Back in the 1960s, there were only 12 trained paramedic units in the entire United States. Concerns about people practicing medicine without a license led to paramedic units being declared illegal in most of the country. The result was so devastating that healthcare activists began lobbying to change legislation. And stepping up to help with the cause? A cheesy TV show called Emergency! that ended up helping to save tens of thousands of lives.

About The Disappearing Spoon

Hosted by New York Times best-selling author Sam Kean, The Disappearing Spoon tells little-known stories from our scientific past—from the shocking way the smallpox vaccine was transported around the world to why we don’t have a birth control pill for men. These topsy-turvy science tales, some of which have never made it into history books, are surprisingly powerful and insightful.

Credits

Host: Sam Kean
Senior Producer: Mariel Carr
Producer: Rigoberto Hernandez
Associate Producer: Sarah Kaplan
Audio Engineer: Rowhome Productions

Transcript

Picture someone you love. A parent, a cousin, a dear friend. Now imagine walking into a room and finding them slumped over, clutching their chest, gasping in pain. You would be frantic. And first thing, you would probably dial 911.

Within minutes, paramedics in an ambulance would be racing toward your home, their sirens blaring. They would rush in with equipment. Maybe they’d administer drugs or shock your loved one’s chest with a defibrillator. And with any luck, they’d save their life.

God forbid that anyone listening has had to live through something like that. But even if you haven’t, you almost certainly know what paramedics do and how they save lives during emergencies.

What you might not know is that the scenario I just outlined—someone collapsing, calling 911, paramedics rushing in—would have been impossible a half-century ago. Not because we didn’t have the technology. We did. But because being a paramedic was illegal in most of the United States.

It’s true. And this episode explains why. It also explains what changed everything—a cheesy TV show. In fact, given its impact and the sheer number of lives saved, it is arguably the most important television show in history.

From the Science History Institute, this is Sam Kean and The Disappearing Spoon, a topsy-turvy science history podcast where footnotes become the real story.

Paramedics are medical personnel who help people during emergencies. They hurry to the scene, stabilize people, and can perform certain procedures, like opening someone’s trachea to get them breathing. They can also administer some drugs and use a defibrillator to restart someone’s heart.

Back in the 1960s, there were only twelve trained paramedic units in the entire United States. Twelve, for a nation of over 200 million people. There was one good reason for this, and one bad reason.

The good reason was laws that banned people from practicing medicine without a license. It’s a sound idea. In previous decades, snake-oil salesmen and other quacks ran amok in the United States. Their potions and bogus treatments were ineffective at best and killed people at worst. So, most states passed sweeping laws to ensure that doctors were licensed.

But those laws ended up being too sweeping. In most cases, for non-doctors, providing any medical care beyond basic first aid was illegal. Anyone who tried to do more, like a paramedic, could be prosecuted and convicted of crimes, even if they saved people’s lives. Any doctor who trained paramedics could be convicted of crimes as well.

In response, some American communities tried to adopt an approach to emergency medicine pioneered in Belfast in Northern Ireland. There, ambulances were staffed by physicians, who would rush out to save people during emergencies.

But that model didn’t work well in the United States. Northern Ireland is relatively compact. The United States is vast and sprawling. The U.S. didn’t have nearly enough doctors to staff all the necessary ambulances anyway. So, the doctor-in-ambulance model was abandoned.

Instead, healthcare activists took aim at the laws that put a de facto ban on paramedics. They proposed tweaking those laws to add exceptions for providing emergency care. It seemed straightforward. The most obvious people to train for this role were firefighters, who already had training in first aid and CPR.

However, when activists took on these laws, the second, bad reason for the lack of paramedics reared its head—special interest groups, who adamantly opposed the changes.

One such group was doctors. They complained that they had undergone years of training and didn’t want amateurs “monkeying” around with people’s health. They derided firefighters as “hose jockeys” who had no business practicing any medicine whatsoever.

Nurses hated the proposed new laws even more. Functionally, their work resembled things that paramedics did, and nurses feared losing their livelihood. Summarizing their plight, one Illinois doctor said: “This whole mobile medical thing is loaded with danger… How would you like it if someone, after only a few weeks’ training, took over your … job?” So, nurses worked with doctors to block new laws that would legalize paramedics.

Sadly, people died as a result. A 1966 report from the National Academy of Sciences explained that over 100,000 people died in accidents every year in America. Accidents also permanently injured another 400,000. In addition, hundreds of thousands more suffered heart attacks, strokes, or other acute ailments. The report estimated that paramedic teams could have saved at least 67,000 of those people every year. 67,000. And that was a minimum. The true number was likely higher.

