1 00:00:01,280 --> 00:00:04,320 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,360 --> 00:00:13,640 Speaker 1: of I Heart Radio. Hello, and welcome to the podcast. 3 00:00:13,640 --> 00:00:17,720 Speaker 1: I'm Holly Frying and I'm Tracy V. Wilson. Okay, Tracy. 4 00:00:17,760 --> 00:00:20,200 Speaker 1: There have always been situations where people have been in 5 00:00:20,280 --> 00:00:23,439 Speaker 1: need of immediate medical care. Yep, that's just part of 6 00:00:23,480 --> 00:00:27,000 Speaker 1: being a human. Uh. And we spoke recently in an 7 00:00:27,000 --> 00:00:30,520 Speaker 1: episode about how military needs during wartime have driven a 8 00:00:30,520 --> 00:00:34,240 Speaker 1: lot of innovation in emergency medicine, but of course civilians 9 00:00:34,280 --> 00:00:37,839 Speaker 1: need emergency care as well, and our current pandemic has 10 00:00:37,880 --> 00:00:40,680 Speaker 1: brought the focus onto the medical care providers who are 11 00:00:40,720 --> 00:00:44,479 Speaker 1: often doing far more than seems humanly possible to take 12 00:00:44,520 --> 00:00:47,600 Speaker 1: care of their patients. And as I continued to see 13 00:00:47,640 --> 00:00:51,080 Speaker 1: headlines specifically about how to know when to seek emergency 14 00:00:51,120 --> 00:00:54,160 Speaker 1: care during this time, it made me want to talk 15 00:00:54,200 --> 00:00:57,040 Speaker 1: about some of the really big moments in emergency medicine 16 00:00:57,080 --> 00:01:01,480 Speaker 1: as a developing field, because it's actually still a baby. Um, 17 00:01:02,200 --> 00:01:07,760 Speaker 1: it's a fairly new area in medicine. And also we 18 00:01:07,800 --> 00:01:10,440 Speaker 1: want to make sure that, in the interest of expectations management, 19 00:01:10,760 --> 00:01:13,160 Speaker 1: we let everybody know that this is primarily looking at 20 00:01:13,200 --> 00:01:17,240 Speaker 1: emergency care in the US. We briefly mentioned developments in 21 00:01:17,280 --> 00:01:20,760 Speaker 1: other countries just here and there, But that's about it, 22 00:01:20,840 --> 00:01:23,800 Speaker 1: And even narrowed down mostly to one country, it is 23 00:01:23,800 --> 00:01:28,000 Speaker 1: still a two parter and it is still nowhere near comprehensive. UH. 24 00:01:28,040 --> 00:01:31,280 Speaker 1: There are entire books written about the history of emergency 25 00:01:31,319 --> 00:01:34,440 Speaker 1: care just in the US, but I wanted to talk 26 00:01:34,480 --> 00:01:36,319 Speaker 1: about it and kind of honor the people that do it. 27 00:01:36,640 --> 00:01:38,800 Speaker 1: So what we're gonna do here is cover some of 28 00:01:38,800 --> 00:01:43,000 Speaker 1: the key areas and developments in its relatively short history. 29 00:01:43,400 --> 00:01:45,559 Speaker 1: So in this first episode, we're going to talk about 30 00:01:45,600 --> 00:01:48,800 Speaker 1: early emergency response services and a little bit of CPR 31 00:01:48,920 --> 00:01:53,280 Speaker 1: history and the advent of the emergency care specialty for physicians. 32 00:01:53,440 --> 00:01:56,280 Speaker 1: And then in the next episode we're going to cover 33 00:01:56,400 --> 00:01:59,080 Speaker 1: an important white paper that served as a turning point 34 00:01:59,120 --> 00:02:01,920 Speaker 1: for emergency met US in UH. We'll also talk about 35 00:02:01,920 --> 00:02:04,480 Speaker 1: the advent of the nine one one service and the 36 00:02:04,560 --> 00:02:08,080 Speaker 1: ambulance service that set the model for all of the others. 37 00:02:08,880 --> 00:02:12,400 Speaker 1: The first city ambulance in the United States started rolling 38 00:02:12,400 --> 00:02:15,080 Speaker 1: in eighteen sixty five, and we really don't know a 39 00:02:15,080 --> 00:02:18,400 Speaker 1: whole lot about it. Records are pretty sparse, but there 40 00:02:18,560 --> 00:02:22,880 Speaker 1: is a personnel record for an ambulance driver in Cincinnati 41 00:02:22,919 --> 00:02:26,720 Speaker 1: Ohio's Commercial Hospital. That person was listed in that year's 42 00:02:26,760 --> 00:02:30,880 Speaker 1: hospital records. That driver was a man named James R. Jackson, 43 00:02:31,120 --> 00:02:33,920 Speaker 1: and his annual salary was three d and sixty dollars 44 00:02:33,919 --> 00:02:37,680 Speaker 1: a year. That is all we know, uh And because 45 00:02:37,680 --> 00:02:41,360 Speaker 1: of the scarcity of documentation for whatever that program was 46 00:02:41,400 --> 00:02:45,160 Speaker 1: in Cincinnati. The ambulance that's more commonly cited as the 47 00:02:45,240 --> 00:02:48,200 Speaker 1: first City ambulance was in New York City and it 48 00:02:48,280 --> 00:02:52,080 Speaker 1: was a new initiative at Bellevue Hospital in eighteen sixty nine, 49 00:02:52,720 --> 00:02:55,400 Speaker 1: and it was the brainchild of Dr. Edward B. Dalton, 50 00:02:55,560 --> 00:02:58,720 Speaker 1: who had interned before the U. S Civil War as 51 00:02:58,720 --> 00:03:01,800 Speaker 1: a staff surgeon at the hospital. Dalton had served with 52 00:03:01,840 --> 00:03:04,800 Speaker 1: the Union during the Civil War, working as an inspector 53 00:03:04,880 --> 00:03:08,280 Speaker 1: of field hospitals for the Army of the Potomac. One 54 00:03:08,280 --> 00:03:11,440 Speaker 1: of his duties was establishing a system to get wounded 55 00:03:11,520 --> 00:03:14,400 Speaker 1: soldiers to field hospitals really quickly. He set up a 56 00:03:14,440 --> 00:03:17,680 Speaker 1: similar system to the one that French doctor and recent 57 00:03:17,800 --> 00:03:21,440 Speaker 1: show subject Dominique gen Lerey had done in Europe a 58 00:03:21,440 --> 00:03:25,120 Speaker 1: few decades earlier. And when the war ended, Dalton was 59 00:03:25,200 --> 00:03:28,200 Speaker 1: back in New York and then he applied his experience 60 00:03:28,320 --> 00:03:32,120 Speaker 1: in transporting soldiers to creating a similar service for the 61 00:03:32,120 --> 00:03:36,880 Speaker 1: civilian population there. Bellevue's new ambulance, which was a horse 62 00:03:36,960 --> 00:03:39,960 Speaker 1: drawn wagon, was equipped with a first