Lecture right. So last time we talked a little our Public Health so we said today were going a little bit about now the build of ems. Now todays lecture i will say a little bit a hodgepodge of Different Things coming at you. Right. So were going to talk not only about obviously the upbringing and start of, but were going to really talk about also advances in medicine a little bit. And of talk about some of those other things to really kind of set the picture in regards to what that Public Health issue right because we said the Public Health issue essentially last class was what when it came to ems creation, remember what we said. Yeah, i thats okay. So we get like accidents on the road and stuff like that. Exactly right. So again, were going to build on that, talk a little bit more about, you know, essentially how all that stuff started. And so a few things i want to talk about today, right . So obviously going to define ems. What is actual emergency medical . Right. What do we do in basic terms . And then also summarize some of the history of ems. Were talk a brief history, just because obviously that could be a whole semester class if we wanted it to be right. Were identifying the significant events, specific people that helped shape of the core foundations of vms and of the big things that we even still do today. Right. And that also kind of finish of class talking about some o the 15 components essential to ems that again, that they laid out saying, you know, what are probably some of the minimal things needed to even really get into some started in the first place. Okay. So what is ems . So ems a few things, right . So what do we really do . So Emergency Medical Services, what obviously ems stands f all right. But really, at the core function of it, right. At t of the day, were trying to do training brit people, right place, right time, right. And doing the right in and we ems fills the what does that gap do we think . Right. Because what is the gap between initial care and the hospital . Exactly right. So were filling that gap and thats where we tried to do good things with is filling that gap between where the actual incident, injury or illness, whatever it may be occurs and then filling that gap to the hospital. So providing care from start of injury to definitive care, which obviously is then the hospital. Right. And again, we do through a multiple of different ways. Well talk again the advances that kind of came through. But initially we didnt start with all this stuff. Right. And we have fancy helicopters, fancy ambulances, way more fancier equipment than what it used to be. But i talk about some of those things. So were going to go way back in history. And i say way back in history, i say preindustrial era, but want to talk about what existed then and what existed back then. Compared to now, simply put, not a whole lot, right . Really nothing compared to what we have now, right . So back in the day, what did exist were the fact that there was really no general hospital, right . There were no general practitioners, there were no ers, emergency medicine physicians. Right. But what there was were things like arms, houses and city dispensaries where there was naturally a collection of sick people happening. And in those communities. Right. So it wasnt advertised say, hey, if youre sick or whatever, if you need help, come here. It was more so that thats where a lot of them were already populated. Right. So naturally thats where of those initial kind of what we would explain is today is that prehospital care happening. So again outside of hospital. Now in zero formal sense, was that really happening but it was at least some kind of starting point, right . If we had to compare it to something, right, that we talk about resuscitative efforts and always love talking about this slide because whats going on i remember one in the world is going on in pictures right. Ill tell you, these were resuscitative efforts back in the 1530, 1773, 12,ll that stuff. What do we think thats going . What do we thinks going on here comparatively . And some of the techniques we use today. Yeah, its stimulation. Okay. What kind to get the heart and through okay to get the heart pumping so maybe something resembling cpr or Something Like that, right. Chest compressions maybe giving breaths and stuff like that. Anyone know whats happening . This first photo here, anyone would anyone know what this medevice is . Its not medieval by any means, but thats used to cool down like weapons or anything like used in blacksmith shop. So yes, like a way back of the day. So ill say i have one in my house, i have a fireplace. It was that thing that again, its a below, right . So the thing that pushes air into fires, stuff like that to try make it a little bit hotter. Now, whats, whats that being used here for . What do we t ah. What i even put air right now. W effective do you think this is right now . Its essentially putting a fan up someones face and saying, hey, here, hopefully this will help you breathe right . Not super effective. That being, though, we do something very similar now. Right, which are, again, manual ventilations where okay, maybe you need to have a good seal, maybe a little bit better equipment, maybe can hook up some oxygen. Right. So its lot obviously much more advanced and what this is. Right. What about the second picture here . What do we think. Guesses . No, wrong answers. Yeah, yeah, it is some of barrel for sure. What kind of we think. I will say the second picture always kind of is the interesting one, because i truly. I really dont know. Right i had to look it up and apparently it has something to do with they thought back in the day that by rolling s on a barrel, they were pressing the chest. So with pressures, all that it was helping theeart, i dont know, or sucking air into the lungs, so on and such. Bout that last one kind of a two parter here. Yeah, i like that guys like walking over there for like quite while, but its over his, like, kind of chest area. Okay. So two parts of first of all, whats the benefit this move my patient moved my person whos sick or whatever maybe from point a to point b without me carrying them right. The other thing