given didactic training where they are given information, classwork sort of material. And then they are given multiple exposures to patients in a variety of settings, in the hospital and the field. Probably the strength of our program is the training and the experience, and the clinical exposure that the students are given. When they start training they really start riding on medic units, working at the emergency room the second day of training. As they gain more information, they are able to utilize it and reflect on it as experience in the field. That continues throughout the training whereas in a lot of places, you go to class for several months and then you have a 300 hour internship, here it is actually so the internship or clinical experience starts right in the beginning. And they have access to most of the resources that a physician in training would, the operating room, the emergency room, the ICU’s and CCU’s and various areas in the hospital, and the children’s hospital.
Me: Were they always trained in the field?
Captain Larsen: Yes.
Me: How have the EMS vehicles changed over the years?
Captain Larsen: Well, the biggest change probably occurred right in the very beginning. I’m looking at a picture, you may have seen it, the vehicle we call moby pig. So in 1969 the when program started training, nobody really knew what a paramedic was. Everybody that was starting sort of made that up as they went, nor did they know what sort of vehicle they had to have. So they essentially built a mobile emergency room. It was a medium sized mobile home essentially, with an x-ray machine and special lighting that you would find in an emergency room. And I think that they quickly learned in the first couple of years that most of that was really extraneous, that they didn’t need such a big vehicle. That changed to a sort of pop up campers, they call them. A van with a hyped up top, and then they moved to the more current model, so essentially a big box attached to the head of a van. The vehicles have gotten more and more sophisticated over time, but those were the real three main changes. It was the first giant motor home, and then a van with an extended top, and that went to the box van. And that has gotten better much in the same way that cars have gotten better over the last 30 years or so.
Me: What do you think the next advancement in Medic One will be?
Captain Larsen: Well most of the advancements, there is no magical solution, so we try and find the most appropriate use of safety in these vehicles. So we drive a lot of miles driving around the city with headlights and sirens on, and create an environment that is as safe as possible for the patient and the provider. So that’s an advancement we are working on right now. We are always trying to find the appropriate use of technology, not just because it exists, but if we use this technology, will it improve survival. That’s really the metric that we try and use, which makes our job easier and improving survival too. So, the vehicles, also looking at new equipment. They are considering the use of mechanical CPR devises in very limited circumstances, typically during transport where it is difficult to safely perform CPR. And there is always the possibility of trying to find the right combination of medications that will help. We have evaluated literally dozens of drugs and strategies over the years, but as it turns out, most of the improvements come from just doing your job better or more efficiently, or even perfectly.
Me: When was dispatcher CPR started?
Captain Larsen: Some version of dispatcher CPR has been around for over 20 years, and we really started evaluating it critically to find out what the best approach to dispatcher CPR is in the 1990’s. At that point in time we evaluated whether it was effective to use just chest compressions over the telephone vs chest compressions and ventilation, which at the time was the model that citizens were taught for their CPR. As it turns out, it is probably easier to teach people chest compressions over the phone, and in fact it is just as good or slightly better for telephone or dispatcher CPR to do compressions only. And that study was basically replicated 10 years later basically with the same result. The Idea has been around for 30 years, it has been practiced routinely for over 20. We are getting better at identifying who needs CPR over the telephone. I think that is the other piece that goes hand in hand. Not just when you tell somebody how to do it, but how to identify the patient who needs it. Because sometimes you don’t know whether somebody has had a stroke, or if they are just sleeping, or if they have truly suffered a cardiac arrest.
Me: Why, in your opinion, does Medic One continue to have the best survival rates in the world?
Captain Larsen: I think our survival rate is up there, I don’t know if at any given year we can say it is the best. I think it is because of the leadership and the same things we talked about in the beginning of the discussion. The idea of looking critically at what we are doing on an ongoing basis. The mantra for that is to measure and improve. If you’re not measuring something, it’s hard to know if you’re improving at it. And literally for cardiac arrest, we measure, record, capture the entire resuscitation literally second by second. We can look at the heart rhythm, we can look at the chest compressions, we can look at the medications we gave, when we shocked the heart, and just careful attention to detail and trying to do a little bit better every day.
Me: How do feel the Medic One Foundation has impacted the program?
