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(Brig: t. 91; cpl. 16)
The brigs Rescue and Advance, specially reinforced and fitted out for Arctic service, were offered on loan to the U.S. Government by Henry Grinnell in 1850 for use in tracing the ill-fated expedition which, in May 1845, had sailed from England under Sir John Franklin seeking a northwest passage. Two years later the Admiralty dispatched relief expeditions. Since there was still no news of the expedition by 1 May 1850, the U.S. Congress authorized the President to accept Mr. Grinnell's offer. In accordance with the wishes of both Congress and Mr. Grinnell, both ships were manned by volunteers from the U.S. Navy.
On 22 May, the expedition, commanded by Lt. Edward J. DeHaven, sailed from New York with Reseue's captain AetinR Master Samuel P. Griffin, second in command. Sailing independently the first days out, the two ships rendezvoused at the Whale-fish Islands in Disko Bav, Greenland, and on 29 June headed for Melville Bay and the northern route across Baffin Bay to Laneaster Sound. On 1 July they eneountered their first pack fee off Haroe Island. On the 8th they were caught in the fee north of Upernavik and spent the next 21 days forcing their way through the iee.
Free on the 29th, the brigs continued through the heavy floes of Melville Bay into August. On the 19th, they entered Laneaster Sound. By the 23d, Rescue was off Cape Riley Devon Island. There, Griffin and others from his crew joined searchers from a British squadron in the discovery of a campsite previously occupied by an unknown Royal Navy party.
On the 26th, the American expedition attempted to enter Wellington Channel and search to the north of Cape Spencer. Meeting another British ship, they learned that positive evidence of the Franklin party had been found between the Cape and Point Innes. Ice, however, blocked further progress to the north, through the channel, and to the west, into Barrow Strait.
On the 27th, the search vessels, British and American, gathered in a cove! later named Union Bav, at Beechey Island to plan coordinated searches. As the commanders made their plans, a shore party discovered three graves on the island, across from Cnpe Riley. Franklin's first winter quarters had been found.
From that time on however, little progress was made in the search, even though sledge parties were sent out. One such
party frotn Rescue followed traces of a similar journey by a party from one of Franklin's ships, Erebus or Tcrror, almost to ape Bowden. Continuing past that point they discovered a bay which now bears Griffin's name.
During early September further attempts were made to penetrate the ice barrier to the west. On the 12th, Rescac's rudder post was split in a storm off Griffith's Island and on the 13th the two ships, Advance towing Rescue, turned east in hopes of returning to the United States that season. On the 14th, however, they were caught, frozen, midway across the entrance to Wellington Channel. A winter of drifting began.
During September and October they drifted in Wellington Channel, discovering in the process the northern peninsula of Devon Island which they named after Grinnell. In November they oscillated with the winds and currents near Beechey, and in December they drifted down Lancaster Sound. On 14 January 1851, they were carried into Baffin Bav. At the end of May, their imprisoning floe neared Davis Strait and on 5 June, the fee began to break up. Rescue, repaired, parted company with Advan.ce. On the 7th, she was free. On the 8th, Advance cleared the ice.
Both ships replenished in Disko Bay and into August attempted to renew their search. But the fee was heavier than the previous year and neither ships nor men could have lasted through another winter. Seurvy had struck, but no one had died. A second winter in northern Baffin Bay would have brought a return of the disease and disaster
The ships turned south. Advance reached New York 30 September 1851. Rescue followed her into port on 7 October. Both ships were subsequently returned to Mr. Grinnell and Advance was prepared for a second Arctic expedition.
Iran hostage rescue mission ends in disaster
On April 24, 1980, an ill-fated military operation to rescue the 52 American hostages held in Tehran ends with eight U.S. servicemen dead and no hostages rescued.
With the Iran Hostage Crisis stretching into its sixth month and all diplomatic appeals to the Iranian government ending in failure, President Jimmy Carter ordered the military mission as a last ditch attempt to save the hostages. During the operation, three of eight helicopters failed, crippling the crucial airborne plans. The mission was then canceled at the staging area in Iran, but during the withdrawal one of the retreating helicopters collided with one of six C-130 transport planes, killing eight service members and injuring five. The next day, a somber Jimmy Carter gave a press conference in which he took full responsibility for the tragedy. The hostages were not released for another 270 days.
On November 4, 1979, the crisis began when militant Iranian students, outraged that the U.S. government had allowed the ousted shah of Iran to travel to the U.S. for medical treatment, seized the U.S. embassy in Tehran. The Ayatollah Khomeini, Iran’s political and religious leader, took over the hostage situation and agreed to release non-U.S. captives and female and minority Americans, citing these groups as among the people oppressed by the U.S. government. The remaining 52 captives remained at the mercy of the Ayatollah for the next 14 months.
President Carter was unable to diplomatically resolve the crisis, and the April 1980 hostage attempt ended in disaster. Three months later, the former shah died of cancer in Egypt, but the crisis continued. In November, Carter lost the presidential election to Republican Ronald Reagan, and soon after, with the assistance of Algerian intermediaries, successful negotiations began between the United States and Iran. On the day of Reagan’s inauguration, January 20, 1981, the United States freed almost $8 billion in frozen Iranian assets, and the 52 hostages were released after 444 days. The next day, Jimmy Carter flew to West Germany to greet the Americans on their way home.
At approximately 0400 on Saturday, 12 February 1983 the M/V Marine Electric sent a distress call. The vessel was taking on water and sinking off the Virginia coast in 20&ndash 40 foot seas with winds in excess of 60 knots. The Rescue Coordination Center Portsmouth alerted the Navy at NAS Oceana and the Coast Guard Air Station at Elizabeth City. The ready HH-3F helicopter from Coast Guard Air Station Elizabeth City was immediately dispatched. It was one hour-fifteen minutes enroute in freezing rain. By the time the helicopter arrived the ship had sunk and 34 people were now desperately fighting for their lives in the frigid waters. The rescue basket was prepared and lowered but numbed by severe hypothermia the men were unable to grab the basket and pull themselves in. The Navy helicopter, with a rescue swimmer, was delayed because NAS Oceana did not keep a ready-crew on board the station at night but due to a shorter enroute time to the scene the Navy H-3 helicopter arrived on scene just shortly after the Coast Guard. The Navy swimmer immediately deployed but had difficulty with the &ldquoBilly Pugh&rdquo net collapsing in the rough seas. The two crews agreed to have the rescue swimmer work with a rigid basket lowered from the Coast Guard helicopter. For over an hour, both aircraft, supplemented by a second HH-3F out of Elizabeth City, positioned themselves to receive survivors. The Navy rescue swimmer swam to the point of exhaustion in 40-foot seas in his effort to save as many as he could. Conditions were so severe and the temperatures so cold that sea water on his facemask froze. A number of hoists were made but only three persons were recovered alive. Tragically a total of 31 crewmen perished.
The Congressional Merchant Marine and Fisheries Committee convened hearings to question why the world&rsquos premier maritime rescue service was unable to assist people in the water. It became apparent during the hearings that the existing Coast Guard techniques and equipment were inadequate for rescue in such circumstances as occurred with the Marine Electric.