aid kit that 63 00:03:40,040 --> 00:03:45,480 Speaker 1: included tourniquets, bandages, sponges, whiskey or brandy, depending on what 64 00:03:45,560 --> 00:03:48,760 Speaker 1: source you read, and a straight jacket in case a 65 00:03:48,840 --> 00:03:52,840 Speaker 1: patient was unruly or dangerous. It also had floor slats 66 00:03:52,880 --> 00:03:54,920 Speaker 1: that could be taken out of the wagon and used 67 00:03:54,920 --> 00:03:58,800 Speaker 1: as a stretcher. Bellevue's ambulance didn't have a siren. The 68 00:03:59,000 --> 00:04:02,680 Speaker 1: driver would bang a gong as he drove to alert 69 00:04:02,720 --> 00:04:07,560 Speaker 1: other people on the road. To get clear seems challenging 70 00:04:07,640 --> 00:04:11,360 Speaker 1: to me, Dalton's ambulance was called to scenes of medical 71 00:04:11,400 --> 00:04:15,480 Speaker 1: need one thousand, four hundred one times over the years 72 00:04:15,520 --> 00:04:19,000 Speaker 1: that number grew, and even as motorized ambulances were developed 73 00:04:19,040 --> 00:04:22,560 Speaker 1: and that happened first in Chicago, these horse drawn wagons 74 00:04:22,560 --> 00:04:26,520 Speaker 1: of Bellevue still covered their territory alongside their automated colleagues. 75 00:04:26,800 --> 00:04:29,279 Speaker 1: That went on for years. The last of the horse 76 00:04:29,360 --> 00:04:32,920 Speaker 1: drawn ambulances in the fleet was retired in nineteen four. 77 00:04:33,240 --> 00:04:38,240 Speaker 1: In ninety eight, Julian Stanley Wise of Roanoke, Virginia founded 78 00:04:38,279 --> 00:04:41,720 Speaker 1: the Roanoke Life Saving and First Aid crew, and this 79 00:04:41,839 --> 00:04:45,120 Speaker 1: was the first volunteer rescue unit in the country. It 80 00:04:45,200 --> 00:04:48,120 Speaker 1: was made up of ten men, including Wise, and each 81 00:04:48,200 --> 00:04:51,160 Speaker 1: man carried a fishing tackle box as his med kit. 82 00:04:51,720 --> 00:04:56,760 Speaker 1: Inside these kits were tannic acid compound, ammonia inhalent, tincture 83 00:04:56,880 --> 00:05:00,640 Speaker 1: of Merthia late, and poison ivy wash. When I first 84 00:05:00,680 --> 00:05:05,280 Speaker 1: looked over this, the idea that poison ivy wash was included. 85 00:05:06,120 --> 00:05:09,320 Speaker 1: It's obviously very useful to have the poison ivy washed 86 00:05:09,360 --> 00:05:13,799 Speaker 1: in there. Um, but as like an emergency thing that 87 00:05:13,800 --> 00:05:17,240 Speaker 1: that delighted me a little bit. Well, I suspect that 88 00:05:17,440 --> 00:05:20,400 Speaker 1: they were kind of a first aid crew. Yeah, and 89 00:05:20,720 --> 00:05:23,880 Speaker 1: this is out in Virginia. There was probably a likelihood 90 00:05:23,880 --> 00:05:27,000 Speaker 1: that people were getting into some poison ivy calling that 91 00:05:27,040 --> 00:05:31,200 Speaker 1: an emergency treat I also do know somebody who had 92 00:05:31,240 --> 00:05:34,000 Speaker 1: to go to the emergency room because of a poison 93 00:05:34,040 --> 00:05:37,560 Speaker 1: ivy exposure because it was um, it was dead vines 94 00:05:37,640 --> 00:05:40,280 Speaker 1: that they didn't recognize as poison ivy and they were 95 00:05:40,320 --> 00:05:42,800 Speaker 1: outside sweating and it's like they got the oil on 96 00:05:42,839 --> 00:05:46,120 Speaker 1: their face. It was a whole bad situation. Yeah, I 97 00:05:46,160 --> 00:05:49,359 Speaker 1: had a I didn't go to the emergency room. I 98 00:05:49,360 --> 00:05:53,279 Speaker 1: went to urgent kid. I had never been allergic to 99 00:05:53,320 --> 00:05:56,640 Speaker 1: poison IVY until I came into contact with it at 100 00:05:56,640 --> 00:05:59,000 Speaker 1: the same time that I had a tattoo that was 101 00:05:59,040 --> 00:06:01,719 Speaker 1: healing in my body. This is too much, and I 102 00:06:01,800 --> 00:06:03,919 Speaker 1: kind of dealt with the rash. And then one morning 103 00:06:03,920 --> 00:06:06,039 Speaker 1: we were actually on vacation, and I woke up and 104 00:06:06,160 --> 00:06:08,680 Speaker 1: my entire face was swollen, and I was like, goodness, 105 00:06:08,839 --> 00:06:13,799 Speaker 1: get in the car and let's start making Yeah. So 106 00:06:14,000 --> 00:06:17,320 Speaker 1: um so, why is this volunteer rescue plan? Had it start? 107 00:06:17,400 --> 00:06:20,919 Speaker 1: Almost twenty years before? When Julian was only nine, he 108 00:06:21,000 --> 00:06:24,640 Speaker 1: witnessed a canoeing accident that resulted in two people drowning 109 00:06:24,800 --> 00:06:28,240 Speaker 1: because the current was quickly carrying these canoeists away from 110 00:06:28,279 --> 00:06:31,479 Speaker 1: the small amount of help that bystanders were trying to offer. 111 00:06:31,920 --> 00:06:35,800 Speaker 1: They were basically trying to extend tree branches out there. Uh. 112 00:06:35,839 --> 00:06:39,159 Speaker 1: The event, he would later say, left an impression on 113 00:06:39,240 --> 00:06:41,599 Speaker 1: him that just gave him a determination that he carried 114 00:06:41,600 --> 00:06:43,840 Speaker 1: for the rest of his life. Quote right then I 115 00:06:43,880 --> 00:06:47,200 Speaker 1: resolved that I was going to become a lifesaver. Never 116 00:06:47,320 --> 00:06:49,440 Speaker 1: again would I watch a man die when he could 117 00:06:49,440 --> 00:06:52,200 Speaker 1: be saved. And as a young man, in his twenties, 118 00:06:52,520 --> 00:06:55,720 Speaker 1: Wise had taken a job at the Norfolk and Western Railroad. 119 00:06:55,800 --> 00:06:58,279 Speaker 1: He was working as a clerk, and he recruited his 120 00:06:58,360 --> 00:07:02,320 Speaker 1: fellow volunteer rescuers from his coworkers there at the railroad, 121 00:07:02,800 --> 00:07:05,080 Speaker 1: and they actually operated their little setup out of the 122 00:07:05,160 --> 00:07:07,800 Speaker 1: railroad offices, and they used the phone number of the 123 00:07:07,880 --> 00:07:12,200 Speaker 1: railroad's head clerk, Harry Avis, as their contact number. So 124 00:07:12,320 --> 00:07:15,040 Speaker 1: when Harry got an emergency call, he would then relay 125 00:07:15,080 --> 00:07:16,840 Speaker 1: that info to the rest of the crew and then 126 00:07:16,840 --> 00:07:21,200 Speaker 1: they would spring into action. This was not a huge success. Initially, 127 00:07:21,680 --> 00:07:25,559 Speaker 1: only six emergencies were called into the crew their first year, 128 00:07:26,080 --> 00:07:28,840 Speaker 1: and often they weren't speedy enough to do a lot 129 00:07:28,880 --> 00:07:30,800 Speaker 1: of help by the time they arrived on the scene. 