Dr. Eisenberg: I am the medical director for the King County
EMS.
Me: How were you first involved in Medic One?
Dr. Eisenberg: I became involved in 1978. Even before there
was a Medic One in the county. The city began in 1970, Bellevue started in
1973, Redmond in 1975, and the rest of the county in 1979. I came here to implement it in the rest of the
county.
Me: Why do you think medic one was so successful early on?
Dr. Eisenberg: Well there is no easy answer, but there are
several reasons that stand out.One is
the leadership provided by Dr. Leonard Cobb and Dr. Michael Copass. And also
the fact that the fire department had just the right combination of vehicles to
reach somebody quickly, and a fire department willing to take on a new program
which was paramedics.They were new. So,
fire department, medical leadership, and a city where the Fire Stations were
strategically positioned all over the place so you could reach somebody
quickly.
Me: I understand you knew Dr. Cobb, how did he go about
improving Medic One?
Dr. Eisenberg: He and the Fire Chief got together and
decided this was a program worth trying. He heard about, ambulance people, (they
weren’t called paramedics then), going into a community in a city called
Belfast in Northern Ireland. And they reported a program where they rushed an
ambulance to scene of somebody having a heart emergency. They reported their
finding in a medical journal, Dr. Cobb read that journal and said it sounds
like a pretty good idea.So he met with
the Fire Chief, and together they gave it a try and they applied for and
received some federal grant money, and they had funding to start the
program.The program started in 1970.
Me: How did Medic One progress over time?
Dr. Eisenberg: Well its change, it always changes because
they measure what they do and they try to make it better. So they realize very
early on that CPR was not being started quickly enough. So instead of sending
one vehicle from Harborview all over the city, they sent the closest vehicle at
a fire station to arrive at the scene first, and then the medic unit came a few
minutes later.That doubled their
survival just that simple step.And then
they continued to make improvement. If you look at the survival rate when the
program first began, it was about 14% for one type of rhythm. And now it’s 62%,
so you can see it’s made little tiny changes, sometimes a big change, but the
changes have happened continuously over all that time.
Me: What are, in your opinion, the most important studies
that have come out of Medic One?
Dr. Eisenberg: The importance of bystander in CPR and the
importance of firefighters to do defibrillation, and the importance of highly
trained paramedics.They have the
highest trained paramedics in the world, in this community.
Me: What kind of training do the paramedic go through?
Dr. Eisenberg: It’s
pretty much full time training for a year.They start in the summer and take a lot of basic science courses and
then they start their apprenticeship.They ride on the vehicles for hundreds and hundreds of hours.I think even a thousand hours.And then they start their classroom training
for what they need to learn as a paramedic.So, it’s about 9-12 months of training and it totals 2500 hours and the
national standard for training is about 1100.
Me:Is there any way
I could find some of the studies that Medic One has done?
Dr. Eisenberg:Yes,
you would need to learn how to use PubMed.Just type in some of the key names.Just type in Lenard Cobb or L. Cobb and you will probably see all of the
things he has published.You could by
just reading the titles know what it is about.
Me:What are some of
the biggest challenges that Medic One went through to develop?
Dr. Eisenberg:Well,
very early they had a mayor that didn’t support the program and he wanted to
stop it.And in effect said that your
federal grant has run out and I do not want to support it so…good luck.So they had to raise money to help sustain
the program for a couple of years until the city council and Mayor decided to
support it after all.So there was a
rough patch there early on in the program and it almost went belly up.That was probably the most serious challenge
to the program.Ever since then, meaning
ever since about 1973 onward, it has had tremendous public support.The last vote of the people that live here,
who help pay for it, got an 84% yes vote.That’s an extremely high indicator of public support.
Me:I understand that
the paramedics at one point were heavily influenced by the physicians at
Harborview.When did they become
independent, or did they?
Dr. Eisenberg:Very
early on they had a physician riding with the medics.And that was when the program first
began.They realized that was not
sustainable.It lasted less than a year.By the end of 1970 the paramedics were pretty
much on their own.But they have to call
in for permission to do certain things.So if they encounter situations where someone is very, very sick, they
are allowed to treat immediately and then call in.But, if a person is not that sick where they
are going to die in the next minute, they have to call to the control doctor
and discuss the case. They decide then
what needs to happen.So there is very
close medical direction but they are not physically in the vehicle.
