EMERGENCY MEDICAL SERVICES IN MARYLAND
The origin of all emergency medical services lies in the emergencytechniques of Cardio Pulmonary Resuscitation made possible by thetwo Maryland pioneers in pre-hospital emergency care. In 1958, Johnsphysician Peter Safar published a study in the New England Journal ofevaluated emergency artificial respiration techniques, which at that time,repeatedly raising the arms of the patient over the head to induceSpecifically, Safar investigated the efficacy of the chest-pressure/armcompared to mouth-to-mouth and mouth-to-airway techniques, establishing theoverwhelming superiority of the latter over the former (Safar). At approximately the same time, another Johns Hopkins physician,Kouwenhoven, was engaged in research into the development of effectivedefibrillation equipment, when he noted the dramatic effects of externalapplied to the chest compartment on the arterial pressure. His actualconcerned the application of defibrillation panels on dogs, but during theestablishing the proper paddle pressure, he discovered the value
In total, there are more than thirty thousand certified prehospitalemergencymedical service providers administrated by five regional offices inMaryland. EMT certification requires written and practical exams, a fieldinternshipand affiliation with an approved basic life support or advanced lifesupport company. Baltimore firefighters had received CPR training at Johns Hopkins, which they implementedin thefield, on a patient in full cardiac arrest. Today, theMarylandEMS system is the most advanced emergency medical response system in theU. From it's humble beginnings less than fifty years ago, MarylandEmergencyMedical Services has grown from the two bed Shock Trauma Center establishedbyDr. Approximately seven thousand ofthe mostcritically injured patients are transported to Baltimore's Shock Trauma,alone, theoldest and busiest trauma unit in the state (Newman). A statewide network of EMS dispatchcentersensures immediate coordination between first responders and the appropriatemedicalinstitution for each particular type of emergency (Bass). TwelveMaryland StatePolice Med-Evac helicopters operate from eight bases, handlingapproximately five-thousand acute medical emergency and accident evacuations per year. Recertification is necessary every two years and requires twenty-four hoursofadditional training in the form of approved refresher courses. Communications between ambulances and hospitals isadministrated by the Emergency Medical Resource Center, while SystemCommunications is exclusively dedicated to helicopter evacuation andemergencyTransport of critically ill patients. ofcompressing thechest compartment externally. Specifically, Baltimore's Shock Trauma facility was built around theconceptthat Crowley identified in his research, which he called the Golden Hour,referring tothe first sixty minutes of medical crises, when management of acute shockwasidentified by Cowley to be the single most important determinant of therelativesurvivability of cardiac arrest and other life-threatening medicalemergencies(Rosenwald). The entiresystem is headquartered in a single room in Baltimore, where two mainaspects ofemergency communications and logistics are handled separately, under "EMRC"and"SYSCOM" acronyms. In Maryland, the specific tasks of emergency medical responders arebrokendown into specific designations by assignment and related training andcertificationsrequirements as designated by the Maryland Institute for Emergency ServiceSystem: Emergency Medical Dispatchers are responsible for prioritizing 911calls byinterrogating callers in order to ascertain the true nature of theemergency. Cardiac Rescue Technicians require all the skills of EMT's inaddition tointravenous fluid administration, EKG monitoring,defibrillation/cardioversion, andendotracheal intubation.
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