they were trying to do here is apparently, again, a horse is kind of trotting, right . The body was going up and down and that was providing apparently some type of chest compression action. Again, looking at all this stuff. Right. This stuff is very ridiculous compared to what we have now. But again, as a starting point. Right, it was something now i will say and well see if thats video plays. Weve advanced significantly right. Not only in regards to having protocols specifically in place on what medications give what when to give those medications. And also the equipment has gone obviously a lot better than using pillows to try to provide manual ventilation for people right to the point where we actually even have devices where. We have mechanical devices that actually provide chest compressions for you in the hospital and stuff like that. Also in the prehospital setting. Right. So even again, when i first started, we didnt have stuff like this. We were doing manual compressions the entire time. Has anyone ever done cpr before . Right. How exhausting is this . Pretty exhausting. And very, very small person like me. I cant last that long when doing cpr. Right. But guess what . Again, this because im tired. Does that mean i can stop . Absolutely not. Right. So again, stuff like this. So, lucas came out with a device or called the lucas three. This is the third iteration of this device from physio right. Something like this is great because as as the battery is still there, that things just pumping away right at the right rate, right. So, again, super effective, especially in things like medicine or emergency medicine, where yeah, we might have to be doing other things and not use someone to do cpr, right. Also while youre moving around and stuff like that, how effective. Is this not super effective . Right. This again worth making sure that we continuous pause not positive effective right cpr throughout the entirety of that or movement or whatever it may be. Right. So advances in medicine, right. So again, some big ones here. Right. Things like the development general, general anesthesia. Right. Or things like the germ theory. Right. So in 1846, i ballston general hoital, right. Dr. Morton was one of the first ones to actually utilize a form of anesthesia. Right. And back in the day, was it the fancy stuff we have now . Absolutely not. It was essentially just ether gas that they use to knock someone out and that was their form anesthesia. Right. But super effective and also a huge advancement because what could they now theoretically do . They could do, again, a very their form of surgery was. But they could do surgery. Right, which was a huge advance of medicine. And also the fact that you could now so things up or cut things or whatever it may be without someone screaming theyre all theoretically right. So super, super effective and. Also a huge advancement for surgery. And then also the germ theory, 1860s, we discovered that, oh, yeah, germs are actual thing, right . Becae before then what we doing concepts like gloves, right . Washing your hands after dling with patients see here again theyre performing surgery. No ones got gloves, right . Were just doing it right. And obviously then we found out that yeah, thats probably not the best thing to do. Right. And it was causing like infections, which was back in the day, one of the biggest killer people. Right. Things like, infection. Thats why people were dying early. Right. So, again, 1865, antiseptic surgical techniques start to get introduced. Things like penicillin your antibiotics start to get introduced. Also in 1940s, right . So all those things obviously only help Life Expectancy within our patients, which again, were going to talk about causes some other issues as well. Right. Right. So obviously, ems, not about orient emergency medicine, only about treating people, but how do we move people . How do we categorize people . And ill tell you right now theres going to be a theme that you throughout this lecture, that theme, a lot of war theaters, right. Or war settings. Its like right now a lot of advances in trauma, emergency medicine and prehospital really stem from the war setting. Anyone of a thought on why. Theyre deprioritized like if a person has been shot, then it would be safe for us to compare to a person who just got like a shrapnel. Okay, so well say types of patients. Obviously theres more readily a type of patient that we could potentially try these treatments on. Absolutely anything else that i saw him. Yeah a lot more appointments. Yeah. Unfortunately, theres a lot more abundance. So it truly is one of those natural experience that were doing. And i hate to call it an experiment, its a natural way of seeing. And what are some of these clinical practices . Do they work . Do they not work . Right. Because itd be super me to obviously go around and create patients myself. Right. So again, the war settings obviously was a great place for a lot of these things to get introduced. And even today, lot of technologies that we still use today like train tickets right, specific protocols that we use in trauma medicine, a lot of those things developed and really kind of refined a lot of these war theaters. Right. Which is pretty so talking a few of those things. So talk about transportation initially. Right, the concept of actually moving a Patient Point of injury to safer location or somewhere else. Right. One of the first times we saw that was actually to pull psionic wards, right dr. Who was a surgeon in poisons army. Right, was one of the first to develop utilize some type of transportation system. Right. Obviously back in the day didnt have cars. So horse and buggies was definitely the luxury bus method of transportation right but then again advancing from that utilize in more so again motorized vehicles our other war so the civil war and stuff like that, we started to see a similar thing of using kind of horse drawn carriages and stuff like that to move our patients from right point of injury to somewhere else. Because were finding that, hey, lets get into safer location and then lets actually treat them rightoncepts like triage was also developed in the war theater. Right as anyone