130 00:07:30,800 --> 00:07:33,560 Speaker 1: But they kept at it. They kept improving, driven by 131 00:07:33,560 --> 00:07:37,360 Speaker 1: wise Is ethos of quote, save seconds and you have 132 00:07:37,400 --> 00:07:40,520 Speaker 1: a better chance of saving a life. The crew gained 133 00:07:40,640 --> 00:07:43,960 Speaker 1: national attention in ninety one when they revived a sixteen 134 00:07:44,000 --> 00:07:47,560 Speaker 1: year old boy after responding to a drowning call. Yeah, 135 00:07:47,600 --> 00:07:50,720 Speaker 1: they became headline news. And that brings us to the 136 00:07:50,760 --> 00:07:54,240 Speaker 1: topic of resuscitation. But before we get into that, which 137 00:07:54,240 --> 00:07:56,440 Speaker 1: we are going to do, let's take a little breather 138 00:07:56,520 --> 00:08:05,560 Speaker 1: of our own, and we will have a sponsor break. 139 00:08:07,040 --> 00:08:10,360 Speaker 1: So that last element that we talked about of a 140 00:08:10,400 --> 00:08:13,280 Speaker 1: sixteen year old boy being rescued after a drowning call 141 00:08:13,880 --> 00:08:17,560 Speaker 1: brings us to resuscitation in general. So the idea of 142 00:08:17,680 --> 00:08:21,480 Speaker 1: artificially restarting a patient's breathing and heartbeat has been part 143 00:08:21,560 --> 00:08:25,360 Speaker 1: of emergency medical care for hundreds of years. It goes back, 144 00:08:25,480 --> 00:08:29,760 Speaker 1: at least in the Western uh literature to Swiss physician 145 00:08:30,160 --> 00:08:34,200 Speaker 1: Paracelsus in the fifteen hundreds, and in those early days, 146 00:08:34,640 --> 00:08:36,760 Speaker 1: this whole thing was done by using a bellows to 147 00:08:36,880 --> 00:08:39,920 Speaker 1: pump air into the unconscious person's lungs. They would basically 148 00:08:39,920 --> 00:08:41,880 Speaker 1: put the end of the bellows in their mouth and 149 00:08:41,880 --> 00:08:47,480 Speaker 1: then carefully work the bellows. Before that, common but not 150 00:08:47,760 --> 00:08:51,520 Speaker 1: super effective approach was to whip an unconscious person in 151 00:08:51,559 --> 00:08:54,680 Speaker 1: the hopes that it would shock them awake. The earliest 152 00:08:54,760 --> 00:08:58,319 Speaker 1: Western record of mouth to mouth resuscitation being used dates 153 00:08:58,320 --> 00:09:02,360 Speaker 1: back to seventeen thirty two, when Scottish surgeon William Tassick 154 00:09:02,480 --> 00:09:05,880 Speaker 1: was able to revive a coal miner. Eight years later, 155 00:09:06,080 --> 00:09:10,240 Speaker 1: the French Academy de Seance issued a recommendation that mouth 156 00:09:10,320 --> 00:09:14,320 Speaker 1: to mouth resuscitation should be used for drowning victims. Four 157 00:09:14,360 --> 00:09:18,640 Speaker 1: years later, Scotland's Dr Tassick wrote a clinical description of 158 00:09:18,679 --> 00:09:20,760 Speaker 1: the mouth to mouth method that he had used in 159 00:09:20,880 --> 00:09:23,600 Speaker 1: seventeen thirty two. Yeah, when he initially did that, he 160 00:09:23,679 --> 00:09:26,280 Speaker 1: was kind of improvising and trying to figure out a 161 00:09:26,320 --> 00:09:29,480 Speaker 1: way to save this person, and it wasn't until quite 162 00:09:29,520 --> 00:09:31,880 Speaker 1: some time later that he actually wrote it up as 163 00:09:31,880 --> 00:09:35,680 Speaker 1: a way that other people could follow. There was enough 164 00:09:35,679 --> 00:09:39,160 Speaker 1: concern that people were not getting proper resuscitation attention in 165 00:09:39,200 --> 00:09:42,839 Speaker 1: the late eighteenth century that in seventeen seventy four the 166 00:09:42,960 --> 00:09:47,600 Speaker 1: Humane Society for the Recovery of Persons Apparently Drowned was formed. 167 00:09:48,280 --> 00:09:51,559 Speaker 1: This group was established in London at the Chapter Coffeehouse 168 00:09:51,600 --> 00:09:54,800 Speaker 1: in Saint Paul's Churchyard by Dr William Halles and Dr 169 00:09:54,840 --> 00:09:58,559 Speaker 1: Thomas Cogan. The pair had invited a number of friends 170 00:09:58,559 --> 00:10:01,240 Speaker 1: to help establish this Decide i D which was intended 171 00:10:01,559 --> 00:10:05,959 Speaker 1: to promote techniques of resuscitation, and they did this by 172 00:10:06,000 --> 00:10:08,800 Speaker 1: giving awards to people who performed life saving acts so 173 00:10:08,840 --> 00:10:11,080 Speaker 1: they could draw a little attention to it, and that 174 00:10:11,200 --> 00:10:15,000 Speaker 1: society actually continues to this day, although in seventeen seventy 175 00:10:15,040 --> 00:10:18,280 Speaker 1: six the name was changed simply to the Humane Society, 176 00:10:18,320 --> 00:10:20,840 Speaker 1: and then it changed again in seventeen seven to the 177 00:10:20,960 --> 00:10:25,120 Speaker 1: Royal Humane Society. In the eighteen fifties, two different doctors 178 00:10:25,160 --> 00:10:28,560 Speaker 1: in London came up with methodologies for resuscitation having to 179 00:10:28,600 --> 00:10:32,600 Speaker 1: do with repositioning the body. Dr Marshall Hall wrote up 180 00:10:32,640 --> 00:10:37,480 Speaker 1: his method in his book Asphyxia, It's Rationale and Its Remedy. Basically, 181 00:10:37,520 --> 00:10:40,880 Speaker 1: he was encouraging people to roll an unconscious person off 182 00:10:40,920 --> 00:10:43,720 Speaker 1: their back and onto their side, and an effort to 183 00:10:43,920 --> 00:10:48,000 Speaker 1: eliminate any airway obstructions and in some cases rolling farther 184 00:10:48,080 --> 00:10:52,240 Speaker 1: onto the stomach was recommended. Eventually, Hall refined his technique 185 