February 06, 2016
BCAS: How did we get here?
In the mid 1960’s the Heart Lung Resuscitator (HLR) was introduced to many North American ambulance services. This piece of equipment ran on 50 or 90 PSI of an O2 tank. The machine was said to dramatically improve the person’s chance of survival in a cardiac arrest. Well that was the sales pitch in the brochure.
In the 60’s and opportunity to have a piece of equipment that your competitor did not increased the chance of finding more people who would call your service. Of course there were ambulance operators who truly wanted to improve patient care and increase a person’s chance of survival. In 1967 this piece of equipment was in excess of $1500.00, so this was a big chunk of change to a small operator, and hence not that many services acquired this machine. One service in Calgary, Alberta called Universal Ambulance Service bought a couple of these units. The largest private ambulance service west of Toronto was Metropolitan Ambulance Service of Vancouver B.C. The company was very progressive in training, and passionate about improving patient care, so they invested in this new technology.
The concept was good, but the unfortunate design flaws did not allow the machine to function in a manner that really gave a patient more chance to survive than CPR. It did look very impressive when dragged onto a scene. It whizzed, it banged, it blew and it looked very futuristic, and very technical. Like many good ideas in the early days of EMS, the machine was introduced without much research. The following commentary on this device, and the E&J Resuscitator was part of a presentation at an EMS Expo Conference. The presentation was by Michael (Mike) Smith BSc, MICP. Mike has been the lead instructor for the Paramedic Program at Tacoma Community College in Tacoma, Washington for twenty years. Mike is one of the most sought after speakers at local, national and international EMS conferences. Mike has been in the EMS profession for over 30 years.
With no real control over the development and implementation of equipment, we embarked on a trial and error process to expand the contents of our toolbox. One of those tools was the E&J Resuscitator—literally a hard shell suitcase with about fifty pounds of ventilator inside that you unceremoniously humped on to your patient. Once applied, it over ventilated patients almost instantly—to the point of inflating the stomach—resulting in the patient vomiting, which the E&J then blew down into the patient’s lungs. As an old-dog physician once told me, ‘For patients who were going to die from a cardiac problem anyway, the E&J Resuscitator shortened the period of suffering, bringing about the patient’s demise quickly’.
Another loser was the HLR, or the heart and lung resuscitator. A plastic wedge was placed under a cardiac arrest victim and strapped over their shoulders, fixing the straps onto little pegs. When it was turned on, the first two or three compression’s blew out the costochondral cartilage and then the HLR really got going. If you weren’t smart enough to stop and re tighten the straps securing the device, the HLR would bounce around and pretty much loose all intended effectiveness.