Me: Can we start by having you state your name and current
title?
Dr. Cobb: My name is Leonard A Cobb and I am a physician meritus, which means I am an old physician.
Me: Could you tell me a little be about what emergency response was like before Medic One.
Dr. Cobb: That is a good question. This was in the mid 1960s and there really wasn’t an emergency response at that time. At least not in the sense that we see today. The fire department would respond with an aid car and a ladder truck. CPR was just being invented at the time. So really there was not much of a response. The city did have several ambulance companies but the initial response was from the fire department. Once the patient made it to the hospital we had more resources to treat them. A lot of emergency treatments were just being invented at that time. CPR, coronary care units in the hospital, defibrillators and different medications. There was a physician in Belfast Ireland, Dr. Pantridge. Have you heard of him?
Me: Yes, I have.
Dr. Cobb: Well he came up with the idea of a portable defibrillator. This was the first step in trying to bring hospital care out to the community. It would sometimes be hours before the patient made it to the hospital. In Belfast, they would use a resident with a nurse and medic to go out to the patient. This was in about 1966 or 1967. For the first two years we would have physicians ride in the medic unit. Washington State Law prohibited non physicians from doing a lot of things at that time.
Me: What got you interested in creating an EMS?
Dr. Cobb: I am a cardiologist and a number of things developed around that time. I did not start out thinking about making an EMS, it just seemed to come together. We started by approaching the ambulances and that did not work out well. The fire department was very receptive however. Chief Gordon Vickery was very excited about the idea. He was instrumental in keeping the idea going. It was natural to use the fire department because they were already responding to many of the calls.
Me: Can you tell me about your early interactions with Chief Vickery?
Dr. Cobb: What do you mean?
Me: How did you work together to develop the early program?
Dr. Cobb: Chief Vickery was a huge proponent of Medic One. He was enthusiastic from the very beginning and likely Medic One may not have developed without his support. He was instrumental in bringing the fire department and their resources.
Me: How long was the original grant meant to run for? Or was it just an amount of money?
Cobb: I was thinking about that this weekend. By today’s standards, it wasn’t a whole lot, but it was something. We ran out of money, but I think we had about 300 or $400,000. We paid for the medics, we paid for the vehicle, we paid for the medications. Everything came out of it. We were about 2/3 through- and this is part of Lyndon Johnson’s Great Society- it sort of fell apart for funding. So we had to go to the public and ask for their help, and sure enough a big under issue drive was sent up. People from anywhere responded, barbers responded, there was a lot of support for it. We wanted to raise $100,000, and we raised about $200,000. In retrospect, it was probably a blessing because it did put us into the public’s eye, to let them know that they had to step up to the plate. And it gave us a chance to show that the program did work. All in all it wasn’t a bad thing. At the time it didn’t look like there was great fun in asking for money all the time.
Me: So how did you go to the public? Where there organizations, or where there just adds in the paper?
Dr. Cobb: The newspapers were good to us, most of times it was the P.I. That they would ready totals as to how much money had been raised and radio stations would support the effort so that it was publicized. This was at no cost, we didn’t spend any money surprisingly enough. It was just a novel enough thing, that a bunch of people became big intellectual supporters.
Me: What went into creating your first EMS vehicle, Moby Pig?
Dr. Cobb: Well, we didn’t know what to do. Have you ever seen a picture of it?
Me: Yes.
Dr. Cobb: We thought we would make it outfitted like a hospital coronary care unit. We had some built in electronics, monitoring devices. It was a fine, fine vehicle. And it was a motor home, and you could carry a lot of people if you had to. But anyhow, it was not a very good emergency response vehicle. It cornered pretty well, it would go pretty fast. It had a big oldsmobile engine in it with I think about 450 horsepower in it. But it was just awkward to have around. So it lasted about three years then we put it up.
Me: How was the initial Paramedic Training Program determined?
Dr. Cobb: Wow. DO you know what Topsy is?
Me: No.
Dr. Cobb: Well, Topsy was a person in a children’s story. Topsy would sort of grow without any organization or predestination at all, just grow and become very big. The Paramedic Training Program grew like Topsy. We didn’t know what to do exactly. We went out to the army and saw what they were doing, and it was useful, but of course battlefield are their big thing, and so we don’t have a whole lot of battlefield injuries. It was an eye opener for us all. And it solved a couple of things. One thing was that when we had the doctor on board, there were several reasons why we had to do that. One of them was the state law not allowing us to make any provisions for paramedics. So the stuff that needed to happen couldn’t be done without having some sort of a qualified medial person on the scene. But the more important reason was that was the way they learned. They learned by watching. They learned by helping. And the latter part of the program they learned by doing, much like our medical education works in postgraduate education in the hospital. We did not have a firm idea of what we were going to do. If we had to we would do more class room sessions and maybe some more labs. But I think an experienced driven training program was one of my great contributions. Dr. Copus was the main developer of the paramedic training program. It has been a remarkably successful venture. It is expensive and its cumbersome. But the products that emerge from there are outstanding. So take 10 months full time plus activity for a well trained emergency technician experience of at least 5 years to become medics. They spend a certain amount of time in the hospital, the emergency room, the operating room, coronary care unit, intensive care unit and on the rigs. The time on the rigs depend on the medics to do a lot of the teaching. So they learn by watching, helping and this is the same way medical education in the hospital works.
