EMS Hall of Fame: The Pioneers of Prehospital Care—Grace, Page

The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This new series honors these trailblazers. 

William J. Grace, MD

Mobile coronary care in New York City

Frank Pantridge’s novel model of mobile coronary care didn’t take long to spread from Northern Ireland to the U.S. After seeing it in action during a visit to Belfast, William J. Grace, MD, a professor of medicine at St. Vincent’s Hospital, brought the idea to New York City in 1968. It was the first such program in the country. 

While similar U.S. projects used paramedical personnel, Grace used physicians and nurses on his coronary care unit. “Our team responds to the New York City Ambulance Dispatching Agency when a ‘cardiac’ call is announced,” Grace wrote of the program in 1969. “On arriving at the site an electrocardiogram is taken, the monitor is attached to the patient, and an intravenous is begun. Appropriate treatment for arrhythmia may be given by drugs or electrical cardioversion.”¹

The first 161 calls to which the unit responded yielded 41 known or suspected AMI patients and 19 with serious heart disease or who were in congestive failure or paroxysmal tachycardia. Of the latter, three had ventricular fibrillation, and one was resuscitated and survived. Data showed an average time to definitive coronary care of 3.5 hours for patients treated by the coronary care unit vs. 6.1 hours for those receiving routine hospital care. “There is little doubt,” Grace concluded, “that the prompt attention to serious cardiac disease by the [mobile coronary care unit] will result in more prompt alleviation of suffering and serious symptoms in the patients with heart disease than by our present system of delivering the patient to the emergency room.” 

Before his death from cancer in 1977, Grace was a prominent author, lecturer, and editor whose lifetime bibliography included more than 175 papers and editorial appointments on eight medical journals. 

James O. Page

The ‘father of modern EMS’

His 2004 Los Angeles Times obituary described Jim Page as “widely viewed as the most influential proponent of emergency medical services, particularly in fire departments.”² Few figures accomplished more in the advance of American EMS. 

Beginning as an ambulance attendant and firefighter in his native Southern California, Page rose to battalion chief in the L.A. County Fire Department and obtained a law degree. He served as state EMS director in North Carolina and helped lead development of an eight-county system in Western New York. He also famously served as an advisor to the landmark 1970s TV show Emergency!, which helped galvanize public acceptance of and demand for prehospital care. The character of Johnny Gage was named in his honor. 

In 1971 Page was tasked by the L.A. County FD with coordinating the implementation of paramedic services across the county. “Under his command, and with reluctance,” wrote the New York Times in its obituary, “firefighters in Los Angeles County learned to perform cardiopulmonary resuscitation, use heart defibrillators, and administer other emergency procedures, training that has since become common. Fire departments in many cities are now responsible for providing their communities with paramedic services.”³ 

“He helped to take EMS from a fledgling, uncoordinated effort to the beginnings of a true profession,” added Carol Summer, then the publisher of EMS Magazine, which became EMS World. “He made the field more cohesive. He helped to give it direction.”³ 

Page wrote seven books and more than 400 magazine articles and editorials; he and Keith Griffiths also founded the Journal of Emergency Medical Services. Along with partners Doug Wolfberg and Steve Wirth, Page created Page, Wolfberg, and Wirth, the first U.S. law firm devoted exclusively to EMS law. His name graces the International Association of Fire Chiefs’ James O. Page Award of Excellence. 

References

1. Grace WJ, Chadbourn JA. Mobile coronary care unit. Dis Chest, 1969 Jun; 55(6): 452–5.

2. Bayot J. James Page, Advocate of Emergency Services, Dies at 68. New York Times, 2004 Sep 21; www.nytimes.com/2004/09/21/obituaries/james-page-advocate-of-emergency-services-dies-at-68.html. 

3. McLellan D. James Page, 68; Early Backer of Emergency Medical Services. Los Angeles Times, 2004 Sep 12; www.latimes.com/archives/la-xpm-2004-sep-12-me-page12-story.html.

John Erich is senior editor of EMS World. Reach him at john.erich@emsworld.com.