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Published on August 11, 2015

Delivering expert medical care—on four wheels

Delivering expert medical care—on four wheels


This story on Emergency Medical Services highlights what a special place Cape Cod is. The first paramedics in Massachusetts started practicing on the Cape in 1974 in what has been called the “greatest feat of common good” ever accomplished on Cape Cod. – Kevin Morley


The Emergency Room—the ER—is a staple of TV dramas and reality shows. Yet emergency medicine is no longer confined to a room with four walls.

Today, it radiates outward from a hospital-based “Emergency Center” to a well-equipped fleet of ambulances, each staffed with highly trained paramedics and emergency medical technicians (EMTs) in constant radio contact with hospital doctors and nurses.

When a fire department ambulance rushes by on a Cape Cod street or highway, you are seeing the pre-hospital stage of emergency care. In effect, the patient has entered the hospital even though it is still miles away.

Paramedic Pioneers

It was not always so on Cape Cod—or the rest of the country. A groundbreaking report published in 1966 by the National Academy of Sciences painted a bleak picture of the state of emergency medical care in the United States.

The report revealed that sick and injured citizens were transported to hospital in vehicles ranging from police cars to hearses in the care of minimally trained attendants.

In the early 1970s, Cape Cod was one of a handful of areas around the country to pioneer paramedic training. The Cape Cod effort was driven by two emergency department physicians: Dr. Lloyd Bremer at Cape Cod Hospital and Dr. Robert Riggen at Falmouth Hospital.

At the time there were no formal standards or training programs for paramedics, so the doctors created their own.

One of the early challenges was the need for a single-purpose radio system between the ambulances in the field and the hospitals, with a dispatch center in between. The doctors applied for and received a grant to fund the Centralized Emergency Medical Dispatching system, known as CMED. (CMED).

The foundation awarding the grant could not distribute the money directly to hospitals, private individuals or municipalities.

Undeterred, Drs. Bremer and Riggen organized town officials and fire and police chiefs in what has been called the “greatest feat of common good” to ever be accomplished on Cape Cod: the creation in 1974 of the non-profit Cape & Islands Emergency Medical Services System, Inc., or CIEMSS.

The first paramedics in the Commonwealth of Massachusetts began practicing on Cape Cod some four months later.

Working Both Sides

CIEMSS currently offers all the continuing education required for more than 500 paramedics and EMTs from every community in Barnstable County.

By law, hospital Emergency Departments must assign an Affiliate Hospital Medical Director, or AHMD to work with CIEMSS and its own medical director. The AHMDs ensure that Cape paramedics and EMTs stay current with the latest technology and protocols.

Cape Cod and Falmouth hospitals have two of the best. In addition to their medical training, both physicians have experience on the other side of the emergency center door.

Evan Weinstein, MD, is the AHMD from Falmouth Hospital and the CIEMSS Medical Director as well. He started his career as a ski patroller and a basic EMT, then worked as a paramedic and firefighter while in college.

Dr. Weinstein continued to be active in EMS throughout medical school and during his emergency medicine residency. Today, he also serves as the medical director of the Barnstable County Public Safety Answering Points handling 911 calls.

Jacob Crowell, MD, a graduate of the University of Massachusetts Medical School, is the Cape Cod Hospital AHMD. He is a Dennis Fire Department call firefighter, following in the footsteps of his grandfather, father and uncle.

When not working a shift in the emergency center, Dr. Crowell could very well be responding to a car crash or a fire.

Because of their experience in the back of the ambulance, both doctors bring a special perspective to the training provided by CIEMSS. “Beyond what’s in the textbook, we know what’s important and a challenge to those in the field,” Dr. Weinstein said.

The result is a well-trained cadre of more than 400 pre-hospital paramedics, the first responders for emergency care on Cape Cod.

“Our experience in the field gives us increased respect and appreciation for the work done by the paramedics and EMTs,” Dr. Crowell says. “This motivates us to provide them with the best training possible.”

Did You Know?

  • The 15 fire departments in the Cape and Islands system logged 86,763 ambulance calls between 2013 and May 2015.
  • Cape Cod Healthcare’s emergency centers in Hyannis and Falmouth handle around 133,000 patients per year and are the busiest in Massachusetts during the summer months.
  • Cape Cod and Falmouth hospitals opened new emergency centers in 2015, with 52 private treatment rooms at Cape Cod Hospital and 33 at Falmouth.
  • Emergency training has three levels: basic, advanced and paramedic. To become certified as paramedics, trainees log around 1,000 hours of classroom time, 400 hours of clinical training in the Emergency Center and other hospital departments and 200 hours of ambulance duty.
  • Paramedics work under the medical license of the emergency center doctors.