The rescue swimmers or equivalent had been used by other services for some time. The U. S. Air Force Aerospace Rescue and Recovery Service pararescue operations evolved from trained parachute rescue teams utilized in the latter part of World War II. Originally limited to pararescue operations the scope was expanded over the years to include SCUBA capabilities. During the Vietnam conflict the pararescue man was part of the helicopter rescue teams recovering downed airmen. The U.S. Navy had trained aviation rescue swimmers in support of naval aviation operations.
At the operating level there were Coast Guard personnel that were aware of the need for a rescue swimmer capability within the Coast Guard. Visionaries at several Air Stations created their own rescue swimmer programs. Most notable of such initiatives were New York&rsquos Air Station Brooklyn&rsquos team and California&rsquos Air Station San Francisco&rsquos Sea Air Rotor Wing Evacuation Team (SARWET). With assistance of Air Force personnel training programs were set up. Everything, however, was in house and subject to limited funding. There was no advocate or support at the Headquarters level. This was partly due to the fact that the Coast Guard had been and was in a fight for its very existence the budget was extremely limited and instituting a new program was not top priority.
Congress mandated in the Coast Guard Authorization Act of 1984 that &ldquoThe Commandant of the Coast Guard shall use such sums as are necessary, from amounts appropriated for the operational maintenance of the Coast Guard, to establish a helicopter rescue swimmer program for the purpose of training selected Coast Guard personnel in rescue swimming skills.&rdquo
The responsibility for research and implementation of this project was given to The Aviation Division (G-OAV) at Coast Guard Headquarters. LCDR Dana Goward, of the Aviation Plans and Programs Branch, was assigned to develop a proposal for a Helicopter Rescue Swimmer Program and determine the funds required to implement it. LCDR Ken Coffland, Chief of the Aviation Life Support Branch, was named Program Manager. To assist them was ASMCM Larry Farmer, the Aviation Survivalman (ASM) Specialist at the Coast Guard Institute in Oklahoma City, Oklahoma.
The source and designation of Coast Guard helicopter rescue swimmers was addressed. Aviation ratings in the Coast Guard, in addition to flight crew duties, were maintenance orientated and highly specialized. The extensive training and the maintaining of demanding rescue swimmer qualifications required a specific rating dedicated solely to this function. It was decided to transform a present rating rather than establish a new one. The rating most easily transformed was Aviation Survivalman (ASM). Transition of the ASM rating, however, raised concerns for individuals within that rating who had no interest or the ability to become rescue swimmers. This was resolved by exempting individuals who were E-7 or above and providing a satisfactory procedure to change to a different rating for the others. In June 1984 the Commandant authorized a five-year period to implement the program throughout Coast Guard aviation. Physical fitness standards and requirements were established. The requirements were mission specific. Female personnel who possessed the strength and stamina and met the established standards were eligible to become rescue swimmers.
The initial concept of the Coast Guard program was primarily a maritime rescue resource similar to the Navy&rsquos. An agreement was entered into with the Navy by which Coast Guard helicopter rescue swimmers were trained at the U. S. Navy Rescue Swimmer School at NAS Pensacola, Florida. Training commenced on 10 September 1984. The Coast Guard Air Station Elizabeth City was the first unit to go operational in March of 1985. Two months later the Air Station recorded the first life saved by a rescue swimmer when a severely hypothermic survivor was unable to climb into the rescue basket.
Training for the Aviation Survivalman rating is both specific and intense. As of 1 January 1986, individuals have been required first to pass a physical fitness screening test and then attend sixteen weeks of Aviation Survivalman &ldquoA&rdquo School at ATTC Elizabeth City. This was followed by four weeks of training at Rescue Swimmer School. It was determined that the ability to provide pre-hospital life support for rescued individuals was a necessity. For a short period of time hospital corpsmen were part of the flight crew. Due to weight and space limitations on HH-65 and HH-60 helicopters it was decided that Coast Guard helicopter rescue swimmers should be qualified to perform these duties eliminating the need to carry a hospital corpsmen in the aircraft. Therefore, in addition to their other training, rescue swimmers are required to attend three weeks of training at EMT School at Coast Guard Training Center Petaluma, CA.
ASMCM Farmer developed the Coast Guard Helicopter Rescue Swimmer Manual to promulgate policies and operating procedures. The rescue swimmer deployed either by free fall from the helicopter or via the hoist cable and equipped with mask, fins, snorkel, and appropriate anti-exposure garments, would swim freely to assist the survivor. Master Chief Farmer, himself a rescue swimmer, was selected to lead the Rescue Swimmer Standardization Team at Air Station Elizabeth City established in September 1984. The Rescue Swimmer Standardization Team remained at Elizabeth City until August 1988 when it was transferred to ATC Mobile.
A comprehensive schedule was developed for the implementation of the program throughout Coast Guard aviation. Every air station providing operationally ready helicopters for search and rescue was required to utilize rescue swimmers. In addition to Air Station Elizabeth City, San Francisco followed on November 1 1985 Astoria on 31 January 1986 Clearwater on 11 August 1986 Sitka on 20 November 1986 and Cape Cod on 1 December 1986. Implementation would continue but there was considerable resistance within Coast Guard aviation regarding the need for rescue swimmers. Reasons and opinions put forth by those opposed were numerous and varied. Some had merit and were addressed. In most cases, however, it was a resistance to change. One of the greatest challenges was overcoming this resistance.
Initially there was a reluctance to deploy rescue swimmers except under favorable conditions. As operational experience was gained the saving of life dictated otherwise and rescue swimmers were increasingly utilized in extreme weather conditions. On 10 December 1987, Air Station Sitka, Alaska, received a distress call from the F/V Bluebird taking on water about 10 miles southwest of Sitka. An HH-3F was quickly launched to search for the vessel. The weather conditions were terrible. Visibility was down to ¼ mile in a severe snow storm, the seas were running at about 25 to 30 feet and the wind was blowing at 35 knots with gusts up to 70 knots. Aboard the vessel was a 33 year-old man and his 6 year-old son both of whom were wearing survival suits. In the heavy seas the tall rigging of the sinking boat swayed violently from side to side with the stern already awash. Despite numerous attempts the pilot and hoist operator were unable to get the rescue basket to the two people on the boat. The two survivors abandoned the vessel as it rolled and went down by the stern. The man&rsquos survival suit leaked and immediately filled with water. After several attempts to get into the basket, it became apparent that they could not. The rescue swimmer, ASM2 Jeffery Tunks, volunteered for deployment. In a few short moments Petty Officer Tunks was in the turbulent water and swimming to assist the two individuals. Fighting heavy seas and winds, Petty Officer Tunks struggled to get the two survivors into the rescue basket. Once secured, they were hoisted to the hovering HH-3. With the aircraft being buffeted by extremely gusty winds during the subsequent effort to recover the rescue swimmer, Petty Officer Tunks was dragged through an enormous sea swell, causing him to lose his mask and snorkel and sustain an injured back. Tunks was ultimately recovered and with the two survivors safely aboard, the HH-3 returned to Sitka. For his courage and presence of mind in deploying into conditions as yet not previously encountered during previous rescue swimmer operations ASM2 Jeffery Tunks became the first rescue swimmer to earn the Distinguished Flying Cross the nation&rsquos highest peacetime award for heroism.