who heard the term before in a medical setting or not, whats triage basic terms. Yeah, its like looking at everyone thats hurt and treating the one the person thats most injured or most that needs the most. So yeah, in basic terms, absolutely right. Its a way of categorizing patients from least severe to not really severe at all. Right. And the whole of that is to make sure that were utilizing resources effectively, which is the biggest thing, and also try to improve or increase the number of patients who are going to survive most. So again, that was initially started to utilize again earlier on, but really wasnt widely accepted until world war one where they utilized kind of like that color coding system that use now where green is, theyre fine, red is their a very critical patient a black tag being typically they are in that imminent death scenario right where they most will die unless they are taken to a hospital, given resources very quickly. Right. So some examples of it where, again, now were starting to see this kind of case of prehoit medicine in very basic terms of providing whether injury has occurred right. Utilizing vehicles actually move some of these patients. Okay. So now we move on to then industrial era a little bit and the industrial era then starts to bring some additional issues. And i say issues regards to dangerous for people, right. Although a lot of good stuff came out as well too. Right. So again, industrialization of course. Right, immigration. So we have a huge boom in population, right . We have larger we do have the world wars that occurred. Right. Which was obviously a huge event. But that being said, though, in regards to medicine because of those improvements, right, we started see decrease in mortality, right. We started to increase of the capabilities of these doctors that also the hospitals itself because of advanced in clinical Medicine Technology on and such right a lot of these treatments are also improving from way so what do we see here we saw that the cause of death was starting to change was starting to shift so starting to different type of Patient Population in out world and we need to now start figure w ways to overcome this new issue. And what were some of the issues soin the day, what did we say was one of the g causes, things like infection . Well, things like the germ theory and penicillin. Did really good job knocking a lot of those things. So now people were living longer, right . We went from Life Expectancy of your early thirties late twenties to now up the 5060s and maybe even the seventies. So what did we now see with with that increase in Life Expectancy . Now we start to see some of those chronic illnesses occur, right cardiovascular disease, things like cancer where of course not saying that those things cant happen at a young age. Of course they do. But were starting to see a much more increase in those. They are typically more known as chronic diseases, right. Illnesses that are associated with typically with age. In addition to that, heres big one, right . Accidental are now starting to be, first of all, a thing and also increasing numbers. Why. Why people are working in factories. They dont have safety protocols. Yeah, this picture right here, right. Big steel factories and all this stuff, there building ships and theyreing all kinds of different stuff. But what doesnt expect exist back then . Osha, right. Theres no safety regulations. People wearing hardhats. People are shown to work in shorts. Who knows . Right. So obviously, again, we have this environment of inherent danger with all this equipment that, oh, the way is probably the first time were using some of this stuff and were still not really sure if its truly safe or not, but were using it because it works right. And then on top of that, we have this scenario where people arent really protected. So yes, obviously were going to start to see accidental deaths increase. Right . So working in more harsh conditions and harsher environments. So what do we do . Well, we said we should probably figure out some things to actually help these people where the injury has occurred. Now, we already said that that happened in the war setting. Right. But what about civilians because now were starting to see accidental deaths again, more traumatic occur in that civilian civilian population. So what do we do . So we started to come with the concept of things like first aid, which still exists today. Right. What is first aid class . Right. First aid class for the civilian typically is very basic things that you can do to very quickly assess or identify and then very quickly treat, at least stabilize until you can them to definitive care, which in the first aid world would be again a higher provider like nine one or again things a hospital right and those concepts obviously worse exactly or very close to being same back in the day. So the American Red Cross was one of the kind of core leaders in regards to developing this first date system or First Aid Training programs. Right so clara barton, who was a nurse, 19 im sorry, 1881, founded American Red Cross. And their main goal was to essentially provide aid and assistance in times of disaster and war. Right. Which, again today still American Red Cross, that their main goal. Right. So when big disasters like hurricanes and stuff like that come through, who are the ones providing additional shelter, food and stuff like that . Thats the American Red Cross, right . So that goal still exists even today now. Again, german, they claim themselves the birthplace of First Aid Training, at least the United States. Right. And it was actually one of the first incidents, a recorded instance of, First Aid Training to the civilian right in american history. Now, why was that so german pennsylvania was a mining town essentially. Right. And this first group of people are trained are actually 25 miners who are trained. First aid. Now, why miners. Do you think thats. Do you think that makes sense . Was it just a random group of people . What do we think . Yeah, it was a dangerous condition to work. Yeah, absolutely. And dangerous, but where are you when you are a miner . Underground. And who knows how long it takes