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History of Hennepin County Medical Center Ambulance Service Editor's note: This article would have required a great deal of trouble to write, if it were not for the work of a couple of our paramedics. Carl Ostling's article, "The History of Mill City Ambulance" was originally published in the "One Down", a publication of the Hennepin County Association of Paramedics and EMTs (HCAPE). Much of his original research can be seen here. Tom Ward, one of our supervisors, also contributed some information on the early days of what is now the Hennepin County EMS System. So thank you Carl and Tom. The City Hospital of Minneapolis was established in 1887. Minneapolis, at that time, had a population of about one hundred and twenty thousand, and was a rapidly growing and wealthy community. This tremendous growth made necessary an organized ambulance service.
Minneapolis' First Ambulance "The custom in our city of conveying the sick by hacks, accident cases by patrol wagons, in all kinds of weather, from all distances, is familiar to all. I am satisfied that such means of conveyance are not only uneconomic, but that precious lives are lost annually by this method." This report resulted in an ambulance being built for the hospital in the early summer of 1894. It was kept at a livery stable until funds could be secured to furnish the necessary horses for running it. The hospital contracted with Thomas Gavin and son, who cared for the ambulance and furnished a driver at $1.50 per hitch. Two hundred and sixteen patients were transported to the hospital between August and January. During this time, the hospital, health department and the police department divided the ambulance calls between them. The health department carried cases with contagious disease; the police department responded to emergency or accident calls; the hospital ambulance transported ordinary cases of sickness. In 1895, the hospital ambulance was moved from the livery stable to the hospital grounds, on the urging of the Minneapolis Superintendent, who pointed out that many patients could leave the hospital earlier if they could be transported to their homes.
The Beginning of ALS? In 1902, a telephone service was first used. The police began to notify the hospital by telephone of the coming of a case, which made possible more efficient care of patients upon their arrival. In 1908, the city provided the police department with an automobile ambulance. In 1911, the Board of Charities and Corrections made provision for the purchase of an automobile ambulance for the hospital. A year later, the hospital received its new Electric Winton ambulance. It did twenty miles per hour and had a pedal gong to clear traffic. Two ambulance drivers were hired, and the horse drawn ambulances were finally discarded. Having the city ambulance service divided among three independent city departments resulted in much confusion and overlapping. Undesirable delays in service often occurred. These unavoidable delays in making calls on patients resulted in many complaints. So in 1916, the ambulance services were reorganized. The contagious disease ambulance was transferred to the hospital from the Police Department. The hospital medical residents were placed in full charge of the ambulance service of the city.
These changes necessitated an increase in equipment for the ambulance service. One ambulance and two runabout vehicles were provided. The hospital garage was enlarged to accommodate the machines and four additional drivers were hired. The use of the hospital ambulance service was restricted from time to time. In 1919, a ruling was made that merchants and others may no longer call on the hospital emergency ambulance to move patients to their homes or to private hospitals. Private ambulances were to be used in such cases. In 1923, the Board of Public Welfare ruled that the hospital ambulance should not be requisitioned to move patients from the city to Glen Lake Sanatorium(Later Oak Terrace Nursing Home). In 1928, calls outside the city limits were discontinued, except in cases where some responsible village official approved the call and the attendant charge which was $2.23 per call. This rule remained in effect until January 1, 1964, when the county took over control of the hospital. The number of calls per year from 1925 through 1930 numbered nearly seven thousand or about seventeen calls per day. The total annual budget of the department in these years was approximately $13,500.
Prior to 1965, ambulance drivers received no formal medical training, nor were they required to have any. Any medical knowledge they possessed was received on the job. According to Herman Logan who retired in 1957 after thirty-nine years as a driver, " You can't panic at the sight of blood. Your job is to help the doctor, and you have to get your hands right in it." Logan was working in a garage back in 1912 when he agreed to fill in for an ambulance employee at City Hospital. The man he substituted for never returned and Logan never left. At the time, he was the only driver employed, and worked twenty-four hours a day, seven days a week, with two evenings off and he lived at the hospital. The pavement didn't go past Franklin Avenue back then. Bumping his 1912 Winton that did twenty miles per hour over dirt ruts or muddy roads was on call, clear out to Lake Minnetonka (as Logan often did) was a chore in itself. There were fewer accidents in those days because there were fewer automobiles. But there were a lot of railroad men injured in the yard, pedestrians run down by horses, and always a few murders or other violent crimes. Little changed in the ambulance service from 1930 to 1969 except run volume and equipment. In 1931, the ambulance made 7,688 trips. In 1950, the service did 7,785 trips, 5,587 with a doctor on board. Run volume was highest between 4 pm and midnight. In 1946, the service had a 1938 Packard, a 1941 Packard, and two 1932 Ford Model Bs with V-8 engines. Ambulance drivers worked eight-hour shifts and were paid $1.00 per hour. In 1948, the ambulance service started using Cadillacs, which cost about $10,000 each. These were used until 1961 when the hospital began to switch over to Internationals, which cost $4,200. They were three feet shorter than the Cadillacs, but had the same amount of room for patient care. The Internationals could only handle two stretchers, while the Cadillacs could handle four, with two hanging from the ceiling.