00:10:52,280 --> 00:10:55,600 Speaker 1: to include the application of pressure to the chest. Two 186 00:10:55,720 --> 00:10:59,160 Speaker 1: years later, Dr Henry Sylvester developed an idea along a 187 00:10:59,200 --> 00:11:02,760 Speaker 1: similar line of thinking that repositioning the body could help 188 00:11:02,760 --> 00:11:06,560 Speaker 1: a person breathe. In Sylvester's method, the patient remained on 189 00:11:06,600 --> 00:11:09,240 Speaker 1: their back, but their arms were manipulated to try to 190 00:11:09,280 --> 00:11:13,120 Speaker 1: restart respiration. So first the arms were raised up over 191 00:11:13,160 --> 00:11:17,000 Speaker 1: the heads so the unconscious person's chest would naturally expand, 192 00:11:17,880 --> 00:11:20,360 Speaker 1: and then the arms were crossed and placed over the 193 00:11:20,480 --> 00:11:25,280 Speaker 1: chest to provide pressure to encourage excellation. In eighteen fifty nine, 194 00:11:25,440 --> 00:11:28,560 Speaker 1: Dr Sylvester published his method in the British Medical Journal. 195 00:11:29,160 --> 00:11:31,960 Speaker 1: He was met with some criticism, primarily that if a 196 00:11:31,960 --> 00:11:35,319 Speaker 1: patient remained on their back, their tongue could still obstruct 197 00:11:35,360 --> 00:11:39,280 Speaker 1: the airway just the same. This method was widely touted 198 00:11:39,320 --> 00:11:43,760 Speaker 1: for decades. It was published as a recommended resuscitation technique 199 00:11:43,840 --> 00:11:47,360 Speaker 1: in the handbook Describing Aids for Cases of Injuries or 200 00:11:47,480 --> 00:11:51,640 Speaker 1: Sudden Illness that was written by Surgeon Major Peter Shephard 201 00:11:51,800 --> 00:11:56,080 Speaker 1: of the training organization St. John Ambulance in eight seventy eight, 202 00:11:56,520 --> 00:11:59,880 Speaker 1: and it remained in every subsequent printing of that hand 203 00:12:00,200 --> 00:12:04,840 Speaker 1: until nineteen seventy two. There were other resuscitation methods being 204 00:12:04,880 --> 00:12:09,160 Speaker 1: tested during the late eighteen hundreds, including chest compression, which 205 00:12:09,200 --> 00:12:12,120 Speaker 1: was tested on cats in Germany in eighteen seventy eight. 206 00:12:13,160 --> 00:12:17,680 Speaker 1: By one, chest compression, used alongside ventilation, had saved the 207 00:12:17,720 --> 00:12:21,840 Speaker 1: lives of two human patients in Germany. Compression was also 208 00:12:21,960 --> 00:12:25,079 Speaker 1: seeing some success, first in dogs and then in human 209 00:12:25,120 --> 00:12:28,839 Speaker 1: cases in the early nineteen hundreds in Cleveland, Ohio, as 210 00:12:28,880 --> 00:12:32,520 Speaker 1: part of the work of doctor George Kryle. But compression 211 00:12:32,720 --> 00:12:36,000 Speaker 1: as a means of resuscitation kind of fizzled out until 212 00:12:36,040 --> 00:12:39,560 Speaker 1: it started to be used in tandem with defibrillation decades later. 213 00:12:39,960 --> 00:12:43,360 Speaker 1: The Hall and Sylvester methods were eventually replaced by the 214 00:12:43,440 --> 00:12:47,760 Speaker 1: Holder Nielsen method, developed by a Danish military physical fitness 215 00:12:47,760 --> 00:12:52,280 Speaker 1: instructor in the nineteen thirties. During a massage, Nielsen noticed 216 00:12:52,320 --> 00:12:55,200 Speaker 1: that when he was lying face down and the therapist 217 00:12:55,200 --> 00:12:58,640 Speaker 1: applied pressure between his shoulder blades while standing in his head, 218 00:12:59,040 --> 00:13:03,839 Speaker 1: he exhaled involuntarily. So he combined this idea with positioning 219 00:13:03,880 --> 00:13:06,920 Speaker 1: the patient's arms crossed above them with their head turned 220 00:13:06,960 --> 00:13:10,120 Speaker 1: sideways and resting on their arms. So yeah, he would 221 00:13:10,160 --> 00:13:12,360 Speaker 1: basically it's almost like you would lie down like in 222 00:13:12,400 --> 00:13:14,680 Speaker 1: the sun at the beach on your stomach. If you 223 00:13:14,720 --> 00:13:17,520 Speaker 1: did such things like with your head resting in your arms, 224 00:13:17,559 --> 00:13:20,120 Speaker 1: and then from above and in front of your head, 225 00:13:20,400 --> 00:13:24,760 Speaker 1: he would apply compressions in a regular period. In nineteen 226 00:13:24,800 --> 00:13:28,360 Speaker 1: fifty six, a big breakthrough an emergency medicine came when 227 00:13:28,440 --> 00:13:32,400 Speaker 1: Dr Peter Safar, an Austrian born physician, met Dr James 228 00:13:32,400 --> 00:13:37,360 Speaker 1: Elam at a convention of anthesiologists. Two years earlier, Elam 229 00:13:37,360 --> 00:13:40,720 Speaker 1: had published research proving that expired air that's the air 230 00:13:40,760 --> 00:13:45,200 Speaker 1: a person exhales ventilated in a mask or endotracheal tube 231 00:13:45,360 --> 00:13:49,240 Speaker 1: could enable adequate oxygenation to keep a patient's blood gases 232 00:13:49,640 --> 00:13:52,800 Speaker 1: in normal levels. This meeting led to the two of 233 00:13:52,840 --> 00:13:56,040 Speaker 1: them working together, and in nineteen fifty eight he published 234 00:13:56,040 --> 00:13:59,200 Speaker 1: a paper in the Journal of the American Medical Association 235 00:13:59,679 --> 00:14:03,280 Speaker 1: out finding experiments that had compared mouth to mouth ventilation 236 00:14:03,440 --> 00:14:06,720 Speaker 1: performed by lay people to the whole journeils and method 237 00:14:06,760 --> 00:14:09,199 Speaker 1: that was being performed by members of the Baltimore City 238 00:14:09,240 --> 00:14:13,960 Speaker 1: Fire Department. Mouth to mouth was by far more successful. Yeah, 239 00:14:13,960 --> 00:14:16,000 Speaker 1: that was like a big deal because it was like, 240 00:14:16,040 --> 00:14:18,080 Speaker 1: we have professionals doing it the old way, and we 241 00:14:18,120 --> 00:14:20,080 Speaker 1: have people we just trained off the street doing it 242 00:14:20,160 --> 00:14:24,320 Speaker 1: our way and they're having better success. Safar and Elam 243 00:14:24,440 --> 00:14:28,000 Speaker 1: continued to be at the epicenter of significant developments in 244 00:14:28,040 --> 00:14:31,520 Speaker 1: resuscitation because they went on to collaborate with other medical 245 00:14:31,560 --> 00:14:35,080 Speaker 1: scientists who were doing research in similar or related areas. 