CITATION TO ACCOMPANY THE AWARD OF THE DISTINGUISHED FLYING CROSS
JEFFERY D. TUNKS AVIATION SURVIVALMAN SECOND CLASS UNITED STATES COAST GUARD
Petty Officer TUNKS is cited for extraordinary heroism during aerial flight on the night of 10 December 1987 as rescue swimmer on Coast Guard HH-3F 1486 engaged in the perilous rescue of a man and his son from the F/V BLUEBIRD which sank in storm tossed waters 10 miles southwest of Sitka, Alaska. The helicopter launched into a blinding snowstorm and severe turbulence to assist the stricken 26 foot fishing vessel foundering in 30 &ndash foot seas. The two survivors abandoned the vessel as it rolled and went down by the stern. After several unsuccessful hoist attempts in the 70 knot winds, Petty Officer TUNKS voluntarily deployed into the frigid, angry seas. Swept back 75 yards from the victims as he was being lowered, Petty Officer TUNKS struggled through the towering waves to reach the survivors who were by now immobilized by the icy water entering their survival suits. He calmed and reassured them. Then with Herculean effort Petty Officer TUNKS was able to pull the survivors away from the sinking vessel, grab the sea tossed rescue basket after several attempts and roll them into the relative safety of the basket for hoisting. Later, as Petty Officer TUNKS was himself being hoisted, the helicopter was driven backwards by particularly violent gusts Petty Officer TUNKS was smashed into the breaking waves which ripped away his mask and snorkel and injured his back. Petty Officer TUNKS&rsquo remarkable fortitude and exceptional daring in spite of imminent personal danger saved the father and child from perishing at sea. His courage and devotion to duty are most heartily commended and are in keeping with the highest traditions of the United States Coast Guard.
Operations such as this continued to occur with increased regularity. As more people became aware of the significant enhancement that rescue swimmers gave to SAR team capabilities attitudes changed and resistance to the program changed to endorsement. The rescue swimmer became &ldquomy swimmer.&rdquo
Like so many programs in the Coast Guard, lack of funding was a problem. The program was temporarily halted during 1987 and much of 1988. Fortunately funding for the program was restored in 1988 and implementation of the remaining air stations was rescheduled. Ten air stations went operational during 1988-1989. Budget constraints occurred again in 1990 and only three air stations went operational. LCDR Richard M. Wright became Rescue Swimmer Program Manager, and between February and July 1991, he implemented the final five air stations and two air facilities.
Rescue swimmers were being utilized in an increasing variety of operational situations. The Coast Guard was responding to persons in distress along rugged coastlines as well as further inland in ever increasing numbers. Concern was expressed that the training received by rescue swimmers and flight crews did not adequately prepare them for such conditions. The requirement for additional training and procedures did not gain a sense of urgency until a rescue swimmer was nearly killed in an attempt to rescue a stranded hiker off a 120 foot cliff along the rugged Oregon coastline.
LCDR Wright with the assistance of ASMCM Darrell Gelakoska, who became Chief of the Rescue Swimmer Training Branch, evaluated techniques whereby the rescue swimmer remained attached to the hoist cable and deployed directly to a survivor. This was followed by a program to expose rescue swimmers to severe sea conditions. ASMCM Gelakoska recommended in early 1995 that advanced training be provided in hazard awareness and the various new procedures, techniques and equipment that rescue swimmers did not receive in Rescue Swimmer School or normally encountered during operations at their air stations. A formal proposal was made and approved and an Advanced Rescue Swimmers School was established at Astoria, Oregon. The rugged coastline, demanding surf and prevailing high seas provided ideal training conditions. Twice a year for one month periods, HH-65A, HH-60J and Rescue Swimmer Training Branches from ATC Mobile host advanced rescue swimmer training for pilots, hoist operators, flight mechanics and rescue swimmers from all Coast Guard air stations. Although the mission of the school is to conduct training in advanced rescue swimmer operations, the focus is upon integrating the pilots and aircrew into an entire team to enhance the Coast Guard&rsquos ability to conduct helicopter rescue safely and efficiently. It is now a highly sought training opportunity by not only Coast Guard rescue swimmers, but also Navy, Air Force and international students. In 1997, the Coast Guard opened the Rescue Swimmer Training School at Coast Guard Air Station Elizabeth City.
The Coast Guard Helicopter Rescue Swimmer Program has and continues to be outstandingly successful. During the period 1985 &ndash 2004, Coast Guard helicopter rescue swimmers saved more than 5,700 lives. This elite group operates in the most severe weather conditions imaginable deploying into extremely hostile environments. The record of success is directly attributable to the training, professionalism and courage not only of the rescue swimmers but also of the aircrews who deploy them. Only those who have willfully placed themselves in harm&rsquos way and have known that innermost feeling which comes from a personal experience resulting in the saving of life can understand the bonding and uniqueness of this group of kindred spirits. Courage and devotion to duty is a common trait.
Aviation Life Support Equipment
During 1970 a Life Support Section came into being, however, the emphasis was still on flight safety and standardization. Life support equipment was primarily of Navy derivation and those items germane to Coast Guard missions were obtained. It was not, however until late 1979 that helicopter crews were required to attend the Navy&rsquos Helicopter Egress Trainer. Egress inability is no longer a problem. As late as 1981 aircrews were flying in flight suits that did not protect against hypothermia. With the advent of the Rescue Swimmer Program the development of Life support equipment was accelerated. Rescue Swimmer personnel CDR. O&rsquoDoherty, LCDR Coffland, LCDR Wright, ASMCM Farmer and ASMCM Giza were directly involved in acquisition and development of life support equipment.
In 1986 the Coast Guard evaluated two prototype aircrew anti-exposure coveralls resulting in the first anti-Coast Guard exposure coveralls. This evolved into the procurement of the CWU-62P Aircrew Drysuit.
In 1991, working closely with the Gentex Corporation, the Coast Guard developed the SPH-5CG helmet used by helicopter crews. It is a form fit, lightweight composite shell and energy-absorbing liner providing impact protection. It has a visor system to protect the eyes from glare, wind and dust and is equipped with a quick disconnect device for ANVIS-6 night vision goggles. The internal wiring of the helmet is compatible with all Coast Guard aircraft. The helmet dampens noise in excess of 39 decibels. The result is a light weight helmet that provides outstanding crash protection, sound attenuation and comfort.
In fulfillment of its drug interdiction mission the Coast Guard operated E-2C and RG-8A surveillance aircraft. The existing parachute system in the E-2C did not meet Coast Guard requirements and the RG-8A had no bail out system at all. The Aviation Life Support Branch began a search for a parachute sufficiently compact to work in the E-2C and also compatible with the extremely small cockpit of the RG-8A. A parachute manufactured by Butler Parachute Corporation, similar to those worn by the crew of the Voyager aircraft, was chosen. To meet Coast Guard requirements the parachute was modified to contain an LRU-18/C one person life raft and a normal complement of survival aids. The package was designed as a backpack for the RG-8A and as a chest pack for the E-2C and EC-130V.