A New Era: Hennepin County takes control of City Hospital and Ambulance Service around 1960, the City of Minneapolis started proceedings that would allow the county to take over the hospital and ambulance service. There was much arguing between the city and private hospitals in the suburbs who felt they would lose patients to the City Hospital. When the county took over control of the hospital on January 1, 1964, the plan was this: Under the new policy, the existing emergency and ambulance services of North Memorial, which had been serving the north suburbs, would be incorporated into the county setup. For the west and south suburbs, the county would station its own ambulances. One at the county highway maintenance shop in Orono, one at the county highway maintenance shop in Hopkins, and one at the county maintenance shop in Bloomington. The decision whether to bring a patient to a hospital other than the County would rest with the physician riding in the ambulance.
This plan upset Methodist Hospital, which relied on a contractual agreement with Smith Ambulance, not staffed by a physician from the hospital. Vernon T. Spry, administrator of Methodist Hospital, was opposed to providing emergency medical service that the county outlined. He ridiculed the idea that ambulances with interns would be stationed at points outside the city. "What are they going to do between calls, play cards with the driver?" Spry asked. He was afraid that Methodist would be bypassed in transporting patients to General Hospital. The level of emergency care at Methodist was defended by an individual who said, "The primary difference in our operation is only that we believe in our capitalistic way of life and choose to use a private ambulance service." In spite of the arguments and complaints, the plan was put in effect on January 1, 1964. After several months the Orono and Bloomington stations were closed due to lack of calls. The Hopkins station was kept in use primarily to do clinic runs, which were a large portion of the runs done in 1965. During that time, emergency calls were made to 80% of the villages and townships of Hennepin County. The ambulance service had a total of 27 employees: One ambulance foreman, 18-ambulance driver/attendant IIs and eight driver/attendant Is.
Call volume continued to rise for what was now Hennepin County Ambulance. In 1962, the ambulance did 14,308 calls, of which 9,407 were with a physician on board. In 1965 the ambulance service did a total of 21,911 calls. Formal Medical Training for
Ambulance Drivers/Attendant In 1966, 18 municipal ambulance companies formed the Metropolitan Ambulance Association to ensure that local residents who call for an ambulance will have vehicles of a high grade, complete equipment, competent personnel and extensive insurance coverage. Drivers would be required to have a chauffeurs license, a physician's certificate of good health with good eyesight, have no addiction to liquor or narcotics and be the holder of Standard and Advanced Red Cross First Aid Certificates.
No more holding of calls would be allowed. Should the company receiving the call have all vehicles in use, it must pass the call on to another ambulance company. In 1968, the City of Minneapolis received a grant from the federal government to open a regional health care clinic and ambulance for the north side. The grant was for a five-year period, and people from the area were hired to staff the ambulance. They used Hennepin County equipment and offices, but received no funding from the county. The drivers were paid $706 per month and worked eight-hour shifts from 7-3 or 3-11. The ambulance was out of service on weekends and nights, and the County Ambulance covered the area then. If it were busy downtown, the Pilot City Ambulance, as it was known, would cover for the County. The clinic was located in an old Jewish synagogue at 1345 Penn Ave. North. The recruitment of ambulance drivers was done out of a trailer at Plymouth and Emerson N. Recruiters basically walked down the street and asked people if they wanted to be drivers.
The County's First (and last) Physician
Staffed Mobile Coronary Care Unit On October 29, approximately seven months after the van was purchased, it resulted in the death of the first Hennepin County EMT killed in the line of duty. The driver, Dale Eidsvig, and his partner, Paul Hegg, had slowed to nearly a stop enroute to an emergency when the vehicle was struck by a car at 42nd St. and Portland Ave. South. The impact threw the ambulance on its side, throwing Eidsvig from his seat and out the door, with the vehicle landing on top of him. He was 45 years old and left a wife and three children. The van was never returned to service. There have been 2 other line of duty deaths at HCMC EMS; Ambulance Supervisor Nelson Schaefer suffered a serious heart attack while on duty in 1985 and died later that evening. Jim Blanchard suffered a heart attack while treating a critical trauma victim in December of 2002. In spite of his pain, Jim's thoughts were for his patient. He provided every necessary treatment for his patient but ultimately succumbed to his heart attack after safely transferring care to the ED.