Me: Seattle’s paramedic system seems more intense than others nationally, does this come from developing the system from scratch?
Dr. Cobb: Yes. I think so. I think it is much easier to start out with nothing and let things develop as best they can as compared to starting a program that is not working. You have to change this and that. It think we had a big advantage, we did not know it, that we did not know what to do. We just tried as best we can. We had a number of blind alleys that we investigated as well.
Me: I realize Medic Two was a very important part of Medic One. How did you go about implementing a project of this scale?
Dr. Cobb: Medic Two was Chief Vickery’s idea. What happened very early on, I think about year 2-4 we noted that we would send out the fire engine with an aid car or a medic unit with an aid car and not everyone in the fire department knew how to do CPR. It was new! It was relatively new about 10 years old. So we got Chief Vickery to have everybody on active duty in the fire department trained to do CPR. They would get their first or majority of their time on an engine or aid car and they would do CPR until the medics arrive. So Vickery one day said to me, “you know, if you can teach fireman to do it in a relatively short period of time. Why not try the general public?” And I could not think of a good answer why not to. And so we started up Medic Two. Again we got a lot of help from the newspapers, radio, free announcements about where to go and how to sign up. It did prove very successful. Probably close to a million people have been trained under the auspices of Medic Two. Someone did a survey, someone in King County EMS, in downtown Seattle looking at what percentage of people were trained in CPR. It was 79%. That is just an enormous number that have had at least some training in CPR. And that caught on, it caught on nationally as well. The American Heart Association Picked it up and has pursued it rather vigorously. So it’s a good program, it has involved the public, made us involve the public in a meaningful way, and we were way ahead of the game.
Me: Could you tell me a bit about Dr. Copass and his impact on Medic One?
Dr. Cobb: Well, Copass was a resident here at Harborview. And he got interested in what was going on in the emergency room, seeing the medics being trained. So he wanted to see if he could help with the training program and some of the supervision as well. So Copass, he was a neurology resident, so not really thought of as emergency medicine. So anyhow, he had just gotten out of the armory and we kind of keyed in on it, so he took over the training program. And we had two or three people running it before that, but Copass really made it go. He put his heart and soul into it, and did a lot of the things we talked about; exponential training, making sure that they saw firsthand what they were going to be dealing with, and received instruction while they were working with the seniors. And this is a development that Copass for 10 years sort of metmorphasized the program that involved him. It’s probably the best training program in the country, if not the world. It is largely Dr. Copass’s business.
Me: Looking back on the entire program, what do you think made the biggest impact on survival?
Dr. Cobb: For cardiac arrest?
Me: Yes.
Dr. Cobb: That’s a god question, but there isn’t any one point. You have to get there quickly to the patient, you have to do the right thing, rapid response, getting the patient incubated, CPR done without interruption, administration of drugs. They all have to be done, and they have to be done quickly, and in an organized way. There isn’t a single thing that you can say, it doesn’t work that way. You can take one thing, you can have a rapid response which is obviously as important as any, but it doesn’t do any good to have a rapid response if nothing useful is done after the people that respond arrive at the scene. This is a natural question, but you have to have everything working this to be affective.
Me: Is there anything you would like to add before we finish up?
Dr. Cobb: Anything new?
Me: Anything you would like to add.
Dr. Cobb: Oh, anything I would like to add! Like, buy low and sell high?
Me: Sure, anything you want to add.
Dr. Cobb: It has been a worthwhile venture, it is certainly here to stay. I think it has been good for the hospital, it has been good for the medical school, it’s been good for the fire department, and it’s been good for the health department. And there is a large number of people walking around who would not have been walking around otherwise. And there is also a large number of people I have taken care of where their pain is relieved and maybe it isn’t so obvious that they had life saving therapy, but they did have a major reduction of morbidity, that is damage. And they took care of, much like a doctor does. Anyhow, I think that it’s been a worthwhile experience, I am glad it’s here to stay. And I think there will be new things that come along that will improve what we do here, some things we are good at, but other things we will have to see.
