EMS Hall of Fame: The Pioneers of Prehospital Care—Clawson, Cowley

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 series honors these trailblazers. 

Jeff Clawson, MD

The father of emergency medical dispatch

Not all emergencies are equal. With his invention of priority dispatch, Jeff Clawson, MD,  first gave 9-1-1 call-takers the ability to triage the urgency of needed responses. 

As an EMT and dispatcher in Utah before starting medical school, Clawson realized in the mid 1970s the need for a system of standard, protocol-based caller interrogation. He designed a card-based system of such protocols, alphabetized by chief complaint and containing essential questions to ask callers and prearrival instructions to give them in certain situations. Ultimately these became the Medical Priority Dispatch System (MPDS) and helped turn 9-1-1 communications personnel into the “first first responders” they are today. 

MPDS categorizes call levels from alpha (minor) to echo (immediate life threats) depending on patient severity. These values help systems determine appropriate response resources and modes. It offers instructions in cases of immediate dangers like cardiac arrest (e.g., telephone CPR, defibrillator use), choking (the Heimlich maneuver), hemorrhage (bleeding control), and administration of drugs to reverse overdose (naloxone) and anaphylaxis (epinephrine). 

Clawson’s system of priority dispatch has been adapted for use by law enforcement, firefighters, and other medical communication and today is integrated into CAD systems worldwide. MPDS products are available through the Priority Dispatch Corp. 

In 1988 Clawson established the International Academies of Emergency Dispatch (IAED), which now includes members in 46 countries. Their emergency dispatch protocols are used in some 80 million calls a year. Clawson was also central to development of the IAED’s Navigator Conference for emergency dispatchers, as well as the Journal of Emergency Dispatch. He remains active in writing, education, and research related to dispatch issues and currently oversees the development of IAED’s research and educational programs. 

R Adams Cowley, MD

Shock trauma care pioneer

R Adams Cowley, MD, was part of the National Research Council committee that produced the 1966 Accidental Death and Disability white paper, but his contributions to emergency medicine predate even that. 

He was a pioneer in open-heart surgery, performing operations before widespread use of the heart-lung machine, and known for his innovative procedures. Frustrated that many of his patients died of shock soon after seemingly successful operations, he won a six-figure Army grant to study shock in humans. In 1958 Cowley developed the nation’s first clinical shock trauma unit, which despite being known as the “death lab” saved multiple patients. Since 1989 it has been known as the R Adams Cowley Shock Trauma Center.

Cowley is credited with articulating the “golden hour” concept of speedy care for trauma victims. By 1969 he was having badly hurt patients brought to hospital care by helicopter. This drew the interest of Maryland Gov. Marvin Mandel, who in 1973 created a state Division of Emergency Medical Services with Cowley as director. 

The coordinated statewide EMS system Cowley developed, the Maryland Institute of Emergency Medical Services, was the nation’s first, and Cowley fought continually for funding, equipment, helicopters, and anything else it needed. 

He additionally founded the Society of Thoracic Surgeons and National Study Center for Trauma and EMS, enacted in 1986. He invented a surgical clamp that bears his name and a prototype pacemaker used by President Dwight Eisenhower. 

Cowley’s CV ultimately featured more than 400 published professional articles, chapters, books, and white papers, as well as numerous awards and honors, including a Congressional Gold Medal for lifelong commitment to the advancement of trauma care. He died in 1991.