Equipment utilized by the airlines for smoke and/or fire in the cockpit which also provided eye protection was investigated. The EROS Quick Don Oxygen/Smoke mask best satisfied Coast Guard needs. An Underwater Emergency Rebreather was developed as an interim measure and was replaced by an Emergency Survival Air System (ESAS) which was compact and could be placed into the side of LPU-25/P survival vest and greatly enhanced underwater egress.
Billy Sunday Revival 1910
During Sunday's crusade many who belonged to the local Personal Workers League attended and were influenced by Sunday's testimony and became seriously interested in founding a rescue mission in New Castle. At the invitation of the Personal Workers League, Melvin "Mel" Trotter, another prominent evangelist, visited New Castle in October, 1911 to assist in the formation of a rescue mission. Trotter, also a former alcoholic who was saved at the Pacific Garden Mission, was then the Superintendent of the Grand Rapids Rescue Mission (now known as Mel Trotter Ministries) and the founder of 67 other rescue missions throughout the country. Trotter believed rescue missions shouldn't compete with churches, but rather should be an outreach of the church reaching the "least and lost" of our communities.
Trotter assisted the Personal Workers League and Robert McKinney, a prominent member of the League, to found the City Rescue Mission. On October 18, 1911, at the Melvin Trotter meeting held at the First Baptist Church, between $2,500 and $2,600 was raised in pledges for a rescue mission. In today's dollars, the amount pledged would be about $58,000! Edward J. Berquist was appointed to be the first Superintendent. The City Rescue Mission began its work as a mission outreach of the local churches in the basement of Mr. McKinney's New Castle Notion Co. on South Mill Street and then shortly thereafter moved into the Marshall block building on South Croton Avenue. On November 25, 1911, the first draft of the Constitution was drawn up and a board of directors was chosen from various churches in order to ensure the best management of the Mission.
Birth of EMS: The History of the Paramedic
It was the early 1970s. President Richard Nixon had just taken office and America was still entrenched in the Vietnam War. The Godfather was on the big screen and disco danced its way into the mainstream. The most important milestone, however, occured only a few years earlier in 1966. President Lyndon B. Johnson received the report Accidental Death and Disability: The Neglected Disease of Modern Society , which identified accidental injuries as the “leading cause of death in the first half of life’s span.”
The report revealed that in 1965 alone, vehicle accidents killed more Americans than were lost in the Korean War. When evaluating prehospital emergency care, the report identified that “if seriously wounded “¦ chances of survival would be better in the zone of combat than on the average city street.” Additionally, the report identified a lack of regulation or standards for ambulance operations or provider training.
Commonly known as “the White Paper,” this report made several recommendations for the prevention and management of accidental injuries, including the standardization of emergency training for “rescue squad personnel, policemen, firemen and ambulance attendants.” This standardization led to the first nationally recognized curriculum for EMS–emergency medical technician—ambulance (EMT-A)–which was published in 1969. Many consider this document to be the birth of modern EMS.
JEMS founder Jim Page stands with an L.A. County Rescue response truck in 1959. Photo A.J. Heightman
Creation of the Paramedic
Despite the documented regulations, some people believed more could be done in the out-of-hospital setting, including advanced airway management, vascular access and medication administration. This led to the creation and implementation of the emergency medical technician—paramedic (EMT-P) curriculum in the early 1970s, with pioneering work by Walt Stoy, PhD, Nancy Caroline, MD, and others in Pittsburgh. But prior to the declaration of this new title, several organizations had already begun training personnel in advanced procedures and medication administration, creating the nation’s first paramedics.
The first EMT-P curriculum included 400 hours of class, lab and clinical rotations in various hospital settings followed by a 100-hour field internship. As prehospital advanced life support (ALS) care gained favor within systems and communities, more paramedic programs sprouted up around the country.
By 1972, the expectation of advanced-level care on the streets and in the homes of Americans grew, fueled by the iconic TV show Emergency! , which portrayed paramedics providing care in an advanced manner never before seen, now watched by millions every Saturday night. For more than five years, America watched Johnny and Roy swoop in to save lives and help those in distress.
Although just a TV show, Emergency! set a standard expectation for the public and served as a catalyst for many to pursue careers in EMS.
JEMS publisher Jim Page, then an L.A. County battalion chief, served as a technical editor for the show and is credited with making the producer and director portray paramedics as professional and well-educated–a solid step for future EMS educational endeavors.
This 1941 low headroom ambulance was called the “Black Maria” in reference to the small, black vans that transported prisoners in the 1950s. Photo A.J. Heightman
As interest in EMS grew, more and more people attended CPR, EMT and paramedic classes. Still, there were many unanswered questions about prehospital medicine. There wasn’t much science to prove what treatment was effective in the emergency setting and other areas of medicine didn’t provide much guidance. Initial paramedics didn’t have experienced staff members to guide them, and the emergency physician as we know it today didn’t exist.
It wasn’t until 1972 that the first residency program to train physicians specifically for the practice of emergency medicine was established at the University of Cincinnati. Still, advanced cardiac life support (ACLS) didn’t exist until 1979 and wasn’t universally required for paramedic training and certification until the mid 1980s, meaning care of patients in cardiac arrest varied widely from provider to provider. Paramedics were taught by nurses and physicians who were interested in emergency medicine and had visions of what it could look like in an out-of-hospital setting. Many, however, had never worked in the sometimes harsh prehospital setting or in the back of a moving ambulance.
This 1975 International Travelall Ambulance had limited room for supplies. Photo A.J. Heightman
Visionary pioneers of EMS and EMS education recognized the need to further the standardization and regulation suggested in the White Paper. In 1970, the first board of directors of what is now the National Registry of EMTs (NREMT) met to determine the feasibility of creating a national certifying exam. In 1971, Rocco V. Morando was selected as the founding executive director of the NREMT and in the same year, 1,520 personnel took the first NREMT-Ambulance exam.
Seven years later, the first NREMT-Paramedic exam was given in Minneapolis. That same year, the NREMT became a member of the National Commission for Health Certifying Agencies. During this same timeframe, paramedic programs saw the need for validation through a national accreditation process. EMT-P became an approved health occupation through the Council of Allied Health Education and Accreditation (CAHEA) and in cooperation with the Joint Review Committee for EMT-P, and these organizations continued reviewing paramedic programs.
In 1980, the University of California, Los Angeles (UCLA) and Eastern Kentucky University were the first institutions to have their programs reviewed. Other forward-thinking programs quickly followed.
The reviewing entities are now the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP). Both continue to work in concert to evaluate, reevaluate and accredit paramedic programs. As of the press time, CAAHEP reports 365 currently accredited programs and 246 programs in the process of becoming accredited.
Much has changed since the initial development of the EMT-P level of practice. The initial EMT-P curriculum was updated in 1985 and again in 1998. The 2000 EMS Education Agenda for the Future: A Systems Approach carried the vision of the 1996 EMS Agenda for the Future, and 2009 saw the most recent change in paramedic education in the form of the Education Standards. The Education Standards are less prescriptive than the original curriculum. This allows paramedic education to change as the practice changes. This also requires those running paramedic programs to keep current with advances in medicine and to be proficient in the writing of curriculum. For example, paramedic education programs now require more time in field internships than was once required to complete the entire program. Programs are also now aligned with collegiate institutions and graduate paramedics are backed with two- and four-year degrees in their field.
