McDonald's Last Tribute to Emergency Medical Care
Published in the Press Democrat on Sunday, October 15, 2000
Editor's Note: The day before he was killed in a plane crash, Dr. John McDonald, longtime champion of emergency medical care in Sonoma County, was drafting a letter to Press Democrat columnist Gaye LeBaron. He was responding to colleague Dr. Scott Chilcott, who'd written a letter, printed in LeBaron's column, thanking an emergency medical team for saving his life after cardiac arrest. Colleagues who shared McDonald's letter noted that his tribute to pioneers in emergency health care omitted one name -- John L. McDonald.
Dear Gaye,
As you might imagine I read with interest your column of September 21, 2000, which featured the letter from Dr. Scott Chilcott.
Frankly, it is somewhat difficult to imagine Scott being unconscious because I have never known him not to have a wry comment about prevailing events. One can almost envision Scott directing the paramedic as to the proper method of placing the tube in his trachea.
Which brings me to the point of writing to you. Scott gave credit to the physicians and many others who helped to "bring him back from the dead." The paramedic and EMT who "deftly'" placed the tube in his trachea to assist his breathing and who applied the electrodes to his chest so as to transmit energy to his fibrillating heart, also deserve credit. They are Eric Kozlowski and Greg Gizza, respectively.
But more to the point, we should reflect on the giants in the history of resuscitation who provided Kozlowski, Gizzi, Dr. Joel Erickson, Dr. Peter Chang-Sing and others with the tools and knowledge necessary to bring Scott back to life. Having learned from your columns of your considerable interest in history I will provide you with some historical snapshots of the history of human resuscitation, which I believe you will find of interest.
Let's rewind the clock. The year is 1946. Dr. James Elam is an anesthesiologist in Minneapolis, Minnesota assigned to the Polio Ward. A nurse rushes in with a gurney, and as Jim later told the story, the kid on it was blue. "I went into total reflex behavior, stepped out into the middle of the corridor, stopped the gurney, grabbed the sheet, whipped the mucus off his mouth, tilted his head back, took a big breath, sealed my lips around his nose and inflated his lungs.'" Thus was born artificial respiration, at least in modern times.
Four years later, 1950, in Boston (my home city), Dr. Paul Zoll of the Beth Israel Hospital builds a primitive defibrillator to apply electrical current to a fibrillating heart, a technique which he conjectured might result in the resumption of a organized heart rhythm. He does and it does, but many years elapsed before his idea is embraced by his skeptical medical colleagues. In other words he suffers the typical fate of the inventor.
Let's fast-forward to 1960 to the lab of electrical engineer, Dr. William Kouwenhoven, at Johns Hopkins Hospital in Baltimore, Maryland. Dr. Kouwenhoven, a retired engineer, has been retained by Baltimore Edison to research a method of resuscitating linemen who where inadvertently electrocuted. Working with Kouwenhoven in his lab is Dr. Jim Jude, a cardiac surgery resident and an electrical engineering graduate student, Guy Knickerbacher.
While working on their research project, Jude and Knickerbacher note when they press the defibrillating paddles firmly on the chest, as they prepare to pass an electrical current across the chest wall there is a distinct indication on the monitor of forward blood flow. From this observation, the two scientists hypothesized that by rhythmically compressing the chest, they might be able to "pump"' blood and oxygen to the brain.
Thus the elements were in place. It is possible to ventilate the lungs by tilting the head back and breathing expired air, either mouth-to-nose or mouth-to-mouth. It is practical to apply an electrical current to the chest with the intention it be transmitted to the heart to re-establish an organized rhythm, and it is possible to "buy'" time waiting for that electrical current by compressing the chest and moving blood to the brain and other vital organs. Modern CPR and defibrillation were now in place; their implementation in hospitals followed in the 1960s and 1970s.
But one more step was necessary to bring these scientific advances to the Montecito Health Club where the incident occurred and to Dr. Scott Chilcott.
Dr. J. Frank Pantrigde, a physician at Royal Victoria Hospital in Northern Ireland, decided it was "not enough" to apply the principles applied by Dr. Elam, Zoll, Jude, Knickerbacher, and others, only in his emergency department. In 1975, Dr. J. Frank Pantrigde and his colleagues developed the first mobile intensive care unit, sending physicians and nurses into the streets of Belfast with these life-saving techniques.
This closed the loop in terms of the capacity to restart hearts described by Dr. Zoll as, "too good to die."
On December 30, 1977, we were able to institute mobile intensive care units, termed in vernacular, "Paramedic programs" to Sonoma County. Hundreds, perhaps thousands of lives, including Scott Chilcott's, have been saved as a consequence.
We owe to pioneers like Jim Elam, Paul Zoll, Jim Jude, Guy Knickerbacher and all the others in the chain of survival our deepest gratitude for having provided us with the fruits of their diligent, perseverant labor.
I have been fortunate enough to spend time with each of the above and they would be the first to say, as did Isaac Newton, "I have stood on the shoulders of giants," without whose research over the centuries they could not have been successful in bringing together all the necessary elements to save so many lives.
In closing, it is of interest to note the device which transmitted the electrical current to Scott's chest is termed "The Zoll," a fitting tribute to an intellectual giant who died in 1998 at the age of 87, still pursuing his scientific endeavors in his quiet, unassuming, resolute manner.
Sincerely,
Dr. John L. McDonald
Santa Rosa