Dr. Cobb: My name is Leonard A Cobb and I am a physician meritus, which means I am an old physician.
Me: Could you tell me a little be about what emergency response was like before Medic One.
Dr. Cobb: That is a good question. This was in the mid 1960s and there really wasn’t an emergency response at that time. At least not in the sense that we see today. The fire department would respond with an aid car and a ladder truck. CPR was just being invented at the time. So really there was not much of a response. The city did have several ambulance companies but the initial response was from the fire department. Once the patient made it to the hospital we had more resources to treat them. A lot of emergency treatments were just being invented at that time. CPR, coronary care units in the hospital, defibrillators and different medications. There was a physician in Belfast Ireland, Dr. Pantridge. Have you heard of him?
Me: Yes, I have.
Dr. Cobb: Well he came up with the idea of a portable defibrillator. This was the first step in trying to bring hospital care out to the community. It would sometimes be hours before the patient made it to the hospital. In Belfast, they would use a resident with a nurse and medic to go out to the patient. This was in about 1966 or 1967. For the first two years we would have physicians ride in the medic unit. Washington State Law prohibited non physicians from doing a lot of things at that time.
Me: What got you interested in creating an EMS?
Dr. Cobb: I am a cardiologist and a number of things developed around that time. I did not start out thinking about making an EMS, it just seemed to come together. We started by approaching the ambulances and that did not work out well. The fire department was very receptive however. Chief Gordon Vickery was very excited about the idea. He was instrumental in keeping the idea going. It was natural to use the fire department because they were already responding to many of the calls.
Me: Can you tell me about your early interactions with Chief Vickery?
Dr. Cobb: What do you mean?
Me: How did you work together to develop the early program?
Dr. Cobb: Chief Vickery was a huge proponent of Medic One. He was enthusiastic from the very beginning and likely Medic One may not have developed without his support. He was instrumental in bringing the fire department and their resources.
Me: How long was the original grant meant to run for? Or was it just an amount of money?
Cobb: I was thinking about that this weekend. By today’s standards, it wasn’t a whole lot, but it was something. We ran out of money, but I think we had about 300 or $400,000. We paid for the medics, we paid for the vehicle, we paid for the medications. Everything came out of it. We were about 2/3 through- and this is part of Lyndon Johnson’s Great Society- it sort of fell apart for funding. So we had to go to the public and ask for their help, and sure enough a big under issue drive was sent up. People from anywhere responded, barbers responded, there was a lot of support for it. We wanted to raise $100,000, and we raised about $200,000. In retrospect, it was probably a blessing because it did put us into the public’s eye, to let them know that they had to step up to the plate. And it gave us a chance to show that the program did work. All in all it wasn’t a bad thing. At the time it didn’t look like there was great fun in asking for money all the time.
Me: So how did you go to the public? Where there organizations, or where there just adds in the paper?
Dr. Cobb: The newspapers were good to us, most of times it was the P.I. That they would ready totals as to how much money had been raised and radio stations would support the effort so that it was publicized. This was at no cost, we didn’t spend any money surprisingly enough. It was just a novel enough thing, that a bunch of people became big intellectual supporters.
Me: What went into creating your first EMS vehicle, Moby Pig?
Dr. Cobb: Well, we didn’t know what to do. Have you ever seen a picture of it?
Me: Yes.
Dr. Cobb: We thought we would make it outfitted like a hospital coronary care unit. We had some built in electronics, monitoring devices. It was a fine, fine vehicle. And it was a motor home, and you could carry a lot of people if you had to. But anyhow, it was not a very good emergency response vehicle. It cornered pretty well, it would go pretty fast. It had a big oldsmobile engine in it with I think about 450 horsepower in it. But it was just awkward to have around. So it lasted about three years then we put it up.
Me: How was the initial Paramedic Training Program determined?
Dr. Cobb: Wow. DO you know what Topsy is?
Me: No.
Dr. Cobb: Well, Topsy was a person in a children’s story. Topsy would sort of grow without any organization or predestination at all, just grow and become very big. The Paramedic Training Program grew like Topsy. We didn’t know what to do exactly. We went out to the army and saw what they were doing, and it was useful, but of course battlefield are their big thing, and so we don’t have a whole lot of battlefield injuries. It was an eye opener for us all. And it solved a couple of things. One thing was that when we had the doctor on board, there were several reasons why we had to do that. One of them was the state law not allowing us to make any provisions for paramedics. So the stuff that needed to happen couldn’t be done without having some sort of a qualified medial person on the scene. But the more important reason was that was the way they learned. They learned by watching. They learned by helping. And the latter part of the program they learned by doing, much like our medical education works in postgraduate education in the hospital. We did not have a firm idea of what we were going to do. If we had to we would do more class room sessions and maybe some more labs. But I think an experienced driven training program was one of my great contributions. Dr. Copus was the main developer of the paramedic training program. It has been a remarkably successful venture. It is expensive and its cumbersome. But the products that emerge from there are outstanding. So take 10 months full time plus activity for a well trained emergency technician experience of at least 5 years to become medics. They spend a certain amount of time in the hospital, the emergency room, the operating room, coronary care unit, intensive care unit and on the rigs. The time on the rigs depend on the medics to do a lot of the teaching. So they learn by watching, helping and this is the same way medical education in the hospital works.