Continuing to move toward standardization and accountability, the NREMT has stated recently that only students who graduate from CoAEMSP-accredited paramedic programs are allowed to take the NREMT-P exam. This change has forced programs across the country to evaluate their criteria and either seek accreditation, close their doors or graduate students who aren’t eligible to be nationally registered.
CoAEMSP continues to evaluate required competencies required for paramedic programs. One of the recent changes made requires paramedic program directors to hold at least a bachelor’s degree. Now, not only are those who run paramedic programs vested with EMS experience and insight, but they’re also well-educated. Many program directors have moved beyond their four-year degree to obtain a master’s or doctorate.
Maintaining the educational standards set by the profession and demanded by society is not an easy nor an inexpensive task. Successful paramedic programs have multiple faculty and use the latest in communication technology and training.
A paramedic student practices splinting an ankle during ED clinical rotation, circa 1975. Photo courtesy HealthONE EMS
Several of the originally accredited paramedic programs are no longer accredited or in existence. There was no numbering system when CAHEA provided accreditation, so numbering of paramedic programs in the order they obtained accreditation began with CoAEMSP. The remaining active programs of the first ten currently accredited are:
- 600001–UCLA Center for Health Services, Los Angeles, Calif.
- 600002–Eastern Kentucky University, Richmond, Ky.
- 600003–Pennsylvania College of Technology, Williamsport, Pa.
- 600005–HealthONE EMS/Arapahoe Community College, Englewood, Colo.
- 600006–Northern Virginia Community College, Annandale, Va.
- 600007–Centura Health-St. Anthony Hospitals, Denver, Colo.
- 600009–Columbus State Community College, Columbus, Ohio
- 600010–University of New Mexico School of Medicine, Albuquerque, N.M.
Several of the original programs are still accredited, and many continue to work with partners within the industry to advance the profession.
The inside of a Scranton, Penn., ambulance in 1970. Photo A.J. Heightman
Evaluating the Accreditation Process
Directors from paramedic programs serve as site visitors for the CoAEMSP to help with the initial accreditation and reaccreditation of paramedic programs. Faculty from paramedic programs sit on the board of directors for the NREMT and work on test-writing committees and pilot groups. Recently, eight programs worked with the NREMT to look at the feasibility of changing the paramedic psychomotor exam from an isolated skill exam to a scenario-based exam.
UCLA Center for Health Services, HealthONE EMS, University of Texas South West, Creighton University, Inver Hills Community College, Chemeketa Community College, Oklahoma Community College and Gwinnette Technical College worked with NREMT to create a process where paramedic students will create a portfolio of the isolated skills they learned during their program. Upon completion of the program, the isolated skill exam can be replaced with a scenario exam, which may better assess the student’s ability to function as a provider in the field.
Prehospital Medicine Evolution
Evidence-based medicine is changing how we think about the practice of medicine in general, and prehospital medicine is not exempt. We are no longer doing skills or providing treatment because we believe that skill or intervention to be cool or sexy. Patient care needs to be vested in what is proven to make a difference in patient outcome. This process is a large driving force in paramedic education. Much of what we do–including spinal immobilization and endotracheal intubation–is being evaluated. Paramedic programs will serve as advocates to the advancement of evidence-based medicine. Paramedic graduates must know how to not only read and interpret research, but must understand the basis by which a research study is established.
Many don’t understand the complexity and structure of paramedic programs today. Gone are the days when a physician could teach some advanced skills to a provider and then call them a “paramedic.” Paramedic education has matured, as has the EMS profession. Paramedic programs today are well structured, supported within their local EMS community and backed by or found within institutions of higher education. Quality paramedic programs offer themselves up for evaluation by accrediting bodies supporting and participating in the process. Quality paramedic programs are integral components within the foundation of EMS.
History of Rescue I - History
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Special Forces routinely pull off audacious rescue missions. But to do so on live television? That takes extra daring. But it&rsquos what Britain&rsquos Special Air Service (better known as the SAS) did in the spring of 1980. The stakes could not have been higher: rescue the hostages and be lauded as heroes or fail and be blamed for the death of innocents, with the fallout watched by a TV audience in the millions. Thankfully for the SAS, their political masters, and the hostages involved, the mission was a resounding success. What&rsquos more, Operation Nimrod is now the stuff of legend, not least in Britain.
It all started on the morning of April 30. A group of six men, calling themselves the Democratic Revolutionary Movement for the Liberation of Arabistan, calmly walked into the Iranian Embassy in London and announced they were taking control of the building. Since they were armed with machine guns and explosives, and since there was only one armed policeman inside the Embassy at the time, they had it under their control within minutes. In all, 21 people were taken hostage. To secure their release, the terrorists demanded that 91 of their comrades-in-arms be freed from prisons in Iran. The British government was given just 24 hours to make this happen.
Straight away, plans to storm the Embassy and free the hostages were drawn up. The elite SAS were to carry out any rescue mission. At first, however, hopes were high that police negotiators could secure a peaceful end to the siege. They did indeed succeed at getting the terrorists to extend their deadlines. But then, on the sixth day, they executed the Embassy&rsquos press officer, dumping his body out in the street in full view of the watching TV news cameras. Prime Minister Margaret Thatcher, determined to be seen as tough on terrorists, gave the rescue mission her official green light.
The SAS leaders decided on a two-pronged attack. One team of soldiers would abseil down from the roof and enter the Embassy through third-floor windows. Meanwhile, another team would come out of the neighboring building and break in through the first floor. The two teams would then go through the Embassy room by room until they met. At 19:00 on 5 May, Operation Nimrod got underway. Almost immediately, however, it was in jeopardy: one of the men abseiling down from the roof got stuck. The officer in charge told his men to carry on with the plan. It worked.
The terrorists were caught completely by surprise. The better-trained SAS men swept through the Embassy. All the hostages were rescued safe and sound. Five of the terrorists were shot dead, with the sixth taken hostage. TV viewers had watched amazed as the SAS brought the siege to a dramatic conclusion. The SAS men left quickly and quietly. They became national heroes and Operation Nimrod became the stuff of legend &ndash and a blueprint for other special forces to follow when confronted with a hostage situation.
History of the ASPCA
The ASPCA ® is proud of our long, storied history of progress and innovation in the fight against animal cruelty. From medical developments to field rescues to pioneering partnerships, here's a look at some of the successes we—and our millions of supporters over the years—have achieved on behalf of abused, abandoned and neglected animals.
A History of Compassion
While on assignment in Russia as an American diplomat, a New Yorker named Henry Bergh stopped a carriage driver from beating his fallen horse. The year was 1863, and it was then and there that Bergh realized the effect he could have on the world. He soon resigned his post and returned to New York to devote his energy to the prevention of cruelty to animals. In 1866, he founded the American Society for the Prevention of Cruelty to Animals ® .