246 00:14:35,840 --> 00:14:40,160 Speaker 1: Through a connection to anesthesiologists Bjorn Lynde, Safar was introduced 247 00:14:40,160 --> 00:14:44,400 Speaker 1: to a Norwegian toymaker named Asmund Lairdahl, and in working together, 248 00:14:44,800 --> 00:14:47,800 Speaker 1: this team was able to develop the first recessa and 249 00:14:48,120 --> 00:14:54,440 Speaker 1: mannequin to train people in resuscitation techniques. RECESSA and or resuscitation. ANNIE, 250 00:14:54,440 --> 00:14:56,440 Speaker 1: as she is more commonly known here in the US, 251 00:14:57,040 --> 00:15:00,360 Speaker 1: is still produced today by the Layerdal Medical Company. A 252 00:15:00,440 --> 00:15:05,000 Speaker 1: separate team, engineers William Covenhoven and Guy Knickerbocker from Johns 253 00:15:05,000 --> 00:15:09,920 Speaker 1: Hopkins had been developing the first electrical cardiac defibrillator. Around 254 00:15:09,920 --> 00:15:14,160 Speaker 1: this same time, Dr Safar worked on refining the mouth 255 00:15:14,200 --> 00:15:17,040 Speaker 1: to mouth resuscitation technique that he and Elam had come 256 00:15:17,120 --> 00:15:19,480 Speaker 1: up with, and came up with the easy to remember 257 00:15:19,520 --> 00:15:23,920 Speaker 1: A BCS of cardio pulmonary resuscitation. There's abc s are 258 00:15:23,960 --> 00:15:27,000 Speaker 1: airway breathing and circulation, and the idea was that you 259 00:15:27,000 --> 00:15:29,840 Speaker 1: would first check to make sure the airway wasn't obstructed 260 00:15:29,920 --> 00:15:33,760 Speaker 1: and then administer rescue breaths followed by chess compression. And 261 00:15:33,840 --> 00:15:36,560 Speaker 1: that remained the standard and was probably what a lot 262 00:15:36,600 --> 00:15:38,920 Speaker 1: of us learned. If you're in my age group, I 263 00:15:38,960 --> 00:15:42,160 Speaker 1: definitely learned the A B c's when I had a 264 00:15:42,360 --> 00:15:45,280 Speaker 1: very basic CPR training in high school. We did it 265 00:15:45,640 --> 00:15:49,720 Speaker 1: until and at that point the order of operations recommended 266 00:15:49,800 --> 00:15:52,560 Speaker 1: was changed for the first time in forty years, and 267 00:15:52,600 --> 00:15:56,120 Speaker 1: then it became C A B training with chest compressions 268 00:15:56,160 --> 00:15:59,520 Speaker 1: beginning first and then doing the airway and rescue breaths. 269 00:16:00,000 --> 00:16:01,960 Speaker 1: And this is because it has been determined that a 270 00:16:02,000 --> 00:16:06,520 Speaker 1: patient's circulation can be supported through chest compressions enough to 271 00:16:06,600 --> 00:16:09,960 Speaker 1: keep oxygen aated blood flowing through the tissues. And if 272 00:16:10,080 --> 00:16:12,440 Speaker 1: that is already in place while the airway check and 273 00:16:12,480 --> 00:16:15,080 Speaker 1: rescue breathing is done, there is a better chance of 274 00:16:15,120 --> 00:16:18,520 Speaker 1: success for resuscitation. And we're gonna come back actually to 275 00:16:18,680 --> 00:16:21,160 Speaker 1: Dr Safar. In the second part of this two parter 276 00:16:21,640 --> 00:16:24,640 Speaker 1: coming up, we will find out how a general practitioner's 277 00:16:24,680 --> 00:16:28,720 Speaker 1: exhaustion led to the developments of the first full time 278 00:16:28,800 --> 00:16:32,480 Speaker 1: emergency jobs for physicians. First, we will take a quick 279 00:16:32,560 --> 00:16:43,960 Speaker 1: sponsor break. In nineteen one, the idea of doctors who 280 00:16:44,000 --> 00:16:48,200 Speaker 1: were specifically focused on emergency medicine as their job, rather 281 00:16:48,240 --> 00:16:50,600 Speaker 1: than it being a shift on a rotation for a 282 00:16:50,640 --> 00:16:54,760 Speaker 1: doctor who normally had other patients and duties manifested in 283 00:16:54,800 --> 00:16:58,160 Speaker 1: the work of doctor James Mills Jr. Mills was a 284 00:16:58,200 --> 00:17:01,560 Speaker 1: general practitioner and Alexander d of Virginia who was the 285 00:17:01,600 --> 00:17:05,879 Speaker 1: President elect of the Medical Staff at Alexandria Hospital and 286 00:17:05,880 --> 00:17:09,520 Speaker 1: the Alexandria Hospital's Emergency department was really in a state 287 00:17:09,600 --> 00:17:13,240 Speaker 1: of crisis, a crisis that Mills was tasked with fixing. 288 00:17:14,000 --> 00:17:17,280 Speaker 1: For one thing, patient visits to the emergency department had 289 00:17:17,480 --> 00:17:21,240 Speaker 1: increased by three hundred percent in the decades between nineteen 290 00:17:21,280 --> 00:17:24,399 Speaker 1: fifty and sixty. By the end of nineteen sixty, they 291 00:17:24,400 --> 00:17:27,840 Speaker 1: were seeing as many as eighteen thousand patients a year. 292 00:17:28,280 --> 00:17:30,920 Speaker 1: That averages out to a little more than forty nine 293 00:17:31,000 --> 00:17:33,560 Speaker 1: a day, and that was in an apartment that did 294 00:17:33,600 --> 00:17:37,199 Speaker 1: not have a dedicated medical staff. There had been a 295 00:17:37,240 --> 00:17:41,040 Speaker 1: plan in place to use medical students from nearby Georgetown 296 00:17:41,119 --> 00:17:44,600 Speaker 1: to cover shifts, but that didn't quite work out, and 297 00:17:44,680 --> 00:17:46,879 Speaker 1: Mills was one of several doctors on staff at the 298 00:17:46,920 --> 00:17:50,120 Speaker 1: hospital who did shifts in the emergency department. But there 299 00:17:50,119 --> 00:17:52,000 Speaker 1: were a lot of doctors who didn't. They either just 300 00:17:52,040 --> 00:17:54,680 Speaker 1: didn't want to or it couldn't fit into their schedule. 