April 2005 Book Corner

Some of you may have read a news item last December 26 on the passing of one of the true EMS pioneers, Dr. Frank Pantridge. Pantridge developed the first portable defibrillator in 1965, while working at the Royal Victoria Hospital in Belfast, Ireland. This tool allowed him and others to create the first mobile intensive care unit, which ultimately led to the creation of paramedics and prehospital advanced life support as we know it here in the U.S. and Canada.

Pantridge wrote an autobiography about his life and his pioneering efforts with the portable defibrillator and the “Lifemobile” experiment, titled An Unquiet Life. Published in 1989, it is out of print and only available through British used bookstores and certain libraries. When I’m finally able to get my hands on a copy, I will review it for a future column. For now, though, let’s take a moment to say thank you to one of the great pioneers and visionaries of our craft. Pantridge was 88 when he died.

Speaking of death, last January Fox’s FX channel aired Smallpox, a fictional documentary film created by the British production company Wall to Wall. Smallpox was so realistic that my wife, Vicki, walked into the room during the middle of it and thought we were watching an actual news broadcast.

The bullet: Staffers in several New York City emergency rooms find themselves treating multiple patients who present with flu-like symptoms. These patients are evaluated, treated and sent home, but several return days later in critical condition and ultimately die. Initially, doctors are baffled—until one of them comes up with a correct diagnosis of smallpox. But by then dozens, then hundreds, of folks have come down with the disease, which has spread to London via a business traveler.

The disease becomes an international pandemic creating upheaval worldwide. Countries close their borders. There’s a shortage of vaccine. Neighborhoods are quarantined. In the meantime, New York City public-health investigators track the outbreak back to a mysterious terrorist who came into the city as a biological bomb and deliberately contaminated people. What his affiliation or cause was is never revealed.

Smallpox is an incredibly well-researched, well-written, high-quality production done in a style that grabs and holds your attention without overdoing it. The closing credits include interviews with David Heymann, executive director of communicable disease at the World Health Organization in Geneva, and professor Michael Osterholm of the University of Minnesota School of Public Health.

Setting aside the fact that I’m a bioterrorism instructor, so I have a passion and bias in this area, Smallpox is well worth the trouble of tracking down and watching, and I would strongly urge anyone involved in medicine or emergency response to do so.

Roslyn Bibby, director of public relations for FX, says Wall to Wall made the film for FX and there are no plans to release it on DVD at this time. All I can suggest is that you watch your cable listings for the next time this film is aired.

Speaking of diseases, the Centers for Disease Control and Prevention (CDC) has recently made available a PDF file of its new Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors. This guide is aimed at helping public-health departments respond to multiple types of disasters by providing immediate access to guidance and information that will assist them in rapidly establishing priorities and undertaking necessary actions. It covers everything from environmental issues to post-disaster public information. All in all, it contains a lot of useful information for emergency managers and providers. Check it out at www.bt.cdc.gov/planning/responseguide.asp.

Another resource on the Web that may be of interest to EMS and public-health types, especially in light of the recent tsunami in Asia, is Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness from the National Academies Press. It can be found at www.nap.edu/books/0309095425/html.

Special thanks to paramedic Tim Hillier, director of education for the MD Ambulance in Saskatoon, Saskatchewan, Canada. Some of you may remember that Hillier was a popular and well-received speaker at last October’s EMS EXPO in Atlanta. During his presentation on the history of EMS, he showed a well-made Irish public service announcement promoting the use of seat belts for the general public. He has graciously shared the Web link to it, which is worth checking out: www.cherrypoint.usmc.mil/safety/seatbelts.mpeg.

Every now and again, EMS providers find themselves dealing with serious medical and/or rescue situations where we are the only resource available other than bystanders and looky-loos. Out here in San Francisco, we found ourselves in this predicament on more than one occasion during the 1989 Loma Prieta earthquake response and aftermath.

Fact: Most of the general public does not want to be a victim. Most, if not all, would rather be part of the solution than part of the problem. Don’t believe me? Just take a look at the folks on the American Airlines flight that carried the shoe bomber. You can bet those folks weren’t passively waiting to find out what the emergency response to their situation would be.

However, nothing in our first responder, EMT or paramedic training has prepared us for managing these spontaneous volunteers. Fear not: The National Voluntary Organizations Active in Disaster Volunteer Management Committee has prepared a document/template for managing and working with these folks. While Managing Spontaneous Volunteers in Times of Disaster is aimed primarily at emergency managers and planners, it contains several sections applicable to us down at the worker-bee level. Check it out at www.nvoad.org/managingsponta neousvol.pdf.

In light of events such as the Madrid train bombings, the Christmas tsunami and, even more recently, the Los Angeles-area commuter train wreck, two Web resources on the management of mass fatalities are worth checking out. Both reports, Management of Dead Bodies in Disaster Situations and Infectious Disease Risks from Dead Bodies Following Natural Disasters, are from the Pan American Health Organization. They can be found, respectively, at www.paho.org/English/DD/ PED/DeadBodiesBook.pdf and https://publications.paho.org/eng lish/dead_bodies.pdf.

While they are aimed at public-health and emergency planners and managers, they contain a number of points of interest for both prehospital and emergency department practitioners.