Captain Larsen: The Medic One Foundation has been very useful. Back in 1971 or so, the federal grant that allowed Medic One to start and look at the idea that you could train non-physicians to provide medical care, and whether that would make any difference, that grant ended. Essentially the political power, the mayor, said that’s a great experiment but we are not going to give you any money to continue it. So Medic One continued for a couple of years essentially on bake sales, donations, and can drives and things like that. Then eventually it was supported by a tax levy. There was a little money left over from all those bake sales, and that’s what started the foundation. The foundation’s mission is essentially the same as Medic One: they say that they never stop looking for ways to save lives. The way that they help is that they train the paramedics, they pay for the training of the paramedics. So from the fire department, if I send some people to training, I pay their wages through training. But the Medic One Foundation pays for training, so that is critical. They have also been instrumental in the past in supporting the quality assurance, our ability to look at ourselves to evaluate all of these cardiac arrests. And they have provided some small grants to get research projects started. So they have really funded the activities and provided the support that really hasn’t come from the tax payers and from the levy. They complement the system we have in place in the fire department and the city, and they provide the extra things that really make a difference.
Me: Are you aware of any archive that may contain pictures of Medic One in its early years, or maybe paramedics, or EMS vehicles, or anything that gives you an idea of a change over the years?
Captain Larsen: Sure, we’ve got some pictures that we can share with you that would probably help with that.
Captain Larsen: Jonathan Larsen, I am the captain for Medic One for the Seattle Fire Department. I manage several supervisors and about 70 paramedics.
Me: How long have you been with Medic One?
Captain Larsen: About 30 years in Seattle, but I was trained here a long time ago. And I worked in Thurston County by Olympia for about ten years.
Me: Why do you think Medic One is so successful?
Captain Larsen: Why do I think Medic One is so successful? I would say because of strong leadership an essentially community support and involvement.
Me: What do you think have been the most significant changes over the years that have aided its success?
Captain Larsen: I think careful evaluation and measurement and willingness to try new approaches. So essentially we look very carefully at ourselves, primarily at cardiac arrest, and we measure very carefully, try new things and measure them carefully. We made, not huge leaps, but incremental improvement every year for the past 40 years.
Me: Where are the statistics kept for cardiac arrest?
Captain Larsen: So we have records of every cardiac arrest that has occurred in the city of Seattle outside the hospital since 1970. And those records were originally paper, eventually summarized and put into the databases which is maintained jointly between the University of Washington, who does quality assurance work, and the Seattle Fire Department. So all those records now are essentially in the paper archives or the electronic records and servers.
Me: Who are some contacts I could talk to at the University of Washington I might be able to get those?
Captain Larsen: What are you looking for specifically?
Me: I am just looking for survival of cardiac arrest and what Medic One focusses on, and the changes in survival over the years.
Captain Larsen: So you want longitudinal, or just starting back 40 years ago. It is probably best summarized by a survival curve. We can send that to you, I think so.
Me: Perfect! I am aware that Seattle paramedics have more intense training than any others in the country. Could you describe this training and tell me what they go through?
Captain Larsen: I think you could probably say that our training is more intense, more concentrated, and longer than most places. I don’t know that we could necessarily say that it is more than anybody else. It is essentially a 10-11 month immersion training program. So people who participate in the training program, are assigned from the fire department or EMS agency, they are given to the paramedic training program, and they are trained sort of the way doctors are trained. They are given didactic training where they are given information, classwork sort of material. And then they are given multiple exposures to patients in a variety of settings, in the hospital and the field. Probably the strength of our program is the training and the experience, and the clinical exposure that the students are given. When they start training they really start riding on medic units, working at the emergency room the second day of training. As they gain more information, they are able to utilize it and reflect on it as experience in the field. That continues throughout the training whereas in a lot of places, you go to class for several months and then you have a 300 hour internship, here it is actually so the internship or clinical experience starts right in the beginning. And they have access to most of the resources that a physician in training would, the operating room, the emergency room, the ICU’s and CCU’s and various areas in the hospital, and the children’s hospital.
Me: Were they always trained in the field?
Captain Larsen: Yes.
Me: How have the EMS vehicles changed over the years?
