EMS Hall of Fame: The Pioneers of Prehospital Care—Nagel, Cobb

The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This new series honors these trailblazers. 

Eugene Nagel, MD

Telemetry, remote medical direction

You generally don’t need a doc riding alongside you on the rig. Eugene Nagel was one of the first docs to agree. Medical director for the Miami Fire Department from 1964–1974, Nagel introduced telemetry and remote medical direction to EMS. 

In 1962 Nagel was completing a residency in anesthesia in New York City when a fellow physician suggested he look into the emerging intervention of CPR. He developed an interest that followed him to Miami, where he became an instructor of anesthesiology at Jackson Memorial Hospital and known as a local expert on resuscitation. By 1964 he began teaching CPR to firefighters. 

As the department’s medical director, he persuaded local authorities to allow firefighter-paramedics to use portable defibrillators and begin treatments like IVs and intubation. The key was introducing telemetry to field communications: Nagel was aware of Frank Pantridge’s early efforts at mobile coronary care but thought the idea wouldn’t fly in the U.S. if physicians had to be at all scenes.

Through radio connections and telemetry, he realized, field providers could remain connected to and act as extensions of hospital-based physicians who controlled the responses. Firefighters had a tradition of first aid and rescue, he reasoned, and were positioned strategically throughout the community to respond quickly. 

“We saw telemetry as the key to extending our treatment to outside the hospital, where hitherto trying to legislate it was the dark side of the moon in those days,” Nagel told fellow emergency physician Mickey Eisenberg in Eisenberg’s book Resuscitate! How Your Community Can Improve Survival From Sudden Cardiac Arrest. “The telemetry looked like it might be the ‘open, sesame’ to doing some treatment prehospital.” 

Transmitting EKGs to physicians enabled field defibrillation by the late ’60s and helped inform the EMS Act of 1973. 

Leonard Cobb, MD

Founder, Medic One

The Seattle area is known for having some of the best emergency medical care in the U.S., and for that it can thank among others Leonard Cobb, MD. Cobb and Seattle Fire Chief Gordon Vickery founded the city’s famed Medic One in 1969.

Cobb was a cardiologist at Harborview Medical Center and realized in the late ’60s that emergency cardiac care would be faster and more successful if brought to the patient. Like Nagel, he thought specially trained and equipped firefighters the best candidates to deliver it. He found an ally in Vickery, who was already working to boost his troops’ first-aid capabilities. 

Fifteen initial Seattle firefighters learned the basics of coronary care, how to interpret 12-leads, rhythm recognition, defibrillator use, endotracheal intubation, IV placement, and more. In all they underwent 200 hours of classroom instruction and around 700 hours of physician-supervised internship in the Harborview ER and OR. They hit the streets in 1970, with docs along on every call. 

Successful resuscitations resulted, with lives saved and morbidity reduced. This increased the public's support and demand, which resulted in expansion of the new providers’ training to areas like trauma care and acute illnesses. In 1972 Washington dropped its requirement for physicians on the trucks. 

Medic One today is known for its innovation and excellence in prehospital care generally and cardiac care specifically; Seattle typically is among the U.S. leaders in cardiac arrest save rates. Harborview, the University of Washington, and local fire departments all work jointly in a well-oiled system; layered response often gets BLS care to patients in as little as 3–4 minutes. And in greater King County, more than half of all citizens have been trained in CPR.