Popularly credited with establishing the first paramedic program and paramedic service in the United States, the Miami story centers solely around Dr. Eugene Nagel.
During 1964, Dr. Nagel joined the faculty at the University of Miami School of Medicine, while practicing anesthesiology at Jackson Memorial Hospital.
interests were eclectic.
In addition to his
practice as an anesthesiologist, Nagel
immersed himself in the disciplines of cardiac care, CPR, and aquatic studies.
penchant for CPR, Dr. Nagel
was invited to speak at the International First Aid and Rescue Association
meeting in January of 1964.
The meeting was held in Miami Beach, and Nagel was considered to be the local expert on the topic.
Shortly after the meeting, Nagel
went to Miami Fire Station Number One and offered to teach their firefighters CPR.
Soon, all Miami
firefighters were performing CPR in the field.
The Miami Fire Department
had an extensive rescue service that included heavy physical rescue and extrication as well as a team of rescue divers.
soon found that the department's emergency medical training consisted of basic first-aid training.
was convinced that the only way to save cardiac arrest victims was to have firefighters defibrillate at the scene"22 He
recognized the rescue firefighters' skills and abilities with CPR and began to formulate a training program that would train them as "physician extenders".
But first, Nagel would have to convince Miami Fire Department's chief that his men could provide advanced medical care.
This would prove to be a challenge.
had cultivated a good relationship with the firefighters and rescue personnel, but his
rapport with the chief was less than cordial.
later recounted, "I told the fire chief that I wanted to train the guys in defibrillationHe said, This is a fire department, not a hospital; these are firemen and not doctors.
I do not want you to forget that.'"22
By 1967, Dr. Nagel
had caught wind of Pantridge's work in Belfast.
was impressed with the outcomes and assumed that a similar system could work in Miami.
Having to progress slowly due to the chief's objections, Nagel
started with providing pre-hospital telemetry.
Treatment of the patient in the field would center on a portable telemetry unit that would transmit the electrocardiograms (EKG) over existing radio frequencies to the hospital.
Chief Kenney agreed to the telemetry units as they, "seemed unlikely to hurt the patient or embarrass the department."22 Nagel
received $3, 000 from the Florida Heart Association
to develop a telemetry unit his
specially trained firefighters could use.
The only problem was that no such unit existed.
Telemetry devices that were available at the time were able to transmit over phone lines only.
and the Miami Fire Department
needed a unit that transmitted over the radio.
The company Biocom created a sufficient device for the department.
Housed in a wooden milk crate, "The radio unit was a 28-pound Motorola
The Gulton nickel-cadmium battery weighed 11 pounds.
The final design featured a modulator, radio and battery shock-mounted in an aluminum waterproof case to bring the whole unit to a backbreaking 54 pounds.
14 And by March of 1967, Miami's "paramedics" were serving the public and transmitting EKGs to Jackson Memorial Hospital
and company would go on to report extensively on the efficacy of telemetry and mobile physician medical direction23, 24.
At first, the firefighters were not permitted to do anything besides transmit EKGs.
But as Dr. Nagel
slowly made progress with department officials, field personnel were soon permitted to start IVs and administer certain drugs on standing orders.
And, in 1969, the Miami Rescue Unit expanded to three vehicles
, while annual rescue calls rose from 8, 000 to 15, 000.
The next step in the Miami paramedic evolution was the initiation of field intubation.
Nagel, being an anesthesiologist, saw this as obvious.
Chief Kenney, however, was a tougher sell.
Despite the chief's reluctance, Dr. Nagel
trained nine paramedics in the technique, using both practice dummies and cadavers.
was confident with the paramedics' intubation skills, he
set up a demonstration for Chief Kenney and department officials.
recalled the event,
The next morning, Nagel
had permission to let his
paramedics intubate in the field.
Dr. Nagel later went on to become chair of the anesthesiology department at Harbor General Hospital in Los Angeles, California.
continued to advocate for EMS
career, including a six year period in which he
authored a column for the trade magazine Emergency Medical Services
Also, from 1972 - 1980 Dr. Nagel served as chair of the medical advisory committee to the International Association of Fire Chiefs.
22. Eisenberg, M. "Eugene Nagel
and the Miami Paramedic Program.
, E. Hirschman, J. Nussenfeld, S. Rankin, D. Lundblad, E. "Telemetry-Medical Command in Coronary and Other Mobile Emergency Care Systems.
, E. Hirschman, J. Nussenfeld, S. "Mobile Physician Command: A New Dimension in Civilian Telemetry-Rescue Systems.
, E. Hirschman, J. Nussenfeld, S. Liberthson, R. "Prehospital Ventricular Defibrillation.
New England Journal of Medicine.