Me:Is there a way I
can find the data for the improvement of the survival rates throughout the
beginning to the current?
Dr. Eisenberg:Yeah,
I don’t think you will find it all on one graph.I have never seen such a slide.So the short answer is no.
Me:Is there a way I
could find the data, just spread out?
Dr. Eisenberg:Yeah
if you look at the early articles of Dr. Cobb you may find some of the early
reports of the early survival rate.That
would be the best idea of where they started.
Me:Is there a
database for pictures of early Medic One or their survival rate?
Dr. Eisenberg:There
are but they are not easily available.The Seattle Fire Department might have some early photos.You would like to be able to find early
photos of the Seattle Medic One program? (Me: Yes)*shows pictures of “Life in the Balance” and
“Resuscitate”*You could write to the
Seattle Fire Department and see if they have any early photos of the Seattle
Medic One vehicle.I’ sure they have
it.The first vehicle was not like the
modern ones.
Me: Do you see any room for improvement in Medic One at this
time?
Dr. Eisenberg:Yes,
of course.That’s the whole purpose of
measuring each event so meticulously. I think that if we could get bystander
CPR to about 100% we will save more lives, and I think if we can spread
defibrillators out into the community we will also save more lives.So that’s really where most of the emphasis
is, we can’t drive any faster, I don’t think we need to train anymore, so it’s
what happens before the fire department gets there is where changes are going
to make things better.
Me:I read the book
Resuscitate, and it mentioned that hypothermia could help with cardiac arrest,
how does that help with cardiac arrest, and could it help?
Dr. Eisenberg:It may or may not help, it’s a little bit
less clear than people used to think. And it’s unclear if you use it how cold
it should go.It used to be for the last
5-8 years they were cooling people to about 33 degrees, that’s about 6 degrees
colder than you are now.And they
compared that to almost normal temperature and they found no difference. So
people are beginning to question, does cold really make a difference? I would
say it’s uncertain at the moment.The
other question is when do you do it? In the ambulance, at the scene or in the
hospital? Right now the best guess is in the hospital if you going to do it. Oh
now to answer your question: no one knows how it works, it just kind of slows
down the process of life and allows the healing process to kick in quicker and
that’s the general how it’s meant to work.
Me: I know that Dr. Copass was very involved in Medic 1, are
you aware if he is still in the area?
Dr. Eisenberg: he has moved to Sequim, he lives up there now
so he retired. Leonard Cobb still comes in to the office once in a while, he no
longer actively working in this job he is in his mid-80s. But he still comes in
and checks on things.
Me: Do you think Dr. Copass or Dr. Cobb would be interested
in any interviews?
Dr. Eisenberg: Dr. Cobb might, Copass is disabled.
Me: Do you know how we would contact Dr. Cobb to ask him?
Dr. Eisenberg: Yeah let me give you hive office phone so you
can message him.
Me:How has the Medic
1 foundation affected communities outside of Seattle?
Dr. Eisenberg: We have visitors from all over the world and
nation parading through Seattle to learn about it. You might want to check a
website called resuscitation academy.org,
that’s what we use to train people from the rest of the country and world we
trained literally thousands of people in the last 6 years. So that was set up
by Seattle, King County and all the names you mentioned Cobb, and the leaders
to make sure that peoplecould come here
and get a consistent message and
consistent things to bring back.So
instead of having an ad hawk put together tour for a day, instead we have a two
day academy where we bring them all to town, free admission and we teach them
all we know inn two days.And that is
intended to have them go back to their communities and implement some of the
things they have learned about what makes Seattle so special.And that has been going on since 2009.There is a lot of information you will find
on that sight.Oh boy a lot of material
on what we teach and why we think it is important.
Me:How does Medic
One and their percentages compare to the rest of the world?
Dr. Eisenberg:If you look at survival from cardiac arrest
nationally, or let’s just talk about ventricular fibrillation it’s about 25%
nationally, and that’s a data base of about a quarter of the nation’s
population because there is no national data base. This is a voluntary data
base which is probably artificially high because you only agree to send your
information because is pretty good.If
it stinks you’re not going to participate in the data base.So 25% is roughly survival from vf, some
cities, large cities in the east like New York and Chicago are 5-6%, and the
last survival rate from Seattle and King County was 62%. SO that’s the highest
in the world.You can’t die in the city,
they just won’t let you!