Henry Bergh, Founder of the ASPCA
Bergh faced an uphill battle from the start. At the time, America was not a friendly place for animals: workhorses hauled overloaded carts through the streets, dogcatchers were known to kidnap pet dogs and hold them for ransom, and dog fighting and cockfighting were common forms of “entertainment.” But Bergh was determined, and he founded the ASPCA on the clear belief that all animals are entitled to kind and respectful treatment and must be protected under the law.
Looking back, we now know that that Russian carthorse was the “first” in what was soon to be a long line of firsts. When founded, the ASPCA was the first and only humane society in the Western Hemisphere, and its formation prompted the New York State Legislature to pass the country’s first effective anti-cruelty law. Thanks to Henry Bergh, the world was rapidly becoming a better place for animals.
The ASPCA’s official seal, drawn by Frank Leslie and unveiled in 1867.
To the Rescue
It should come as little surprise that the ASPCA’s official seal, drawn by Frank Leslie and unveiled in 1867, depicts an angel of mercy protecting a fallen carthorse from a spoke-wielding abuser. From the start, animal rescue has been at the heart of what we do—both in practice and on the ground. In 1867, the ASPCA operated the first ambulance for injured horses, a full two years before New York City’s Bellevue hospital put the first ambulance for humans into service. Eight years later, Henry Bergh invented a canvas sling to rescue horses the sling would later be used on the battlefields of Europe during World War I.
Over the ensuing years, progress in the field of animal rescue became as much a part of the ASPCA’s DNA as the compassionate roots on which we were founded. In fact, by the early 2000s, the ASPCA had become a common presence in the face of natural disasters, puppy mill busts, dog fighting raids and other forms of cruelty intervention. Following Hurricanes Katrina and Rita in 2005, we deployed staff to the Gulf Cost to assist in animal rescue and recovery, and in ’07, we played an instrumental role in the federal investigation of a brutal dog-fighting operation run in part by quarterback Michael Vick. Already a force to be reckoned with, our reach only grew in 2013 when we announced a groundbreaking partnership with the New York City Police Department (NYPD). In its first two years alone, that partnership increased the number of animal cruelty arrests in New York City by more than 200%.
Innovations in Animal Placement
While animal rescue is a cornerstone of the ASPCA’s efforts, our job doesn’t end once an animal is safe. In fact, the rescue is often just the beginning of an animal’s journey, and our work to get potential pets off the streets and into permanent homes touches every corner or America: the ASPCA’s assistance, funding and expertise help facilitate tens of thousands of animal adoptions around the country every year. But those tens of thousands of animals—now happy, safe and loved—are the result of more than a century of hard, dedicated work.
It began with the opening of our first veterinary facility, a horse dispensary on Manhattan’s 24 th Street, in 1912. From there, the advancements poured forth: ASPCA veterinarians were the first to operate on a horse with a broken kneecap (a procedure considered impossible at the time) and the first to use radium to treat cancer in animals. We advanced the use of anesthesia in animal surgery, and inaugurated dog obedience training classes in 1941. By 1961, we were poised to perform our first open-heart surgery on a dog.
Pet population control, along with effective measures to keep animals from being surrendered, were also a critical key to our success in the field of animal placement. In 1973, the ASPCA Adoptions department began spay/neuter for all adopted animals, and in 1995, we acquired the Animal Poison Control Center (APCC), which is still known as the preeminent animal poison control center in North America. What’s more, we pioneered the use of state-of-the-art microchips for animal identification.
Never content to rest on our laurels, our innovations have continued to the present day. In 2007, we launched the ASPCA Partnerships program to support at-risk animals in communities around the country through grants, training and many other resources. In 2013, we opened the ASPCA Behavioral Rehabilitation Center—the first and only facility dedicated to providing behavioral help for canine victims of cruelty—and just last year we completed the expansion of our Canine Annex for Recovery & Enrichment (CARE) ward, which treats victims of cruelty rescued through our partnership with the NYPD. In 2015, we also acquired Humane Alliance, a national pioneer in high-quality, high-volume spay/neuter services and training.
Pioneers of Protection
Field rescues, medical operations and behavioral treatment are all methods we use to save the life of an animal, but at the ASPCA, we are also focused on the bigger picture—that is, saving the lives of many animals at once. Henry Bergh set the tone in the 1870s when he became a prosecutor of animal abuse cases outside of New York City, and from then on, we have made it a top priority to work closely with all levels of government to pass stronger anti-cruelty laws, and to defeat harmful bills.
In 1873, the ASPCA played a role in enacting a federal law requiring that all shipped animals be allowed food, water and exercise during extensive transit. We also promoted the use of the mechanical “gyro-pigeon” as an alternative to live pigeon shoots. Numerous victories followed. The Animal Welfare Act of 1966 was passed with support from the ASPCA it is the only federal law that regulates the treatment of animals in research and exhibition. In 1998, we successfully petitioned the U.S. Food and Drug Administration to declare meat from downed animals adulterated, and in 2003, we supported the development of Humane Farm Animal Care—the first organization to establish standards accepted by the U.S. Department of Agriculture and the International Organization for Standardization for the humane treatment of farm animals, from birth to slaughter.
As the decades flew by, our legal efforts gained focus and strength. Millions of people joined the ASPCA Advocacy Brigade to help us fight for better laws in states across the nation, and we continued to see victories in Congress in the form of the Animal Fighting Prohibition Act (2007), the Animal Crush Video Prohibition Act (2010), the Veterinary Medicine Mobility Act (2014) and the Animal Fighting Spectator Prohibition Act (2014)—just to name a few.
In recent years, our work has taken on new life with the formation of animal protection initiatives on both coasts. In 2013, we announced a $25 million, multi-year commitment to Los Angeles to help tackle the city’s homeless animal crisis, and we launched Safety Net programs to assist pet owners where help is needed most.
These three areas of expertise—animal rescue, animal placement, and animal protection—are the bedrock on which the ASPCA stands. They represent the full circle of our work, impacting animal victims of cruelty at every stage, and they comprise the foundation on which we will continue to build for years to come.
We are proud of all that we have achieved since 1866, but we know that there is no time to rest. In fact, we just recently announced the relocation of the ASPCA Behavioral Rehabilitation Center to a permanent new facility in Weaverville, North Carolina. What’s more, we published an ASPCA-sponsored study in early 2017 showing dramatic decreases in shelter intake and euthanasia of homeless dogs and cats, and an 18.5% increase in adoptions—proof that progress is occurring on a national scale. We look forward to continuing to use the strength of our experience to become more effective than ever before—from permanently banning horse slaughter to further reducing the number of at-risk animals in shelters and communities nationwide, we have set our sights on a very bright future, indeed. With millions of supporters all around the country, we know that we are closer than ever to achieving our ultimate goal: a nation free from cruelty to animals.
Submarine escape and rescue: a brief history
The disaster which befell the Russian submarine Kursk in August 2000 caught the world’s attention and became a galvanising event in drawing renewed focus on submarine safety in the new century. Public empathy worldwide seemed to be driven by the belief that when a submarine goes down there is little that can be done for the crew. However, the history of successful submarine escape and rescue is as long as the history of the submarine itself.
As submarine capabilities were gradually introduced in various navies around the world, a common question also emerged: what can be done in the event of a submerged accident that disables the submarine and prevents it returning to the surface? Essentially the answers remain the same.