301 00:17:55,400 --> 00:17:58,480 Speaker 1: So wait times we're getting longer and longer, and the 302 00:17:58,560 --> 00:18:01,359 Speaker 1: hospital struggled to have an of medical staff on hand 303 00:18:01,600 --> 00:18:05,840 Speaker 1: to see to their growing emergency patient load. In the meantime, 304 00:18:06,200 --> 00:18:09,000 Speaker 1: Dr Mills was really having his own problems. He worked 305 00:18:09,040 --> 00:18:13,000 Speaker 1: incredibly long hours as a g P. In an interview 306 00:18:13,000 --> 00:18:15,600 Speaker 1: that he gave in nineteen sixty five, he said, quote, 307 00:18:15,640 --> 00:18:18,719 Speaker 1: one night, I came home after one am from working 308 00:18:18,760 --> 00:18:21,520 Speaker 1: a day that had started that morning at seven. I 309 00:18:21,520 --> 00:18:24,920 Speaker 1: remember thinking that as a chronically tired and overworked GP, 310 00:18:25,280 --> 00:18:28,520 Speaker 1: I wasn't being fair to myself, my family, or my patients. 311 00:18:29,080 --> 00:18:32,960 Speaker 1: It came to me that in emergency service, with regular hours, 312 00:18:33,000 --> 00:18:35,720 Speaker 1: I would be able to practice much better medicine. If 313 00:18:35,720 --> 00:18:38,199 Speaker 1: I could get three other good men to join me, 314 00:18:38,320 --> 00:18:41,000 Speaker 1: we'd have a team that could provide top notch treatment. 315 00:18:41,240 --> 00:18:46,080 Speaker 1: And his idea in that moment invented emergency medicine specialization. 316 00:18:46,760 --> 00:18:49,800 Speaker 1: He recruited three other doctors from the hospital to test 317 00:18:49,840 --> 00:18:54,119 Speaker 1: this novel idea with him, Dr John McDade, Dr C. A. 318 00:18:54,200 --> 00:18:57,480 Speaker 1: Low Ridge, and Dr William Weaver, and Mills and his 319 00:18:57,560 --> 00:19:00,720 Speaker 1: colleagues negotiated a deal with the hospital that would both 320 00:19:00,760 --> 00:19:04,000 Speaker 1: fill the needs of the emergency department and give these 321 00:19:04,040 --> 00:19:08,040 Speaker 1: doctors a much better work life balance. From a financial 322 00:19:08,080 --> 00:19:10,600 Speaker 1: point of view, it was a contract that would give 323 00:19:10,640 --> 00:19:13,320 Speaker 1: them the same or better income than they had already. 324 00:19:13,920 --> 00:19:16,600 Speaker 1: The hospital received a subsidy to cover the cost of 325 00:19:16,640 --> 00:19:20,240 Speaker 1: impoverished patients, and for other patients, they charged five dollars 326 00:19:20,240 --> 00:19:23,760 Speaker 1: a visit. But their shifts were really the big revolution here. 327 00:19:24,320 --> 00:19:27,720 Speaker 1: The emergency department was a small room essentially at this 328 00:19:27,800 --> 00:19:30,800 Speaker 1: point in this hospital. It was just four square feet 329 00:19:30,880 --> 00:19:34,040 Speaker 1: and it had four stretchers, and to cover that, each 330 00:19:34,080 --> 00:19:37,560 Speaker 1: doctor worked twelve hour shifts for five days straight, so 331 00:19:37,600 --> 00:19:40,800 Speaker 1: they would either work midnight to noon or noon to midnight. 332 00:19:41,200 --> 00:19:43,959 Speaker 1: And then after working five days on this schedule, they 333 00:19:43,960 --> 00:19:47,560 Speaker 1: would have five days off, which was a completely mind 334 00:19:47,640 --> 00:19:50,480 Speaker 1: blowing schedule for any doctor at the time, and it 335 00:19:50,520 --> 00:19:53,840 Speaker 1: gave them all much more downtime than they had as GPS. 336 00:19:54,600 --> 00:19:57,440 Speaker 1: But to be clear, although they were very glad to 337 00:19:57,480 --> 00:19:59,919 Speaker 1: have more time off, of course, the team that Mills 338 00:20:00,080 --> 00:20:04,119 Speaker 1: assembled was completely dedicated. They really wanted to make this 339 00:20:04,160 --> 00:20:07,399 Speaker 1: system work, not just for themselves, but for the hospital staff, 340 00:20:07,680 --> 00:20:11,920 Speaker 1: the hospital administration, and of course for the patients. Outside 341 00:20:11,920 --> 00:20:15,520 Speaker 1: of the economic and life balanced drivers, Mills was also 342 00:20:15,640 --> 00:20:18,280 Speaker 1: motivated by a desire to meet the healthcare needs of 343 00:20:18,320 --> 00:20:23,119 Speaker 1: Alexandria's impoverished and at risk population. Because he had taken 344 00:20:23,119 --> 00:20:25,920 Speaker 1: shifts in the emergency department and because he had done 345 00:20:26,000 --> 00:20:29,719 Speaker 1: volunteer outreach to provide care to the city's poor, he 346 00:20:29,800 --> 00:20:33,240 Speaker 1: was keenly aware of two things. First, there was a 347 00:20:33,280 --> 00:20:35,560 Speaker 1: gap in the system that made it hard for poor 348 00:20:35,680 --> 00:20:39,040 Speaker 1: and minority communities to get healthcare. Many of them were 349 00:20:39,040 --> 00:20:42,800 Speaker 1: turning to the emergency department to fill that gap. Second, 350 00:20:42,920 --> 00:20:47,960 Speaker 1: he recognized that not having healthcare contributed to ongoing poverty, 351 00:20:48,000 --> 00:20:50,320 Speaker 1: so he also wanted, with this move to full time 352 00:20:50,359 --> 00:20:53,879 Speaker 1: emergency care, to dedicate as much effort as he could 353 00:20:54,080 --> 00:20:56,480 Speaker 1: to seeing to the needs of communities that might not 354 00:20:56,640 --> 00:21:00,240 Speaker 1: ever have access to a regular GP. This for it 355 00:21:00,280 --> 00:21:03,560 Speaker 1: to make emergency care into its own fully staff department 356 00:21:03,920 --> 00:21:06,359 Speaker 1: came to be known as the Alexandria Plan, and the 357 00:21:06,400 --> 00:21:10,320 Speaker 1: Alexandria Plan got a lot of attention, and that attention 358 00:21:10,359 --> 00:21:12,680 Speaker 1: came not just from the hospital staff in the community, 359 00:21:13,080 --> 00:21:16,280 Speaker 1: but also the media and other hospitals who started to 360 00:21:16,280 --> 00:21:21,400 Speaker 1: wonder if similar organizational structures might work for them. Over 361 00:21:21,440 --> 00:21:25,600 Speaker 1: the next several years, the emergency department at Alexandria's patient 362 00:21:25,680 --> 00:21:30,240 Speaker 1: load doubled, and other hospitals soon started to emulate them. 363 00:21:30,320 --> 00:21:33,679 Speaker 1: Seven years after the