Me: Seattle’s paramedic system seems more intense than others nationally, does this come from developing the system from scratch?
Dr. Cobb: Yes. I think so. I think it is much easier to start out with nothing and let things develop as best they can as compared to starting a program that is not working. You have to change this and that. It think we had a big advantage, we did not know it, that we did not know what to do. We just tried as best we can. We had a number of blind alleys that we investigated as well.
Me: I realize Medic Two was a very important part of Medic One. How did you go about implementing a project of this scale?
Dr. Cobb: Medic Two was Chief Vickery’s idea. What happened very early on, I think about year 2-4 we noted that we would send out the fire engine with an aid car or a medic unit with an aid car and not everyone in the fire department knew how to do CPR. It was new! It was relatively new about 10 years old. So we got Chief Vickery to have everybody on active duty in the fire department trained to do CPR. They would get their first or majority of their time on an engine or aid car and they would do CPR until the medics arrive. So Vickery one day said to me, “you know, if you can teach fireman to do it in a relatively short period of time. Why not try the general public?” And I could not think of a good answer why not to. And so we started up Medic Two. Again we got a lot of help from the newspapers, radio, free announcements about where to go and how to sign up. It did prove very successful. Probably close to a million people have been trained under the auspices of Medic Two. Someone did a survey, someone in King County EMS, in downtown Seattle looking at what percentage of people were trained in CPR. It was 79%. That is just an enormous number that have had at least some training in CPR. And that caught on, it caught on nationally as well. The American Heart Association Picked it up and has pursued it rather vigorously. So it’s a good program, it has involved the public, made us involve the public in a meaningful way, and we were way ahead of the game.
Me: Could you tell me a bit about Dr. Copass and his impact on Medic One?
Dr. Cobb: Well, Copass was a resident here at Harborview. And he got interested in what was going on in the emergency room, seeing the medics being trained. So he wanted to see if he could help with the training program and some of the supervision as well. So Copass, he was a neurology resident, so not really thought of as emergency medicine. So anyhow, he had just gotten out of the armory and we kind of keyed in on it, so he took over the training program. And we had two or three people running it before that, but Copass really made it go. He put his heart and soul into it, and did a lot of the things we talked about; exponential training, making sure that they saw firsthand what they were going to be dealing with, and received instruction while they were working with the seniors. And this is a development that Copass for 10 years sort of metmorphasized the program that involved him. It’s probably the best training program in the country, if not the world. It is largely Dr. Copass’s business.
Me: Looking back on the entire program, what do you think made the biggest impact on survival?
Dr. Cobb: For cardiac arrest?
Me: Yes.
Dr. Cobb: That’s a god question, but there isn’t any one point. You have to get there quickly to the patient, you have to do the right thing, rapid response, getting the patient incubated, CPR done without interruption, administration of drugs. They all have to be done, and they have to be done quickly, and in an organized way. There isn’t a single thing that you can say, it doesn’t work that way. You can take one thing, you can have a rapid response which is obviously as important as any, but it doesn’t do any good to have a rapid response if nothing useful is done after the people that respond arrive at the scene. This is a natural question, but you have to have everything working this to be affective.
Me: Is there anything you would like to add before we finish up?
Dr. Cobb: Anything new?
Me: Anything you would like to add.
Dr. Cobb: Oh, anything I would like to add! Like, buy low and sell high?
Me: Sure, anything you want to add.
Dr. Cobb: It has been a worthwhile venture, it is certainly here to stay. I think it has been good for the hospital, it has been good for the medical school, it’s been good for the fire department, and it’s been good for the health department. And there is a large number of people walking around who would not have been walking around otherwise. And there is also a large number of people I have taken care of where their pain is relieved and maybe it isn’t so obvious that they had life saving therapy, but they did have a major reduction of morbidity, that is damage. And they took care of, much like a doctor does. Anyhow, I think that it’s been a worthwhile experience, I am glad it’s here to stay. And I think there will be new things that come along that will improve what we do here, some things we are good at, but other things we will have to see.