May always ends with the Memorial Day weekend, a time of picnics, parades and, for those of us in the emergency response business, increased professional activity. Indeed, Memorial Day weekend traditionally kicks off the summer season for park rangers, lifeguards and the swiftwater/river rescue types among us.

The real meaning of Memorial Day, however, is to honor those servicemen and women who have given their lives defending our country. These next two reviews are about healthcare providers—one a Vietnam combat medic who made it through the conflict, and the other a World War II combat surgical nurse who didn’t. This Memorial Day, please take a moment to honor all of our brother and sister healthcare providers who have gone before or are currently serving at home or abroad. Thank you.

Medic! The Story of a Conscientious Objector in the Vietnam War is the memoir of Ben Sherman, who was 23 and a conscientious objector when he was drafted in 1968. At that time, American forces had just put down the Tet Offensive, and many replacements were needed.

Medic! is the story of Sherman’s battles with the draft board and the U.S. Army, not to refuse to be a soldier and serve his country, but to be allowed to follow his beliefs and do so as a noncombatant. The ultimate compromise, after many months of trials and tribulations, was that he was trained as a combat medic and shipped off to Vietnam.

His arrival there was marked by a rocket attack as he was getting off the plane. He treated his first casualty before ever being assigned to his unit. Once there, he was assigned to morgue duty, cleaning up and preparing U.S. soldiers killed in action for shipment home to their families. After a conflict with a fellow soldier in the morgue, he was snatched up by a senior medic and mentored for field and helicopter/dustoff duties.

From patrolling deep in the Cambodian bush to dealing with the confusion and near-sensory overload of treating patients in a firefight to being inundated with casualties, Sherman lays out a well-written tale that describes rookie mistakes and the learning curve many of us go through in that transition from EMT student to fully functioning field medic.

And then there’s that other half of service: dealing with the bureaucracy that most institutions (like our armed services or, for that matter, some EMS departments) have become—places where learning the official and back-channel ways of getting things accomplished is just as important as the organization’s actual mission.

Medic! is a dark but well-told account about a year in Sherman’s life that involved service to others under extremely trying conditions. It’s worth picking up, or at least tracking down through your local library. There’s a reason Memorial Day and Veteran’s Day are national holidays. Sherman’s book helps remind us of it.

Medic! The Story of a Conscientious Objector in the Vietnam War by Ben Sherman. Presidio Press, 2002. ISBN: 0-89141-848-2. U.S. $6.99, CAN $10.

American Nightingale is the biography of Frances Slanger, a MASH surgical nurse and one of only 17 nurses to land on the Normandy beaches shortly after D-Day. Her unit stayed just behind the front all the way into Germany, where she lost her life to a German artillery shell. Bob Welch, an award-winning columnist and professor of journalism at the University of Oregon, does a masterful job of sharing, not telling, who this quiet, mysterious but dedicated combat nurse was, and the tremendous impact she had on her patients, coworkers and indeed the entire war effort.

Slanger, daughter of a Jewish fruit peddler, was born in Warsaw, Poland, and spent her early childhood surviving World War I and several pogroms in the Warsaw ghettos. She and her mother emigrated to Boston to join her father, who was already working there to bring his family the better way of life America represented. Even as a girl, Slanger was known for being smart, quiet, determined and an aspiring writer.

All of these traits came together as she defied first her parents’ wishes, then the anti-Jewish prejudices of the times to attend nursing school while still working and helping support her family. In the aftermath of Pearl Harbor, she answered her nation’s call for skilled nurses in the military. Still quietly dealing with anti-Semitism from some of her officers, she and 16 other nurses were part of the 45th Field Hospital Unit, which included some of the first American nurses to set foot in occupied Europe.

American Nightingale chronicles all of this and the unit’s advance across France and into Germany. Along with the floods and droughts of patients, unit movements and day-to-day camp/unit life, Slanger also kept writing. One evening she composed a letter to the editor of the military newspaper Stars and Stripes, and mailed it off. Before it was published, she lost her life, along with several other members of her unit, in a nighttime shelling of her area.

This alone would be enough for any of us: A well-lived life doing what we do, taking care of others, frequently in less-than-ideal conditions. However, the letter Slanger wrote was so moving that for only the second time—the other being for a letter from Gen. Dwight Eisenhower—the Stars and Stripes editors replaced their regular editorial with her letter. It literally became an international inspiration for the war effort.

The letter talked about how Slanger and her sister nurses had read accounts in some newspapers and magazines sent in by grateful GIs praising the work of the nurses and calling them heroes. She explained, matter-of-factly but with quiet passion, that yes, they were working under rough circumstances, but nothing compared to what the frontline soldiers were going through. The nurses weren’t heroes, she said, just folks trying to do their jobs. Her death—the first combat death of an American female in the European theater—along with her letter, caused a tremendous outpouring of grief and respect among the troops and the American public. To honor Slanger’s life and work, the military named its newest and largest hospital ship after her.

American Nightingale is a terrifically written biography about one of our own who gave her all and inspired millions more.

American Nightingale: The Story of Frances Slanger, Forgotten Heroine of Normandy by Bob Welch. Atria Books, 2004. ISBN: 0-7434-7758-8. U.S. $27, CAN $32.

That’s it for this Book Corner. Remember to take a moment this Memorial Day to honor those who gave their lives. Take care and be safe, everyone.