Instead, as it was, all ambulance teams could do was bandage people up. Their main job was simply to grab people and rush them to the hospital for real treatment. Crazily, half of all so-called ambulances in the country were just hearses driven by funeral-home directors. If you died on the way, well, they just turned around and headed over to their funeral parlors to fit you for a casket. The paramedic gap was a serious flaw in the U.S. healthcare system.

Now, a few cities did manage to start paramedic groups. Miami had one, as did Jacksonville. But they operated in a shadow realm. They were practicing underground medicine, knowing they could be thrown in jail or sued at any time.

Another interesting case was California. Despite heavy lobbying from doctors and nurses, a bill establishing limited paramedic services passed the state assembly in 1970. But then-governor Ronald Reagan announced plans to veto it.

Hearing this, one supporter of the bill—Kenneth Hahn, the Los Angeles County supervisor—tried a Hail Mary. Hahn arranged to meet with Reagan and plead his case.

During the meeting, Hahn explained how the paramedic service would work. He put his thumb down on Reagan’s desk and drew an imaginary circle around it. He explained that his thumb was the hospital where the unit would be headquartered. Then he started naming nearby cities where the unit would operate. Inglewood, Culver City, Hawthorne.

Reagan interrupted him. He asked, “Do you mean this program will cross city boundaries?” Hahn said, yes. It had to, in order to be effective. Reagan sat back stunned, a strange look on his face. Hahn no doubt thought he’d blown his chance, although he could not understand why.

Then Reagan started telling him a story. Thirty years earlier, in 1941, Reagan’s father had suffered a heart attack and needed immediate care. But for liability reasons, the nearest ambulance could not cross city lines and attend to him. By the time an ambulance could get there, it was too late: Reagan’s father died.

But the new bill on his desk would eliminate that scenario. Ambulances, with trained paramedics, could save people anywhere. Right then and there, Reagan decided to reverse his veto. The bill was going to be law.

Now, this bill was not a sweeping reform. It allowed for paramedic services to operate only in cities with more than six million people. Which at the time in California meant just Los Angeles.

In fact, ironically, the legislator who co-sponsored the bill soon suffered a heart attack in the State Capitol building in Sacramento. An ambulance came, but Sacramento was not large enough to warrant paramedics. All they could do was rush him to the hospital, and he was dead on arrival. Had he fought harder to expand the bill, he might have lived.

Still, even getting paramedics into Los Angeles was a big deal. It would definitely save people’s lives. And the two teams that began operating there would have an outsized impact on the nation, for a simple reason: because Los Angeles was the show biz capital of the world.

Paramedics were about to go to Hollywood.

In early 1971, a producer named Jack Webb was trying to start a new television show. Webb had created the police drama Dragnet, and he envisioned a new show centered on firefighters. After all, firefighting is inherently dramatic—people rushing into burning buildings.

But the more Webb thought about it, the more he realized his firefighting idea had a problem. One episode featuring a burning building would be pretty juicy. But what about the third or fourth show about a burning building? Or the twenty-fifth? The concept seemed likely to grow stale.

To find his way around this dilemma, Webb held a meeting with Captain Jim Page of the L.A. Fire Department. After Webb explained his problem, Page suggested something. That Webb expand his focus and center the show on paramedics. Picture a duo running around town, saving lives. They could still fight fires sometimes. But they could also save people from heart attacks, race to car accidents, deliver babies, and more. The idea offered a richer dramatic palette.

Webb loved the idea and started developing a pilot. He called the show Emergency!—with an exclamation point very much included.

The main characters were two firefighters. Johnny Gage was a young hotshot with an active romantic life. Roy DeSoto was an older family man. They worked closely with a group of doctors and nurses at a hospital and they raced to rescue people in a big fire truck, Engine 51.

And I have to say, the show’s a bit shlocky sometimes. The pilot episode starts with Johnny Gage rushing to a scene where an electrical worker has fallen onto some powerlines, and of course he’s shaking and frying.

The pilot made some medical bloopers, too. One rescue worker reads a guy’s blood pressure off a gauge even though he has not actually put the cuff around the man’s arm. Later, a rescue worker mentions a woman who’s broken two arm bones, her radius and ulna. But a doctor later talks about fixing her fibula, a leg bone.

