Emergency! and the Legalization of Paramedic Services

This essay … seeks to document the pivotal role of Emergency! in producing an array of legal changes that resulted in an explosion in the availability of paramedic services during the time that the TV show aired new episodes….

The legalization of paramedic services required major changes in legal principles relating to both criminal and civil liability. For example, laws in all states made it a crime for non-physicians to practice medicine without a license. These laws rendered paramedic services unfeasible due to the fact that many of the medical functions that paramedics could have performed constituted the practice of medicine. Paramedics could be criminally prosecuted under these laws even if they had undergone training and could demonstrate expertise in carrying out their paramedic tasks.

Civil liability rules also posed significant challenges for the development of paramedic services. Paramedics could be ordered to pay damages for any harms that patients incurred due to paramedic negligence. A showing of negligence was not a significant hurdle for plaintiffs to overcome since, in most jurisdictions, performing illegal medical procedures constituted negligence per se. Even apart from the negligence per se reasoning, paramedics were likely to be held to the same standard of care as physicians.

The Senate Report on the Emergency Medical Services Systems Act of 1973 summarized the legal challenges facing the development of paramedic services. The report stated that “[t]he reported bill directs the Secretary to conduct a study of the legal barriers to the effective delivery of medical care under emergency conditions …. The provision of emergency medical services is affected in some states by inflexible laws on licensure, malpractice and liability.”

Adding to the need for legal changes that would have to occur if paramedic services were to develop and expand was the opposition demonstrated by many physician and nurse groups to the paramedic concept. For example, two researchers writing in 1969 surveyed over 1,300 Wisconsin physicians. The researchers asked the physicians whether they would be willing to permit paramedics to perform duties closely related to their medical specialties. The majority of physicians responded in the negative.

The physicians’ professional association, the American Medical Association (AMA), recommended delay, the favorite tactic of opponents who might not want to directly challenge a reform. The AMA’s position was that more experimentation was needed before legislation authorizing paramedic services was enacted. Individual doctors, however, were not so restrained. For example, one Illinois doctor thought that “[t]his whole mobile medical thing is loaded with danger …. How would you like it if someone, after only a few weeks’ training, took over your husband’s job?” …

Nurses often opposed the legalization of paramedic services more stridently than doctors because paramedics presented a potential “turf” issue for many nurses and nursing groups. Legalization of paramedics created a risk that duties previously regarded as part of the nursing profession would be shifted to paramedics, especially with respect to new medical technology. Thus, a number of nursing associations initially went on record as opposing the legalization of paramedic services….

As a result of these challenges and despite the glimmerings of hope for including paramedics in improved emergency services, the reality was that actual paramedic services were virtually non-existent at the end of the 1960s. As of 1971, only twelve paramedic units were in existence in the entire United States. However, in the absence of legislative authority, several of these units operated somewhat clandestinely.

As luck would have it, however, two of these twelve paramedic units were based in Los Angeles, the show-biz capital of the world. California was the first state to enact a comprehensive law authorizing paramedic services, and the two Los Angeles paramedic units operated under the authority of that law, the Wedworth-Townsend Paramedic Act of 1970.

Reflecting the uncertain toehold of paramedic services, the Wedworth-Townsend Paramedic Act was merely an experimental pilot program. The law expired automatically two years after its enactment, and it authorized paramedic services only in counties “with a population of over 6,000,000” people, meaning that the paramedic services that Wedworth-Townsend authorized were limited to Los Angeles County. Despite its rudimentary and hesitant approach, however, the Wedworth-Townsend Paramedic Act provided the impetus for Emergency! …

Popular culture’s contribution to the development of paramedic services began shortly after the enactment of California’s Wedworth-Townsend Paramedic Act. In the words of Los Angeles County Fire Captain Jim Page, who was involved in the early paramedic training programs in Los Angeles, “May 11, 1971 was a day of great significance to the paramedic concept.” On that date veteran television producer Robert Cinader, working with Jack Webb (of Dragnet fame) met with Captain Page and other Los Angeles County Fire Department officials to discuss the development of a new television series based on the exploits of fire department rescue personnel.

