A Service Looks at 40

A fixture in the Gulf area and premier name in the private ambulance business, Louisiana-based Acadian Ambulance celebrated its 40th anniversary in 2011. Founder Richard Zuschlag, now its chair and CEO, reflects here on his company’s journey. For more on Acadian, see its commemorative publication, Knowing Life Matters: The First 40 Years of Acadian Ambulance Service, available at https://bluetoad.com/publication/?i=71358&pre=1.

For the past 40 years, I have been privileged to watch the growth and development of EMS. As one of the founders and the current CEO of Acadian Ambulance Service, I have seen almost unimaginable advances in medical transportation and prehospital care. EMS has bridged the gap from the scene to the emergency room, saving untold numbers of lives in the process.

Many can’t remember a time before the simple act of dialing 9-1-1 brought highly trained medical professionals to the rescue. In 1971, when Acadian was founded in Lafayette, LA, there was no 9-1-1, no centralized communication system. A call for help summoned funeral-home attendants who had no medical training. Emergency rooms weren’t always staffed; in fact, having physicians available 24 hours a day came about only because ambulances started bringing in patients around the clock.

When funeral homes were forced out of the ambulance business by federal regulations and high costs, it left a void in many communities, including Lafayette. That’s when my two partners and I went to local officials to seek approval of an ambulance service supported primarily by family memberships. They agreed, and Acadian Ambulance Service was on its way.

We started with two ambulances and eight medics who had returned from Vietnam and were looking for work. These medics had honed their skills in the military; now they would use them to help the public.

Before founding Acadian I had worked as a communications engineer, so it was fitting that improving communications was one of our first goals. At the beginning our medics found their way to calls using gas-station maps and landmarks; our ambulances were equipped with two-way radios, which had a limited range and constant interference. In fact, we shared a radio frequency with a lumber company, which meant messages to and from ambulances carrying patients sometimes had to wait while instructions were given to trucks hauling logs.

Within Acadian’s first decade we established a dispatch center, partly funded by the Robert Wood Johnson Foundation, which was recognized as an industry leader and became a model for other services across the nation. We received the first FCC license to transmit telemetry from the scenes of heart attacks to emergency rooms. Today our medics transmit 12-lead EKGs wirelessly to physicians’ smart phones, allowing some patients to bypass ERs and go directly to cath labs. This dramatically reduces the critical door-to-balloon times and improves chances for favorable outcomes.

Other advances have been equally impressive. For example, our former Vietnam medics had grown accustomed to using medical helicopters to transport patients. We recognized that air ambulances would be a perfect fit for south Louisiana, with its many rural areas so difficult to reach by ground. So, 30 years ago, we launched Air Med Services to help improve survival rates in remote areas, and now serve millions with helicopter and fixed-wing medical aircraft.

Ambulances also have kept pace, moving from retrofitted standard vans to actual emergency rooms on wheels. The use of GPS mapping, computer-aided dispatch and mobile data terminals has improved efficiency and cut response times.

Protocols have changed as well. Forty years ago medics were taught to “scoop and run.” Over the next couple of decades, with advances in training, they started treating on scene for extended periods of time. As the EMS industry has matured, medical protocols have too. Now medics are taught to rapidly package and transport patients on certain types of calls while performing many interventions on the way to the hospital.

This evolution in training has been one of the most significant changes in EMS. At Acadian it has been a priority from the start. While we were blessed with Vietnam vets when our company began, our rapid growth meant we needed a steady supply of medics. We began training our own EMTs in the 1970s and were one of the first to offer a 700-hour National Registry paramedic course in Louisiana. This focus on training eventually led to the creation of our National EMS Academy, which has trained tens of thousands of EMTs and paramedics.

As our industry continues to struggle with a shortage of first responders, I’m excited to see that the National Registry has been able to standardize course curricula and testing in 45 of the 50 states. EMS also has benefited from the national accreditation process. To achieve accreditation, companies have to achieve and maintain rigorous standards. It’s hard work, but it’s essential in an industry where lives are at stake.

All of these changes have vastly improved our ability to help the public. But one of the most gratifying changes I have seen is the public’s willingness to help until the ambulance arrives. The growing popularity of bystander CPR classes—including our own HeartStarter program in Lafayette, which has trained thousands—and the availability of AEDs in public places show that people are far more likely to offer aid than they ever were before.

Going forward I expect our industry to put more emphasis on efficiencies as we work to deal with rapidly rising healthcare costs and declining reimbursement levels. We’ll continue to push for and adapt to new technology and medical advances, to be flexible and to be innovative.

Forty years from now, I’m sure EMS will have evolved as much as it did from 1971 to 2011. But I’m also confident about this: Our industry is filled with people who care, who want to give and who want to serve. No matter what the past has held or the future brings, that has never changed, and it never will.