beginning of the Alexandria Plan, the 364 00:21:33,760 --> 00:21:37,880 Speaker 1: idea of emergency medicine as a specialty was established enough 365 00:21:38,440 --> 00:21:42,080 Speaker 1: and demand for specialized training was high enough that the 366 00:21:42,119 --> 00:21:46,399 Speaker 1: American College of Emergency Physicians was founded. Dr Mills and 367 00:21:46,440 --> 00:21:50,280 Speaker 1: his trailblazing colleagues served in key positions within this organization, 368 00:21:50,880 --> 00:21:54,080 Speaker 1: but in the interim something else had happened which changed 369 00:21:54,119 --> 00:22:00,200 Speaker 1: the emergency landscape. On July, President Lyndon B. Johnson's find 370 00:22:00,200 --> 00:22:04,119 Speaker 1: a set of Social Security amendments into law, which included 371 00:22:04,160 --> 00:22:09,600 Speaker 1: provisions for the creation of two important programs, Medicare and Medicaid. So, 372 00:22:09,720 --> 00:22:11,760 Speaker 1: just in case you're not familiar with these two forms 373 00:22:11,760 --> 00:22:15,680 Speaker 1: of healthcare coverage, here is a very brief broad strokes rundown. 374 00:22:16,400 --> 00:22:20,480 Speaker 1: Medicare is federally funded and was initially created to offer 375 00:22:20,560 --> 00:22:23,720 Speaker 1: coverage to people sixty five and older who in the 376 00:22:23,760 --> 00:22:27,520 Speaker 1: nineteen sixties insurance market had a really hard time getting coverage. 377 00:22:28,000 --> 00:22:31,160 Speaker 1: That program has since expanded to include coverage for people 378 00:22:31,160 --> 00:22:35,600 Speaker 1: with disabilities and people meeting specific criteria related to end 379 00:22:35,640 --> 00:22:39,560 Speaker 1: stage renal disease. The program also added coverage for things 380 00:22:39,600 --> 00:22:43,960 Speaker 1: like prescription drugs over time. Medicaids function was and is 381 00:22:44,040 --> 00:22:47,919 Speaker 1: to provide medical insurance to low income families and individuals. 382 00:22:48,480 --> 00:22:51,520 Speaker 1: This is a federal and state program where the federal 383 00:22:51,560 --> 00:22:55,159 Speaker 1: government subsidizes at least half of the state's costs in 384 00:22:55,200 --> 00:22:59,920 Speaker 1: providing services to Medicaid beneficiaries, just has has been the 385 00:23:00,040 --> 00:23:03,359 Speaker 1: case with Medicare. The Medicaid program has evolved over time, 386 00:23:03,720 --> 00:23:07,560 Speaker 1: and it has expanded to include pregnant women, people with disabilities, 387 00:23:07,640 --> 00:23:10,880 Speaker 1: and those with long term care needs in their coverage guidelines. 388 00:23:11,720 --> 00:23:15,320 Speaker 1: Medicaid is not consistent state to state, though each state 389 00:23:15,359 --> 00:23:18,880 Speaker 1: has leeway to shape the program into what theoretically best 390 00:23:18,920 --> 00:23:22,320 Speaker 1: suits that states constituents, and it is also possible for 391 00:23:22,400 --> 00:23:26,199 Speaker 1: a person to qualify for both programs. So we mentioned 392 00:23:26,200 --> 00:23:29,560 Speaker 1: a moment ago that the Alexandria Hospitals patient load and 393 00:23:29,600 --> 00:23:32,960 Speaker 1: the emergency department doubled over the course of several years, 394 00:23:33,440 --> 00:23:36,159 Speaker 1: and those new programs were a significant driver of that 395 00:23:36,280 --> 00:23:40,119 Speaker 1: uptick in numbers because more people had insurance coverage, and 396 00:23:40,160 --> 00:23:42,520 Speaker 1: that meant that there were more cases where people were 397 00:23:42,640 --> 00:23:45,920 Speaker 1: using the emergency department instead of seeking out a GP 398 00:23:46,160 --> 00:23:49,800 Speaker 1: for their routine healthcare needs. In the five years following 399 00:23:49,800 --> 00:23:54,080 Speaker 1: the legislation that created Medicare and Medicaid, emergency department visits 400 00:23:54,119 --> 00:23:56,520 Speaker 1: in the US went from twenty nine million a year 401 00:23:56,920 --> 00:24:01,440 Speaker 1: to forty three million. And this also created an entirely 402 00:24:01,520 --> 00:24:05,080 Speaker 1: new problem in terms of poor communities, which was a 403 00:24:05,119 --> 00:24:09,840 Speaker 1: growing population in cities. In the nineteen sixties, most inner 404 00:24:09,840 --> 00:24:13,879 Speaker 1: cities had hospitals which were considered urban teaching hospitals. That 405 00:24:13,920 --> 00:24:17,520 Speaker 1: meant that their emergency departments were staffed by interns and residents, 406 00:24:17,600 --> 00:24:20,960 Speaker 1: and there were often few or no full time emergency 407 00:24:21,000 --> 00:24:25,639 Speaker 1: doctors working there to supervise or guide the department. Naturally, 408 00:24:25,840 --> 00:24:30,240 Speaker 1: this meant that the poor often received substandard care. Cincinnati 409 00:24:30,280 --> 00:24:34,800 Speaker 1: residents from the primarily black neighborhoods around Cincinnati General Hospital 410 00:24:34,920 --> 00:24:38,639 Speaker 1: became so frustrated with the mediocre care and long await 411 00:24:38,680 --> 00:24:41,919 Speaker 1: times at the hospital that a group of demonstrators marched 412 00:24:41,920 --> 00:24:45,639 Speaker 1: on the facility. Their protests led to meaningful change to 413 00:24:45,760 --> 00:24:48,920 Speaker 1: fill the gap in dedicated emergency physicians in the city. 414 00:24:49,040 --> 00:24:52,880 Speaker 1: The University of Cincinnati started the country's first emergency medicine 415 00:24:53,040 --> 00:24:57,359 Speaker 1: residency training program. When the program began in nineteen it 416 00:24:57,440 --> 00:25:00,600 Speaker 1: had only one resident, but it quickly grew, and other 417 00:25:00,640 --> 00:25:04,080 Speaker 1: cities around the country that had similarly left teaching hospital 418 00:25:04,119 --> 00:25:09,200 Speaker 1: emergency departments without dedicated full time physicians also began partnering 419 00:25:09,200 --> 00:25:13,639 Speaker 1: with their local universities to offer similar programs. Even so, 420 