Cinader’s initial concept focused on physical rescue situations. Cinader asked Captain Page for help in developing rescue scenarios that could be depicted in a weekly series. Captain Page began collecting story ideas, but soon came to believe that the focus on physical rescue situations was too limiting and stated, “[t]here [are] only so many kinds of cave-ins, building collapses, and similar calamities that could be depicted without encountering potentially boring similarities.” As fate would have it, Captain Page was familiar with Los Angeles County’s experimental paramedic operations. Moreover, shortly after his initial meeting with Cinader, Captain Page was promoted to the office of Battalion Chief, and as a result had the County’s two paramedic units under his command. Battalion Chief Page then suggested to Cinader that the focus of the show be changed from physical rescues to depicting paramedics in action.

Cinader’s reaction to Page’s paramedic proposal was initially cool, but he quickly became a believer. Cinader became a fixture in the fire stations that housed the paramedic units, and he accompanied the paramedics on numerous emergency calls. In September 1971, Webb and Cinader signed a contract with the National Broadcasting Company (NBC) television network to produce a two-hour world premiere movie based on the work of the paramedics. The movie, titled Emergency!, was first shown in Los Angeles in December 1971 and aired nationally in January 1972.

In the pre-cable, pre-satellite era when most American television viewers had access to programming only on three national networks and perhaps one or two local stations, Emergency! became a very popular series that ran on Saturday nights on NBC. New one-hour episodes of Emergency! continued to air through 1977, totaling 129 one-hour episodes and 6 two-hour Movies of the Week. Emergency! was often ranked among the ten most-watched shows in the country, and its national audience averaged about 30 million viewers per episode.

The popularity of Emergency! coincided with the explosive expansion of paramedic services. As mentioned above, twelve paramedic units (some of dubious legality) were operating in a few states in 1971. In 1974, President Ford signed the Emergency Medical Services Systems Act into law. That law established funds for which local communities could apply for the purposes of establishing or improving their emergency medical services systems. The Senate Report on the Act identified the requirements that communities were required to meet in order to receive funding. Barely two years after Emergency! went on the air, paramedic services had moved from a scarce and sometimes illegal resource to a requirement for receiving federal funds:

The importance of adequate training of the paraprofessional, who, in most instances, is the first person at the scene of the emergency, cannot be overemphasized …. These individuals on the emergency scene … are capable of providing lifesaving care and utilizing complex equipment essential to save the patient from death and protect him from serious disability.

With the aid of federal funding, by the end of 1975 (during the first 3 years that Emergency! was on the air), forty-six of the fifty American states had enacted laws authorizing paramedic services. By the end of the decade, about one-half of all Americans lived within ten minutes of a paramedic unit.

An analysis of Emergency!’s influence on the rapid expansion of paramedic services must begin with the acknowledgement of the familiar bromide that “correlation does not equal causation.” That is, Emergency! may not have played an independent role in the development of paramedic services, but rather its popularity may have reflected the same interest in paramedic services that produced their spread throughout the country. However, ample evidence supports a conclusion that the TV show was a primary factor that fueled the legal changes that allowed paramedic services to develop and expand….

As time has passed, Emergency! continues to be recognized as a primary influence on the development of paramedic programs. For example, in the year 2000, the president of the American College of Emergency Physicians recognized “the significant role the TV series Emergency! played in raising public awareness of emergency care and promoting the early history and development of modern EMS.” … Looking backwards from the year 2000, Long Beach Deputy Fire Commissioner Scott Kamins tells much the same story:

I remember watching that show [Emergency!] when I was 10 years old, and it is definitely what pushed me into fire services …. There were hardly any emergency service units in local fire departments back then in the early 1970’s, and it was this show that made people want to have such teams in their community while at the same time making it an attractive career path….