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Medical Care in the Streets

Nancy L. Caroline, MD
JAMA. 1977;237(1):43-46. doi:10.1001/jama.1977.03270280045020.
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AN EMERGENCY medical services delivery system is as strong as its weakest link.1,2 As data on acute myocardial infarction and multiple trauma have been accumulated over the past several years, it has become clear that a considerable portion of morbidity and mortality occurs outside the hospital, before the patient reaches medical care.3 It has similarly become clear that implementation of high standards of advanced prehospital life support—at the scene and in transport—can improve the outcome of critically ill and injured patients, thus reducing the need for prolonged, often futile, terminal intensive care. Because of increasing awareness of these facts, the past several years have seen a burgeoning of paramedicstaffed mobile intensive care units (MICUs), equipped to deliver sophisticated medical care on the scene for a variety of medical and surgical emergencies. Advanced emergency medical technicians, or paramedics, are trained in arrhythmia recognition, administration of medications, intravenous infusion, endotracheal


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