There are two options available for the crew of a submerged disabled submarine (DISSUB) escape or rescue. Escape is the process where the DISSUB’s crew leaves the boat and reaches the surface without external assistance while rescue is undertaken by outside parties who remove the trapped crew from the submarine. At the dawn of the modern submarine age the initial focus was given to escape. Appearing around 1910 the first escape systems were derived from the breathing apparatus used by coal miners. These used a soda-lime cartridge which binds large quantities of carbon dioxide, cleaning the air breathed. The system utilised in the first submarine escape was the German Dräger breathing apparatus, used when the submarine U3 sank in 1911.1 A number of similar systems followed with the Davis Submarine Escape Apparatus (DSEA) being adopted by the Royal Navy in 1929 and the Momsen Lung used by the United States Navy (USN) until 1957.
These escape systems remained prevalent until 1946 when the Royal Navy held an inquiry into escape from sunken submarines. The inquiry found no difference in survival rate between those who used a DSEA to escape and those that did so unaided.2 As a result the DSEA was replaced with the ‘free ascent’ or ‘blow and go’ technique. Free ascent involved the crew member beginning the ascent with compressed air in their lungs. During the ascent the submariner breathed out at a controlled rate, allowing air to escape. This was a continual process, as the air expanded in the lungs due the decreasing pressure experienced en route to the surface. To limit the chance of being affected by decompression sickness, the escapee would use the bubbles of expelled air to judge the ascent by staying behind the smaller bubbles. To aid in the escape, a crew member might also use a life jacket or buoyant ring. In this case the rate of ascent was more rapid, which required the submariner to blow more rapidly throughout the journey to the surface. Buoyancy assisted free ascent continues to be practiced by Royal Australian Navy (RAN) submariners at the Submarine Escape and Rescue Centre at HMAS Stirling in Western Australia.
After a brief flirtation with free ascent, the USN implemented the Steinke Hood in 1962. Literally a hood with a plastic face mask attached to a life jacket, the Steinke Hood allowed the crew member to breath air trapped in the hood on their ascent following escape. Breathing in the trapped air reduced the chances of contracting the bends if the user breathed normally.
Free ascent and the Steinke Hood were favoured for their ease of use, but both systems had one glaring flaw: they failed to provide protection from the elements once the submariner reached the surface. This was apparent in 1950, when HMS Truculent sank following a collision with a merchant vessel within sight of the British shore. All of the 72 crew made it to the surface but only 15 survived with the rest swept out to sea by the tide and lost. These shortcomings were again evident with the Kosmsomlets disaster in 1989.
Of the Soviet submarine’s 69 crew, 34 of those who made the ascent to the surface later died from hypothermia, heart failure or drowning. In the 1990s a large percentage of the world’s navies operating submarines, including the RAN, replaced their existing escape systems with either the British developed Submarine Escape Immersion Ensemble (SEIE) or local versions of that design. Using trapped air, similar to the Steinke Hood, the SEIE covers the user completely and importantly, provides thermal protection. Further, the suit has an inbuilt life raft that, once on the surface, can be linked to other life rafts. The suit allows for an escape from 185 metres.
Prior to 1939 it was generally considered that if the crew could not escape the DISSUB then there was little that could be done to rescue them. During the 1920s some navies, in particular the USN, used salvage type operations with some success. However, these early rescue operations were conducted under ideal conditions which seldom occurred in practice. Often the amount of damage suffered by the submarine was unknown, which meant the submarine could not be moved as it might break apart in the process. Time was also a factor as the crew would have only three days of air at the most. Unfavourable conditions on the surface would prevent a salvage operation being carried out, as was the case in 1927 with the American submarine S-4 when gale force winds prevented the rescue from commencing in time. Due to the difficulties involved, salvage was abandoned as a means of rescue. Thinking on submarine rescue changed dramatically in 1939 with the sinking of USS Squalus. During seagoing trials an equipment failure resulted in the flooding of Squalus’ aft torpedo room, engine rooms and crew’s quarters killing 26 of the boat’s 59 crew instantly. Quick work by the remaining submariners prevented further flooding but the boat, now disabled, came to rest 74 metres below the surface. Since Squalus was carrying out the exercise in company with her sister ship, USS Sculpin, the DISSUB was quickly located and the alarm raised. What followed was the first true and, to this day, only successful submarine rescue.3 The submarine rescue ship Falcon arrived on site with submarine salvage and rescue expert Lieutenant Commander Charles B ‘Swede’ Momsen, USN, on board.
Momsen, the man who invented the Momsen Lung, employed the newly developed McCann Rescue Chamber to great effect. The chamber was a large steel bell that was lowered from a surface vessel to cover the submarine’s escape hatch. Once attached it was possible to reduce air pressure and open the hatch to allow the trapped submariners to climb aboard. Using the chamber the 33 surviving crew members were rescued in four trips. The McCann Rescue Chamber System remains in service in several contemporary navies, including the USN and the Turkish Navy. Submarine rescue philosophies evolved further in the 1960s following the loss of two American nuclear powered submarines, US Ships Thresher and Scorpion, despite both boats being lost in waters that precluded escape or rescue. After considering a variety of options, including submarines with in-built escape pods (similar to the Russians) and submarines with front ends that could be blown to the surface, the USN developed the Deep Submergence Rescue Vehicle (DSRV). Entering service during the 1970s the DSRV, a manned mini-sub that mates with a DISSUB’s hatch and could carry 24 people at a time, offered great flexibility. With two built, one is maintained in an operational state so it can be flown in a C-5 cargo plane to a port nearest the DISSUB. It can then be placed onboard either a modified US or allied submarine. Operating from a submarine means that rough surface conditions or ice is less likely to adversely affect rescue operations.
