The Woman Who Helped Bring EMS to North Florida

Back in the early 1970s, emergency medical services were just getting started. To that point movement of sick and injured people within the U.S. had been performed largely by funeral homes. But most funeral homes did not have medically trained personnel and carried little, if any equipment for saving lives. It was a time of scoop-and-run when someone was in crisis.

A group of physicians wrote a well-known “white paper” describing the professional prehospital medical services that needed to be established. Many hospitals were eager to take on this challenge, even though it had never been done before. But who would administer these programs? What training would their personnel need? What equipment would they use? How would they communicate with base stations and hospitals? What were the legal grounds surrounding these new services? These and many more questions began to be worked out as ambulance services sprang up across the nation. 

New Environment, New Approaches

In this new and unstable environment, Tallahassee Memorial Hospital (TMH), in Florida’s capital city, was approached by the city and Leon County governments to provide this prehospital service in North Florida. Local funeral homes had been transporting sick and injured people but were willing to turn that service over to TMH. TMH agreed and on August 8, 1972 started the first ambulance service in Tallahassee and Leon County. To lead it hospital bosses chose a woman who had attended the first EMT class at Tallahassee Community College: Marilyn Crook, a 44-year-old mother married to a sheriff’s detective. As one of her classmates and fellow EMS workers, Robbie “Doc” Boissiere, says, Crook had “the maturity and life experience to make the endeavor a success.” She was one of the first, if not the first, female ambulance service/EMS directors in Florida and the U.S. 

After taking the EMT class, each member hired by TMH had to learn how to actually respond to medical calls. Each motor vehicle crash, stroke, shooting, and stabbing was a first, a unique learning experience, and Crook accompanied crews regularly, even as she was learning how to manage this new concept called an ambulance service. 

“She took a group of people with no previous medical experience and turned them into an excellent, cohesive unit, capable of meeting any challenge presented,” says Boissiere. “Marilyn was a natural leader.” 

The First Female Ambulance Director

In addition to helping define the new concept of EMS, Crook also had to contend with a mostly male workforce unused to being directed by a woman. Crook’s friend Julie Holt, a nurse who worked in the TMH emergency room, says, “I think it was difficult for her to be the first female in this role, and some of the guys tested her to see if they could get away with stuff or if she was a pushover. Her supervisors tested her too, but I think she was the right person for this job—she was strong, confident in her knowledge, and would hold her ground and not back down, but in a professional and polite manner.” 

Crook initially directed a staff of 25 EMTs, two of whom were female. Back in those days there was no such thing as paramedics. Managing all the personnel, training, equipment purchases, medical coordination, and more was a gargantuan task. Crook put the patient first and pushed her personnel to do the same. 

The learning curve included stocking each ambulance with appropriate equipment. There was no minimum standard required at the time. She had to establish in-service education before there were guidelines for it and evaluate how field crews were performing on calls. “She was good at logistics, ensuring her people had the correct tools and training they needed to provide the best possible field care,” Boissiere says. “She ensured in-service education before that was even defined.” Each day meant a new challenge in this expanding field in its infancy. 

Management and Mentoring

Crook realized early that she had to take a firm, yet caring attitude toward such a tough profession. She excelled at being a good manager, teaching subordinates how to do the job correctly, yet dealing effectively with the human side of EMS. 

“As time went on I began to recognize how gifted she was working with people, guiding people, leading people, and mentoring people,” says Bobby Bailey, who worked for Crook and eventually took over as EMS director. “One of her strong characteristics was teaching you and giving you the opportunity to develop yourself while she was behind the scenes, coaxing you along. I think a lot of folks who worked for her did not appreciate at the time how much of an influence she was in their lives and careers.”

Crook oversaw expansion of the service from 25 workers to more than 100. New challenges included dispatch systems, systems to track medical calls, medical direction, and interactions with emergency room staff and other agencies. New state and federal requirements began to roll out. New drugs and medical technologies arrived, such as procedures for cardiac arrest, trauma, and pain management. In those days the protocols even included jugular vein access, central lines, intracardiac injections, and pericardiocentesis. It was an exciting and dizzying time to be in EMS—everything was new and somewhat experimental. 

The Human Side of EMS

Crook dealt with difficult circumstances both internally and externally. The new ambulance service was part of the hospital and had to fit into that medical model. While Crook pursued that integration, she had to coordinate with other first responder agencies that had been well established for years and had leaders unaccustomed to working with women. 

