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Although CPR could be administered by ambulance crews, the delays involved in moving the victim to hospital prior to defibrillation were too great to allow many to survive. The first major advance in prehospital care occurred when Frank Pantridge addressed possible ways of reducing the high mortality rate associated with myocardial infarction.
He recognized that most individuals who died did so within an hour of the onset of symptoms. Despite opposition from colleagues and the authorities, he and his resident, John Geddes, implemented the world's first mobile coronary care unit MCCU in Belfast in During the first 15 months of operation, the MCCU attended 10 patients who had ventricular fibrillation outside hospital, and all were successfully defibrillated.
However, time was often wasted waiting for staff to arrive at the MCCUs prior to dispatch, and many cities had only a single MCCU serving a large geographic area. Response times were often slow, and those who had cardiac arrests before the MCCU arrived usually did not survive. The MCCU system was a breakthrough in prehospital care, but was limited by the concept that defibrillation had to be administered by a physician.
Because of legal impediments which forbade paramedics from administering treatments other than first aid and CPR without orders from a physician, Nagel used a system of ECG telemetry and radio communication to allow the emergency room physicians to issue orders to paramedics, allowing intervention at the scene.