US Navy DSRV with HMAS Rankin in Hawaii (RAN) Other navies followed the lead of the USN and developed their own portable rescue capabilities. The Royal Navy’s LR5 Submarine Rescue Vehicle (SRV) is similar to the DSRV in most aspects but instead of using a modified vessel the LR5 uses a ship of opportunity as the Mother Ship. The LR5 is part of the UK’s multifaceted Submarine Rescue Service which also includes the Submarine Parachute Assistance Group (SPAG) and the Scorpio Remote Operated Vehicle (ROV). Composed of selected staff members from the submarine escape training tank and rapidly deployable, the SPAG functions as a first–on-site capability that provides assistance to a DISSUB or to those who have escaped. The obvious benefit of the SPAG is that timely assistance and coordination can be provided in order to avoid another Truculent or Kosmsomlets. The primary function of the Scorpio is to inspect and survey the DISSUB on the ocean floor. It can also clear debris from the site and record data such as water temperature, which is then used to assist in deciding on a suitable rescue strategy. Both the LR5 and DSRV are nearing the end of their lives with each expected to be replaced by new systems by the end of 2008. The LR5 will be replaced by the NATO Submarine Rescue Service (NSRS), a system developed jointly by Britain, France and Norway, while the USN is developing the Submarine Rescue Diving and Recompression System (SRDRS). Both systems are similar and will carry out rescue operations in three phases reconnaissance, rescue and crew decompression. The reconnaissance stage will involve an ROV locating the DISSUB and recording data before a manned vessel conducts the rescue. The final stage, crew decompression, will involve a Transfer Under Pressure (TUP) chamber which enables the rescued submariners to be transferred from the rescue vehicle directly to a decompression chamber, thus preventing exposure to any unsafe atmospheric changes. While many of the developments in submarine rescue have been driven internationally, the RAN has taken the initiative in designing its own rescue system. Prior to 1995 the RAN had no organic submarine rescue system but did have a standing agreement with the USN for use of a DSRV in any emergency situation involving an RAN Oberon class submarine. The introduction of the Collins class coincided with the development of the Submarine Escape and Rescue Suite (SERS) which includes the Australian SRV Remora, the SRV’s launch and recovery system, and decompression chambers with a TUP capability. The capability to conduct a rescue is vital but counts for little if nations are unable to employ elements of another’s rescue capability, where that equipment might be better suited than their own. This was revealed in the post-Kursk disaster analysis. In the disaster’s aftermath the International Submarine Escape and Rescue Liaison Organisation (ISMERLO) was formed, with the primary objective to help coordinate future submarine rescue missions. Through its website, a nation with a DISSUB can note what assets are available, while nations that are capable can respond. With over 40 countries now operating submarines the role of ISMERLO is critical. This is reflected in the fact that the organisation is an intrinsic part of submarine rescue exercises around the world, such as the NATO-sponsored BOLD MONARCH. The RAN also helps to promote regional cooperation on submarine rescue through its participation in Exercise PACIFIC REACH, the triennial Asia-Pacific submarine rescue exercise. In summary, early submarine operations relied on escape as the preferred method of recovering submariners from a disabled submarine. However, accidents and practical experience proved that rescue was also necessary. Momsen and other advocates of submarine rescue championed advancements in rescue systems, life support and recovery coordination. So if the unthinkable happens today, the chances of a successful rescue are significantly greater than they have ever been.
The History of EMS/Paramedic Services
At 8:00 AM on May 1, 1951 the Philadelphia Bureau of Fire placed five Auxiliary Rescue units into service. Beginning approximately 1948, the Bureau of Fire began dispatching its heavy rescue companies on “heart cases.” At that time, there were four heavy rescue companies covering the city. Among the specialized rescue equipment carried by the rescues were resuscitators. As the number of responses to medical emergencies began to increase, it became evident the Bureau was not utilizing its resources wisely by sending a large truck, equipped with specialized tools, and staffed by a crew of six fire fighters. Additionally, there was the risk the heavy rescue units could be needed for a fire or rescue but would not be available to respond due to being assigned to the medical call. The Auxiliary Rescues eliminated these concerns. They were staffed by two fire fighters detailed from the Rescue companies and were equipped to provide basic first aid and administer oxygen via a resuscitator as well as transport the patient to the hospital. This was the beginning of the Bureau of Fire’s foray into emergency medical services.
Approximately 1956, the terminology of the Auxiliary Rescues was changed. Rescue 1A became Rescue 7, Rescue 2A became Rescue 8, Rescue 3A became Rescue 9, Rescue 4A became Rescue 10, and Rescue 6A became Rescue 11. There was no Rescue 5 at this time.
By mid-1961 the Philadelphia Fire Department had seven small rescues in service along with four heavy rescues. The small rescues were responding to an increasing number of incidents while responses for the heavy rescues decreased. A study was undertaken to determine if the services of the heavy rescues were necessary. It was found the heavy rescues went into service at only a small percentage of the fire runs they responded to. Based on the results of the survey, Rescues 3 and 4 were placed out of service on September 18, 1961. Both units were replaced by small rescues.
On February 11, 1963 Rescues 1 and 2 were deactivated as heavy rescues and converted to small rescues. With the demand for the small rescues increasing, it was felt the services provided by the heavy rescue companies were redundant with those provided by the engine and ladder companies. The department now had eleven rescues providing emergency medical service to the city. In the late 1960s and early 1970s, the city of Philadelphia utilized funding from the federal government to increase the number of units in service. By 1972, the number of units had been increased to twenty.
Steps were taken to provide more comprehensive patient care during 1973. Twenty department members completed paramedic training. With this training, members could now administer medications, initiate intravenous, and provide advanced airway management. Prior to this program being implemented, members staffing the rescues were fire fighters detailed into the unit, whose only training was basic first aid and cardiopulmonary resuscitation (CPR).
Rescue 7, at 21st and Market Streets, was selected to be the test unit for the new paramedic program. Beginning October 22, 1973 Rescue 7 responded from Philadelphia General Hospital (PGH) with a doctor on board from 8:30 AM to 4:00 PM Monday through Friday. They responded along with Rescues 1, 3, 9, and 14 on all responses for heart attacks, severe bleeding, and trauma. On October 8, 1973 responses with the selected rescues was amended to the area bounded by Girard Avenue on the north, Snyder Avenue on the south, Broad Street on the east, and 52nd Street on the west. At the end of the trial period, the paired responses accompanied by the physician from PGH were discontinued and the Mobile Intensive Care Unit (MICU) program was placed into operation twenty-four hours a day seven days a week.
As more members received paramedic training, the number of MICU rescues was increased. By 1975 there were a total of six units staffed with paramedics. These units were stationed to provide city-wide coverage. Also during 1975, Emergency Medical Technician (EMT) training became mandatory for all new fire fighters hired by the department. This training provided the member with a higher degree of medical training, including, basic first aid, CPR, and administration of oxygen. Fire fighters with this certification began to be used to staff the rescues that were not MICU.
Three rescues were organized during 1984. These were the first rescues to be placed in service since 1977. This was the beginning of the expansion to the Emergency Medical Services (EMS) division of the department in an effort to keep pace with the ever-increasing volume of calls for medical service. To help alleviate the strain on the EMS system, the First Responder Program was initiated during 1984. Under this program, an engine or ladder, staffed with at least one EMT, would be dispatched along with a rescue on selected medical responses.
Beginning in 1989, the department took the unprecedented step of hiring certified paramedics. Prior to this, the department’s paramedics were hired as fire fighters. They would then volunteer for paramedic training. Under the auspices of this new program, the newly hired paramedics would undergo training in department operations and policies and then be assigned to a unit. There was no need to wait approximately one year for paramedic training to be completed. Because of this, the number of paramedic staffed rescues could be increased quickly, as was the number of units in service.
The terminology for the rescues was changed June 1, 1990. Beginning on that date, the rescues became known as medic units.
As the number of requests for medical assistance continued to spiral upward, the number of medic units was increased in an effort to keep pace. Some of the new medic units began to operate on a twelve-hour basis, during the peak times for service requests to help alleviate the workload. At the present time, there are fifty-five medic units covering the city of Philadelphia. Fifty are full-time units, operating twenty-four hours a day and five are part-time units operating twelve hours each day. Current plans are to add five more units bringing the total number of in-service medic units to sixty.
What started as an attempt to provide basic medical care and hospital transport to the citizens of Philadelphia, has burgeoned into one of the busiest EMS systems in the nation, providing high-level, quality pre-hospital care.