“Male domination was even bigger than the number of males working under her and her male bosses,” says Bailey. “It was bigger than that because she was in some respects on parallel with the sheriff, who was a male and had been there for decades; the fire chief, who had been there for over 50 years; and the police chief, who was also a male and had been there for ages. Trying to establish herself as a peer with those folks must have been a challenge. She developed credibility over time, and they came to respect her and recognize the contributions she made.” 

Crook had high expectations for her employees but also recognized the stress of the job and need for a balanced life outside of work. She approached life and work in the same way, with a straightforward manner and an understanding of how important the job was. 

“She was both human, with a husband and kids of her own, and humane in dealing with the trauma that accompanied the vagaries of emergency care both to patients and her crews,” says Boissiere. “She was conscientious in monitoring the emotional health of her staff, taking an individual, almost motherly interest in our lives without prying or judging. Out of the public eye, we called her ‘Mom.’ She seemed happy with that kind of camaraderie. In public we did not abuse this but treated her with the dignity merited by her position and the respect earned by her leadership.” 

It seemed Crook was always working on gaining the respect of her staff, her superiors, other agency leaders, and medical staff. She seemed to excel at that. Although she was all-business when it was needed, she also knew how and when to show her sense of humor. 

“I remember Marilyn having a great sense of humor,” says Holt. “She wasn’t opposed to laughing and letting her hair down when we were slow in the unit. She could be ‘one of the gang,’ so to speak, but could easily go back to her supervising role in an instant if the atmosphere or severity of the patients changed.” 

Crook recognized early that her crew members were human and needed to decompress after difficult calls. Before the time of employee assistance or critical incident stress, she would pull crews aside and gently make sure they were OK. 

“She would pull crew members out of the rotation and just give them time or try to help them through it,” says Bailey. “She had this great culture of positivity—you couldn’t help but feel positive around her because she was such an outgoing person and always saw the positive side of things. I think that helped a bunch of us stay grounded as we worked through the daily grind of EMS.” 

The Qualities of Great Leadership

Bailey describes Crook as someone who could walk that fine line between being just one of the crew, your friend, and a boss. She fostered an environment where professionalism was paramount and encouraged people to grow personally and professionally. Some of the folks around during her time went on to become doctors and attorneys. 

Another quality Crook exemplified was courage. Later in her career HIV/AIDS became an issue. Some were getting infected from the disease, but not much was known at first about how it was transmitted and what effects it had on the body. One day an interfacility transport came in to move a very sick HIV/AIDS patient a great distance. It required both ground and air transport. The patient needed to go immediately, so Marilyn volunteered to transport them despite any possible risk to herself. She showed her staff that if they took the right precautions, they could treat these patients without fear and with confidence. 

Crook worked closely with her medical director, Thomas Bixler, to advance the EMTs working toward ALS certification before courses and formal paramedic training were available. Quickly realizing that saving lives required moving the medicine into the streets, they began adding one advanced procedure at a time. Each medic received individual training on each drug or procedure and was checked off to administer/perform it. Crook and Bixler were responsible for the advent of ALS in North Florida and share credit for saving countless lives over the years. 

Many years later Crook added a helicopter service to the ground service with the same positive and innovative attitude. 

A Fitting Legacy

Says Bailey, “Marilyn was rustling a bunch of cowboys, and we were developing what EMS is today.” EMS was just being hatched as a profession, and Crook understood that every patient encounter was crucial to moving the profession forward. She was an advocate for both patients and those providing care in the field. She knew how to “mother” her crews and yet hold them to a high standard of care. 

“If you could pick someone to work with who was knowledgeable, dependable, and didn’t mind getting their hands dirty right beside you,” says Holt, “Marilyn Crook would be the person you would pick.” 

“Marilyn was genuine, fair-minded, even-handed, knowledgeable, and a patient advocate before it was fashionable,” adds Boissiere. “She advocated for her staff and set the bar in the days when emergency field medicine had yet to be fully defined. She was savvy in her interactions with administration, the press, and other agencies, and as such was well received and well respected. Hers was truly a legacy, a template for those who followed.”  

Mac Kemp, MEd, NREMT-P,  is deputy chief of clinical affairs for Leon County EMS in Florida.