Most laughable of all, the actors were so unfamiliar with the word “paramedic” that they didn’t know how to pronounce it. They butchered it instead. Whoops.

Still, the pilot more than made up for those booboos with its social impact.

The pilot was set in a fictional world before the passage of the law establishing paramedic services in Los Angeles. In fact, this was a major plot point.

You see, that electrical worker who fell on the powerlines died on his way to the hospital. A nurse there commented that it was a shame that the firefighters who reached the scene first were not trained as paramedics, since they could have saved him.

A doctor overhears this and chews the nurse out, citing all the reasons I mentioned above—that he didn’t want amateurs practicing medicine and invading his turf.

Now, because this was Hollywood, the doctor and the nurse were also secret lovers, so things got intense. But it set up a good conflict over the paramedic law. And the setup later pays off.

At one point, family man Roy DeSoto reveals to Johnny Gage that he has been secretly taking paramedic classes. But he is too scared to put his knowledge into practice, because he could be prosecuted.

Gage asks what would need to change. DeSoto then educates him on the law pending in the California legislature, and how it would help. And in educating and pleading with Gage, DeSoto is also educating and pleading with the audience.

Much of the rest of the pilot was essentially an advocacy commercial—a plea to legalize paramedics. In DeSoto’s words, a new, paramedic-friendly law would be “the most important advance in emergency medicine in the last 50 years.”

Then came the dramatic payoff. Near the pilot’s end, there’s a horrible car accident. Gage and DeSoto rush to the scene. Death seems imminent for a few people. So, they call the hospital. The doctor who scolded the nurse earlier answers.

Gage and DeSoto ask for medical advice—how to treat these dying people. In response, the doctor roars at them not to do anything. He orders them simply to get everyone in an ambulance and hurry them to a hospital, where true professionals can evaluate them.

Gage and DeSoto hang up in disgust. And a moment later they declare, “To hell with orders.” They end up illegally treating the people—and of course saving their lives.

Overall, the pilot did a masterful job of advocating for paramedic services. It explained the practical steps needed to establish them in the legislature, dramatized the deadly consequences of lacking them, and valorized what paramedics could do.

The two-hour pilot premiered on NBC in Los Angeles in December 1971. It aired nationwide the next month. It was a huge hit, and weekly hourlong shows quickly followed.

Emergency! aired on Saturday nights and averaged thirty million viewers. At the time that meant that one in seven Americans was watching a show that was essentially benign propaganda for paramedics. Overall, there were 129 episodes of Emergency!, plus six two-hour movies.

Thankfully, the producers started bringing practicing paramedics in as technical advisors, to avoid making any more dumb mistakes. And the two main actors took paramedic training and did ride-alongs with paramedic crews. For promotion, they also drove Engine 51 on a cross-country tour. Real paramedics spoke at each stop, explaining to people what they did and why it was important.

All this did a few things. First, it made being a paramedic sound cool. Multiple paramedics in later decades credited the show with inspiring them. In fact, the show was so popular that the name “Gage” spiked in popularity in the 1990s, when young men and women who’d grown up watching Emergency! began having babies.

More importantly, the show got laws passed. People saw, however melodramatically, all the good that paramedic services could do. In 1972, a year after Emergency! debuted, Hawaii, Illinois, Oklahoma, and Wisconsin all passed laws to establish paramedic units. Nine more states followed in 1973.

Support for paramedics then got federal traction. President Gerald Ford signed a law in 1974 to provide funds and training for paramedics. By 1975, 46 of 50 states had legalized paramedics.

As I said before, some activists were pushing for these laws before Emergency! debuted, so we cannot attribute 100 percent of these changes to the show alone. Those people worked hard to fulfill their vision.

But after years and even decades of futility and frustration, the show gave them a huge boost. It was a real catalyst for change. Nowadays, paramedics save tens of thousands of lives every year, and it’s almost impossible to find a modern city without paramedic services.

In the year 2000, the Smithsonian Institution recognized the importance of Emergency! and acquired several props from the show for its collection. This included the red firetruck, engine 51. Those items are now a permanent part of our national heritage, and rightly so.

Emergency! almost never makes those lists of the greatest television shows of all-time. And I get that. It certainly lacks the cultural cachet of The Simpsons, or I Love Lucy or The Sopranos. I’m definitely not going to binge-watch it anytime soon.

But next time you spot one of those lists in a magazine or online, reserve a space mentally, an honorable mention, for the campy paramedic drama that’s saved so many lives—and might, someday, save yours.