"Squad 51, this is Rampart. Can you send us an EKG?"

"Ten-four, we're transmitting EKG. We're sending you a strip. Vitals to follow. Pulse is 160. The victim is in extreme pain, Rampart. V-fib.

"Patient is in V-fib! Rampart, we have lost the victim's pulse, beginning CPR. We're defibrillating victim, Rampart."

Although this was dialogue from the TV program "Emergency" which aired on network TV through most of the 1970s, it has become common dialogue with responding ambulance corps today.

The show about the crew of Los Angeles paramedic Station 51 was an indicator of what was going to be the future for communities across the nation.

It was 20 years ago in February that paramedic service officially began in Carbon County with the then Gnaden Huetten Memorial Hospital in Lehighton hosting the first paramedic unit.

The hospital shed the paramedics after a few years, with Lehighton Ambulance Association picking up the service.

Today, the paramedics service has 60 employees including 14 full-time medics, 10 ambulances (seven of them Advanced Life Support units), and four stations. In 2009, the paramedics were dispatched to 6,552 calls, nearly twice the number of calls they made in 2000.

Carbon's paramedic service became operative on Feb. 5, 1990. The initial staff consisted of four full-time paramedics and four full-time emergency medical technicians (EMTs). It relied on volunteers from basic life support (BLS) ambulance squads.

Joni M. Gestl, administrative coordinator for Lehighton Ambulance Association, said the squad still relies on help from volunteers.

"Volunteers are getting harder to find," Gestl added. "They're required to have more intensive training and availability has become a problem for many."

On July 21, 1996 the ALS unit moved to its current headquarters on Iron Street in Lehighton after the Lehighton hospital dissolved its squad association.

Gestl, who was on the first paramedic squad in 1990, said the paramedic service in Carbon was originally set up through the cooperative efforts of the Gnaden Huetten Hospital and the Good Samaritan Regional Hospital in Pottsville.

"It became a financial nightmare for the hospital," Gestl recalls. "They donated the equipment of the ALS for any entity that was going to pick up the service. In Carbon, it was the Lehighton Ambulance Association. In Schuylkill, it was Pottsville EMS."

When the Lehighton unit began, there was just one ALS truck.

"We still provided ALS assists with all the (ambulance) squads as we do now," she said.

She explained how the demand has grown. Penn Forest Fire Company dissolved its ambulance service, so the Lehighton Ambulance opened a station in Penn Forest and provides ALS and BLS service. Summit Hill was looking for assistance, she said, so a station was opened in that community. A fourth station evolved when the ALS merged with Jim Thorpe EMS.

Gestl said it is expensive operating a paramedic unit because of the equipment needed and the size of the staff. She said Lehighton Ambulance Association relies on an annual subscription drive. Individuals and families who subscribe are assured that they won't be charged any more for transport during an emergency than what their insurance covers. If they have no insurance, their subscription fee covers the bill.

Lehighton Ambulance is the primary responder for Lehighton borough and the eastern end of Mahoning Township including Jamestown, Packerton, and Mahoning Heights, said Gestl. She said a mutual aid agreement exists with the Mahoning Valley Ambulance Association.

The paramedic squads work closely with EMS units in Palmerton, Nesquehoning, Lake Harmony, Mahoning Valley, Lansford and the Penn-Mahoning Ambulance, noted Gestl. Lansford Ambulance is the primary ambulance service for Coaldale. Tamaqua Ambulance is the primary responder in Tamaqua.

The dialogue that occurred by paramedics John Gage and Roy DeSoto via ambulance radios with Dr. Kelly Brackett at the fictitious Rampart General Hospital on the TV show has become reality daily for the local paramedics. Gestl explained some of the equipment and pharmaceuticals that the medics carry with them on emergency calls.

"You have ambulances that have very expensive equipment," she said, "and you have the staff with the training to take care of you."

Especially important in the list of equipment is the "Lifepack 12," which has numerous functions including defibrillation, external pacing, it monitors the level of carbon dioxide as well as oxygen in the blood stream, and does 12 lead EKGs.

She added that paramedics are specially trained in handling heart patients.

"That's awesome. We're saving people's lives every day and they don't even know it," she said.

The paramedics are also trained in stroke alerts, she noted, and they can provide special care for stroke patients which is important for survival.

Another area of special training for the medics is trauma patients. By identifying and giving preliminary care to trauma patients, paramedics make direct transport to trauma centers (Geissinger in Wyoming Valley, Lehigh Valley at Cedar Crest which is a Level 1, and St. Luke's in Bethlehem) as well as partnering with medical helicopters PennStar and MedEvac for even more rapid transport.

Even with as many as five staffs on at a time, sometimes the squad is short-handed, especially during ski season.

"We can never predict how much staff we're going to need at any given time," she said. "We're prepared to handle 98.9 percent of what's thrown at us. You cannot predict for the worst-case scenario. We sometimes helps other ALS units and sometimes they assist us."

The bottom line, she said, is "As an Advanced Life Support unit, we bring the emergency room to the patient. It's done with paramedics and medical command through the hospitals."

"We're defibrillating victim, Rampart. Rampart, we have defibrillated victim. He has sinus rhythm.

"Administer two amps of Sodium Bicarb. Insert an airway. Start an IV, 51 - Lactated Ringer's.

"Squad 51, continue to monitor patient and transport immediately.

"We're on our way, Rampart."