00:25:13,800 --> 00:25:17,280 Speaker 1: it took almost a full decade for emergency medicine to 421 00:25:17,320 --> 00:25:20,720 Speaker 1: be recognized as a Board certified specialty by the American 422 00:25:20,760 --> 00:25:23,840 Speaker 1: Board of Medical Specialties. And that is where we will 423 00:25:23,920 --> 00:25:26,600 Speaker 1: leave this off for today. Next time we will kick 424 00:25:26,640 --> 00:25:28,840 Speaker 1: off by talking about a paper that addressed all the 425 00:25:28,880 --> 00:25:32,000 Speaker 1: problems and emergency medical care in the US as the 426 00:25:32,000 --> 00:25:34,679 Speaker 1: need for that care was on the rise. I have, 427 00:25:35,119 --> 00:25:39,160 Speaker 1: instead of listener mail today a plea sort of. It's 428 00:25:39,200 --> 00:25:42,800 Speaker 1: not really a plea, UM. It is a request that 429 00:25:42,880 --> 00:25:45,800 Speaker 1: was put out by the Atlanta History Center UM and 430 00:25:45,880 --> 00:25:47,600 Speaker 1: I saw it and I think it's a really cool 431 00:25:47,640 --> 00:25:51,720 Speaker 1: idea because it enables our listeners, particularly if they are 432 00:25:51,760 --> 00:25:55,440 Speaker 1: in the Atlanta area, to take part in documenting history. 433 00:25:55,880 --> 00:26:00,480 Speaker 1: They posted a blog at the History Center on the 434 00:26:00,600 --> 00:26:04,160 Speaker 1: seventh of this month, that's April uh and they are 435 00:26:04,240 --> 00:26:06,960 Speaker 1: asking for people because they recognize that we are living 436 00:26:06,960 --> 00:26:09,720 Speaker 1: through a very unique time. So they are asking for people, 437 00:26:09,760 --> 00:26:14,840 Speaker 1: particularly Atlanta residents, to send them documentation of how they 438 00:26:14,840 --> 00:26:17,280 Speaker 1: are living in what is going on. They have an 439 00:26:17,320 --> 00:26:21,080 Speaker 1: online donation form and if you are interested in participating, 440 00:26:21,160 --> 00:26:24,639 Speaker 1: they're like, you can do this with photo, video, social 441 00:26:24,680 --> 00:26:29,960 Speaker 1: media posts, your grocery lists, lesson plans, of your teacher letters, etcetera. 442 00:26:30,640 --> 00:26:32,520 Speaker 1: That you can share with them, so they will make 443 00:26:32,640 --> 00:26:34,639 Speaker 1: an archive of what we are living through, which is 444 00:26:34,840 --> 00:26:37,399 Speaker 1: so cool. Uh. If you want information on this, you 445 00:26:37,400 --> 00:26:41,440 Speaker 1: can go to Atlanta History Center dot com, slash blogs, 446 00:26:41,440 --> 00:26:44,560 Speaker 1: slash Coronavirus, dash Collective, or you can just go to 447 00:26:44,640 --> 00:26:47,480 Speaker 1: Atlanta History Center um and if you just do a 448 00:26:47,520 --> 00:26:50,920 Speaker 1: search for Corona Collective, it comes up. I just think 449 00:26:50,920 --> 00:26:53,760 Speaker 1: it's a really cool thing. Atlanta is in a weird place. 450 00:26:53,920 --> 00:26:58,200 Speaker 1: This won't air for a little bit, but our restrictions 451 00:26:58,440 --> 00:27:02,560 Speaker 1: on what businesses can be open have just been shifted 452 00:27:02,600 --> 00:27:06,640 Speaker 1: to opening a lot of things well earlier than anybody anticipated. 453 00:27:06,720 --> 00:27:09,639 Speaker 1: I hope everybody is still saying very safe, and I 454 00:27:09,680 --> 00:27:13,639 Speaker 1: really really hope that they take advantage of this opportunity 455 00:27:13,680 --> 00:27:17,640 Speaker 1: if you live in Atlanta, to contribute and make your 456 00:27:17,720 --> 00:27:20,879 Speaker 1: voice part of this, this ongoing record. They have some 457 00:27:20,960 --> 00:27:24,800 Speaker 1: specific things that they would love answered from different parts 458 00:27:24,840 --> 00:27:27,320 Speaker 1: of the community, like if you work in a medical 459 00:27:27,359 --> 00:27:30,399 Speaker 1: profession or if you're a local business owner, etcetera. And 460 00:27:30,440 --> 00:27:33,240 Speaker 1: that's all in that that blog post I referenced. I 461 00:27:33,280 --> 00:27:36,040 Speaker 1: hope that everybody goes and participates in this from the 462 00:27:36,080 --> 00:27:38,320 Speaker 1: Atlanta area. If you're not from the Atlanta area, it's 463 00:27:38,320 --> 00:27:40,399 Speaker 1: worth taking a look at just to think about the 464 00:27:40,440 --> 00:27:42,120 Speaker 1: kinds of things you're doing in your day to day 465 00:27:42,119 --> 00:27:45,040 Speaker 1: life that might seem mundane or every day but are 466 00:27:45,240 --> 00:27:47,840 Speaker 1: important to documents. Uh. And see if there is a 467 00:27:47,840 --> 00:27:50,240 Speaker 1: similar program in your area. So again, that's at the 468 00:27:50,280 --> 00:27:53,320 Speaker 1: Atlanta History Center dot com. There's no the and that 469 00:27:53,440 --> 00:27:55,960 Speaker 1: it's just Atlanta History Center dot com. Uh. And you 470 00:27:55,960 --> 00:27:57,399 Speaker 1: can go to their blog and look for it, or 471 00:27:57,440 --> 00:28:00,400 Speaker 1: you can do a search for Corona Collective to super 472 00:28:00,400 --> 00:28:02,719 Speaker 1: cool program. If you would like to write to us, 473 00:28:02,920 --> 00:28:04,920 Speaker 1: you can do so at History podcast at i heeart 474 00:28:05,000 --> 00:28:07,560 Speaker 1: radio dot com. You can also find us everywhere on 475 00:28:07,600 --> 00:28:10,600 Speaker 1: social media as missed in History. And if you would 476 00:28:10,600 --> 00:28:12,960 Speaker 1: like to subscribe to the show, we would like that too. 477 00:28:13,000 --> 00:28:14,840 Speaker 1: You can do that on the iHeart Radio app, at 478 00:28:14,880 --> 00:28:22,720 Speaker 1: Apple podcast or wherever it is you listen. Stuff you 479 00:28:22,720 --> 00:28:25,399 Speaker 1: Missed in History Class is a production of I Heart Radio. 480 00:28:25,760 --> 00:28:28,320 Speaker 1: For more podcasts from I Heart Radio, visit the i 481 00:28:28,400 --> 00:28:31,600 Speaker 1: heart Radio app, Apple Podcasts, or wherever you listen to 482 00:28:31,640 --> 00:28:32,479 Speaker 1: your favorite shows.