Captain Larsen: Well, the biggest change probably occurred right in the very beginning. I’m looking at a picture, you may have seen it, the vehicle we call moby pig. So in 1969 the when program started training, nobody really knew what a paramedic was. Everybody that was starting sort of made that up as they went, nor did they know what sort of vehicle they had to have. So they essentially built a mobile emergency room. It was a medium sized mobile home essentially, with an x-ray machine and special lighting that you would find in an emergency room. And I think that they quickly learned in the first couple of years that most of that was really extraneous, that they didn’t need such a big vehicle. That changed to a sort of pop up campers, they call them. A van with a hyped up top, and then they moved to the more current model, so essentially a big box attached to the head of a van. The vehicles have gotten more and more sophisticated over time, but those were the real three main changes. It was the first giant motor home, and then a van with an extended top, and that went to the box van. And that has gotten better much in the same way that cars have gotten better over the last 30 years or so.
Me: What do you think the next advancement in Medic One will be?
Captain Larsen: Well most of the advancements, there is no magical solution, so we try and find the most appropriate use of safety in these vehicles. So we drive a lot of miles driving around the city with headlights and sirens on, and create an environment that is as safe as possible for the patient and the provider. So that’s an advancement we are working on right now. We are always trying to find the appropriate use of technology, not just because it exists, but if we use this technology, will it improve survival. That’s really the metric that we try and use, which makes our job easier and improving survival too. So, the vehicles, also looking at new equipment. They are considering the use of mechanical CPR devises in very limited circumstances, typically during transport where it is difficult to safely perform CPR. And there is always the possibility of trying to find the right combination of medications that will help. We have evaluated literally dozens of drugs and strategies over the years, but as it turns out, most of the improvements come from just doing your job better or more efficiently, or even perfectly.
Me: When was dispatcher CPR started?
Captain Larsen: Some version of dispatcher CPR has been around for over 20 years, and we really started evaluating it critically to find out what the best approach to dispatcher CPR is in the 1990’s. At that point in time we evaluated whether it was effective to use just chest compressions over the telephone vs chest compressions and ventilation, which at the time was the model that citizens were taught for their CPR. As it turns out, it is probably easier to teach people chest compressions over the phone, and in fact it is just as good or slightly better for telephone or dispatcher CPR to do compressions only. And that study was basically replicated 10 years later basically with the same result. The Idea has been around for 30 years, it has been practiced routinely for over 20. We are getting better at identifying who needs CPR over the telephone. I think that is the other piece that goes hand in hand. Not just when you tell somebody how to do it, but how to identify the patient who needs it. Because sometimes you don’t know whether somebody has had a stroke, or if they are just sleeping, or if they have truly suffered a cardiac arrest.
Me: Why, in your opinion, does Medic One continue to have the best survival rates in the world?
Captain Larsen: I think our survival rate is up there, I don’t know if at any given year we can say it is the best. I think it is because of the leadership and the same things we talked about in the beginning of the discussion. The idea of looking critically at what we are doing on an ongoing basis. The mantra for that is to measure and improve. If you’re not measuring something, it’s hard to know if you’re improving at it. And literally for cardiac arrest, we measure, record, capture the entire resuscitation literally second by second. We can look at the heart rhythm, we can look at the chest compressions, we can look at the medications we gave, when we shocked the heart, and just careful attention to detail and trying to do a little bit better every day.
Me: How do feel the Medic One Foundation has impacted the program?
Captain Larsen: The Medic One Foundation has been very useful. Back in 1971 or so, the federal grant that allowed Medic One to start and look at the idea that you could train non-physicians to provide medical care, and whether that would make any difference, that grant ended. Essentially the political power, the mayor, said that’s a great experiment but we are not going to give you any money to continue it. So Medic One continued for a couple of years essentially on bake sales, donations, and can drives and things like that. Then eventually it was supported by a tax levy. There was a little money left over from all those bake sales, and that’s what started the foundation. The foundation’s mission is essentially the same as Medic One: they say that they never stop looking for ways to save lives. The way that they help is that they train the paramedics, they pay for the training of the paramedics. So from the fire department, if I send some people to training, I pay their wages through training. But the Medic One Foundation pays for training, so that is critical. They have also been instrumental in the past in supporting the quality assurance, our ability to look at ourselves to evaluate all of these cardiac arrests. And they have provided some small grants to get research projects started. So they have really funded the activities and provided the support that really hasn’t come from the tax payers and from the levy. They complement the system we have in place in the fire department and the city, and they provide the extra things that really make a difference.
Me: Are you aware of any archive that may contain pictures of Medic One in its early years, or maybe paramedics, or EMS vehicles, or anything that gives you an idea of a change over the years?
Captain Larsen: Sure, we’ve got some pictures that we can share with you that would probably help with that.