The Birth of Paramedics in
Hennepin County The Hennepin County Ambulance Service primary service area at this time consisted of Minneapolis proper (with the exception of that part of Minneapolis north of Broadway and west of Lyndale, which was informally recognized as North Memorial territory), and a few remote facilities such as Oak Terrace Nursing Home in Minnetonka and the Hennepin County Work House. All runs, including runs to these remote facilities were responded to by crews from the ambulance services only reporting station, downtown. Two to three (sometimes four) emergency crews were the norm, depending on time of day. Two paramedics to a crew was unusual and two EMT crews responding to emergency calls was not uncommon. Much of the ambulance staff, vehicles and business were involved in scheduled transportation of nursing home and independent living invalids to HCMC for clinic appointments. You couldn't hire a paramedic back then; you had to train your own. The NREMT did not exist. Paramedics everywhere were an artifact of local training and certification programs. The length and scope of paramedic training rapidly expanded in harmony with trends and curricula in other programs around the country. The Hennepin County paramedic program trained many of the paramedics in all of the existing services of the era. A sizeable number of our current paramedics came from this school. Some of these people date back to the days when the standard for emergency street work was American Red Cross "Green Book" First Aid certification. Organized EMS in Hennepin County
Hennepin County
While prehospital care was often good, there was no was no way of assuring that the closest or most appropriate emergency response vehicle was dispatched; and furthermore, there was at times a lack of communication between prehospital emergency care personnel and hospitals to which the victims were being transported. In addition, in light of new technology, new training, and equipment, that the entire level of expertise of prehospital emergency care personnel within the region could be improved. Dr. Ernest Ruiz, Chief of Emergency Medicine at Hennepin County General Hospital, formed a task force to initiate steps that might be instituted to improve the delivery of emergency health care. At approximately the same time, the Hennepin County Criminal Justice Council was beginning to initiate talks on a universal telephone number (911) for access in all emergency situations. It was felt that by combining a public awareness and easy access to emergency care, together with the coordinated response of the emergency medical care, that citizens in our region could expect to get better emergency care with reduction of death and morbidity. At this time, it was announced that the Robert Wood Johnson Foundation would be making grant awards for areas wishing to improve their emergency hospital care, utilizing their funds for communications operations. Hennepin County Medical Center, two members of the task force, the Hennepin County Criminal Justice Council staff and providers in the region initiated a request to the Robert Wood Johnson Foundation and were awarded a grant totaling $478,254. This grant funded the EMS Project and was administered by the Management Services division of Hennepin County. Funding was also received from the US Department of Health, Education, and Welfare.
The prime aim of the Emergency Medical Project was to improve delivery of emergency health care, particularly in the prehospital setting, to individuals in the western Twin City Metropolitan area. By improving delivery of this care, it was hoped that there would be a substantial reduction in deaths or morbidity due to sudden or emergency illness and injury. It was an aim of the project staff to improve the system in three ways: 1. To develop a coordinated communications system for the dispatching of emergency vehicles to the victim and to coordinate the use of the EMS radio channels for field-to-hospital communications; 2. To train the professional emergency personnel in the area to an appropriate level to achieve the best possible on-scene care of patients. 3. To train the public citizen in ways to obtain emergency medical help when it is needed, and train the public in the basics of emergency care needed to treat a victim until professional help can arrive. During the period of grant funding, the Emergency Medical Services Council was established to serve in an advisory capacity to the Hennepin County Board, staffed by the Community Health Department. The EMS council now serves as a forum for prehospital care issues. Together with the Community Health Department it coordinates the delivery of prehospital care, encompassing a unique blend of franchised public and private ambulance services in the Metro West area. In mid-1977, after the available grant funds had been depleted, the Hennepin County EMS Project became a department of Hennepin County Medical Center and has slowly grown in response to increased training needs in the pre-hospital sector. There has been a decreased emphasis on paramedic training and increased emphasis on the training of First Responders and EMTs. In 1978, a regulation and coordination component of the EMS system was implemented when the Hennepin County Board of Commissioners passed regulations for Advanced Life Support. These ordinances were drafted because the state law of the time did not include differences of training between BLS and ALS ambulance services. The ordinance was drafted and passed in 1978 that included mandatory staffing of two paramedics per ambulance, mandatory use of the communications system, adherence to response time standards and adherence to primary service area standards. In late 1982, this ordinance was redrafted to concur with Minnesota Department of Health's amended law and rules governing life support transportation services. On December 1, 1982, the 911 Emergency Telephone system became operational. Since 1978, the physicians and other EMS staff members have been closely involved in the development of 911 and Minneapolis Computer Aided Dispatch (CAD) which includes the capability for EMS CAD. The 911 Emergency Telephone System originally included 7 counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington. Six phone companies, 77 central telephone offices, 1.15 million phones, and 29 public safety answering points (PSAP). It should be noted that the only goal of the EMS project that was not met was that of centralized EMS dispatch. Each ambulance service does their own dispatching. Paramedics Get Their Title In 1993, the multi-county Metro-West EMS system was disbanded. The countywide system that remains is now called Hennepin County EMS. The Hennepin County EMS Council still oversees the system and administers it through the Hennepin County Community Health Department.
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