Evolution of Pre-Hospital Emergency Care

The first thing to appreciate about this 191 page volume is that it is not a textbook. It was written to celebrate 2 events the 50th anniversary of the publication in the Lancet of the famous Pantridge and Geddes paper entitled; A mobile intensive-care unit in the management of acute myocardial infarction and also the 20th anniversary of the development of a coherent system of emergency medical services in the rugged, rural Canadian province of Nova Scotia. The story begins in 1950s North America, where the specialty of emergency medicine has not been invented yet and no self-respecting hospital doctor would willingly venture into the bear pit that was the emergency room. The situation outside hospital was even worse, with no organised ambulance service just volunteers often the local undertaker whose long hearse could at least fit a stretcher inside (conflict of interest perhaps?). The story then moves to Belfast and the recollections of Dr John Geddes, at that time SHO and then registrar working with Professor Frank Pantridge. The development of the portable defibrillator and cardiac ambulance are detailed some facts were new to me for example, Pantridge wrote to NASA asking for release of advanced miniaturised capacitors necessary for the electrical circuits in the portable defibrillator. NASA agreed and thus, Belfast stole a march on several American universities working on the same project! The book then goes on to chart the pioneers who developed both prehospital coronary/trauma care in North America and modernised emergency departments in certain major cities before finally focusing in on rural Nova Scotia which covers a vast swathe of territory. The final chapter is a short biography of Frank Pantridge. A worthwhile read for those with an interest in the history of Belfast Cardiology, CPR and pre-hospital care in the widest sense. - Dr John Purvis, Consultant Cardiologist. Ulster Medical Journal 2018