New Worlds: Emergency Medical Services

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If something goes wrong — a fire; a home intruder; but especially for the purpose of this essay, a medical emergency — I know exactly what to do. I’ll pick up my phone and call 9-1-1, the emergency number for the United States. Someone on the other end will send an ambulance full of trained medical personnel, who will administer some aid on-site and then (if necessary) take the patient to the hospital, siren blaring all the way.

There are many reasons to be glad I live in the twenty-first century, but it’s startling to me that if I rewind the clock just fifty-five years — to 1966 — this seemingly obvious and sensible concept would not have been available to me.

Ambulances aren’t a new concept, mind you. Ever since we’ve had transportation, we’ve had the understanding that sometimes you need to load up a patient and take them to the doctor, instead of waiting for the doctor to come to them. Armies pioneered systems for transporting wounded soldiers away from the front; these systems got significantly more organized circa the late nineteenth and early twentieth centuries, thanks to conflicts like the U.S. Civil War and World War I. And if you lived in certain parts of the United Kingdom in the nineteenth century, you might enjoy the services of trained medical staff as you were whisked from home to hospital.

But in the U.S., as late as 1966, here’s what you could look forward to in a medical emergency: either a car sent by the local funeral home, or a police van. They’d supply some rudimentary first aid, but apart from that, you wouldn’t get real medical care until you arrived at the hospital . . . which all too often was too late. (It’s impossible not to think of the ghoulish overtones of funeral home employees being the ones to drive you there.) Not until 1967 did a predominantly African-American organization, the Freedom House Ambulance Service, start up the United States’ first proper paramedic system — the first of many, and desperately needed.

Of course, the effectiveness of an emergency medical service depends first on you having effective emergency medicine. And given the state of the art throughout much of human history, neither trained personnel on site nor swift transport to a physician would have done you much good.

So many things about basic first aid seem screamingly obvious to us, it’s hard to understand how it took so long to figure them out. I’m indebted to The Healing Hand by Guido Majno for laying out in clear terms why — to pick one example — even the notion of stopping the bleeding took a while to develop. It seems clear to us because we already understand what’s going on when someone bleeds: we know about the circulation of the blood (a concept that’s all but incomprehensible prior to the invention of the pump, and that’s only the first of several ideas you need to sort out), the roles of veins and arteries, how clotting works, and more. We know that someone can die of internal bleeding with no obvious outward sign, and that sometime external bleeding is incidental to the actual problem. We have techniques like tying off a bleeding vessel instead of applying a tourniquet to the whole limb, the latter of which only buys you time and will create other problems if left on too long. Humans developed multiple different explanations for what was going on with bleeding, some of which came within shouting range of the mark, others of which went wildly astray, but all of which were based on the observations people were able to make with the technology and ideology of the time. Very few of them did much to save lives.

Or what about cardio-pulmonary resuscitation? First of all, let’s get something out of the way: most of the time, this doesn’t actually restart a person’s heart. (Neither, for that matter, does defibrillation, whatever the movies tell you. That’s for hearts beating with certain kinds of arrhythmia, not hearts that have stopped beating entirely.) While CPR will sometimes restore the pulse, like a tourniquet, it’s mostly about buying time, providing artificial circulation and respiration until something more advanced can be done. But as with stopping blood loss, it presupposes that you already understand how those systems of the body work, that the heart pumps oxygenated blood, and that another person can temporarily supply both oxygen and pumping. Without that understanding, there’s no reason to even think of trying.

Even drowning used to be treated as a done deal. If somebody came out of the water and they weren’t breathing, there was nothing you could do — though in reality, people can be revived after a shockingly long time without air, especially if they were immersed in cold water. The simple technique of shoving air into their lungs with your own lungs didn’t come into practice until the eighteenth century, and even then, William Hawes had to offer a bounty on fresh drowning victims to convince people to bring him patients to demonstrate on. The Heimlich maneuver for removing obstructions from the upper airway of a choking victim is barely older than me . . . though the older method, slapping people on the back while they’re bent over, can work just fine; Henry Heimlich himself is the one who campaigned to persuade everyone that was a bad idea.

I’m not entirely sure how successful we used to be at treating conditions like hypothermia. The general idea of “help the person get warm again” is both obvious and sound, but it doesn’t always work; there’s a complication known as rewarming shock where the victim’s blood pressure drops rapidly, leading to cardiac arrest. For a while it seemed like this was caused by too-aggressive external warming, but that seems to be not the case, leaving us without a good explanation. The opposite condition, hyperthermia, is a little more straightforward: get the patient out of the sun, give them fluids, remove some or all of their clothing, and sponge them down or immerse them entirely in cool water. That one we probably figured out a very long time ago; the obstacle was more likely to be social, as heat exhaustion and heat stroke were common problems among enslaved field workers, whose overseers refused to let them rest. (In fact, they’re still a problem among agricultural laborers today, and their employers are not necessarily any more understanding.)

Many fantasy novels have forms of magic that could at least help get patients more rapidly to a medical facility, but few of them seem to apply it that way — likely for the same reasons that the U.S. didn’t apply the lessons of battlefield medicine to civilian life until 1967. Nobody (in or out of story) has really thought about it, or (in story) if they have, they aren’t willing to fund it. When it comes to first aid, on the other hand, the hurdle ought to be less “what can magic do?” and more “how well do the characters understand the problem they’re trying to solve?” A science-fictional future might look back on our current practices and shake its head in pity, because we don’t understand the body as well as we might, nor have we funded the kinds of measures that might save more lives.

Still and all: I’m glad I live in 2021, not in 1966, for this reason and many others besides.

One Response to “New Worlds: Emergency Medical Services”

  1. Zpc

    C.f. also Abbie Sweetwine, the ‘angel of platform 6’. There’s a lot in there that’s both heart-lifting and also generates chewy worldbuilding thoughts.

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