Administration and Leadership

Between a Stethoscope and a Gavel

In late 1959, a young firefighter candidate was given a welcome break from the “grinder”—an affectionate term for the training academy of the Los Angeles County Fire Department (LACoFD).

The young firefighter had been told his “contractual duty is to fight fire”1 and had spent the prior weeks drilling on the techniques of the profession under the Southern California sun.

However, today would be different. Instead of pulling hose and lifting ladders, his afternoon would be spent in a classroom taking a course called “first aid.”

At best, the course was marginal; lasting less than two hours, it was wedged between lectures on “driver education” and “union benefits.”2


Page rose to the rank of Battalion Chief with the Los Angeles County Fire Department and served as a technical advisor for the hit TV series “Emergency!” which catapulted the paramedic concept worldwide.

It was on this day in December 1959 that James Owen Page was introduced to LACoFD’s version of emergency medicine—a field that he would elevate from the periphery of firefighting to the forefront of American public service.

Many recognize James O. Page’s work on the television show Emergency! and his foundation of JEMS as well as his efficacy for developing the field of paramedicine. However, the title of “Father of Modern EMS” was not easily granted to Page. It’s in the aspirations and trials of his often-forgotten early career that the winds of change began to blow for emergency medicine.

My hope in the presentation of this historical look back at the early days of Page’s career is to reinvigorate the life of the young James O. Page to better illustrate the man, and, more importantly, the profession of prehospital emergency medicine.

A Series of Unique Encounters

Born in the San Gabriel suburb of Alhambra, Calif., James O. Page spent much of his early life shifting between family member’s homes in California and Kansas.  

As a teen, he left Southern California for central Kansas, seeking opportunities he could call his own. Opportunities were plentiful for Page, he held a slew of jobs: farmhand, gas station proprietor and auto parts salesman.

However, Page’s introduction to the fire service came from a series of unique encounters.

His father managed a furniture moving company that prospered serving the rapidly growing suburbs of the Los Angeles Basin during the years following World War II. The company frequently employed off-duty firefighters who were looking to supplement their income.

As the driver of his father’s furniture truck, the firefighters shared stories of their career with the teenager during their commute.

Page was enthralled by these tales of adrenaline and drama, and he was encouraged to pick up a job with an ambulance company to better his chances of working for a fire department.

He took the advice and worked as an ambulance attendant in East Los Angeles.3 His experience was less than romantic, “It was a sleazy outfit. They paid a dollar an hour with deductions for mealtime and sleeping. About half the time, the paychecks bounced. The boss gave me six months to read the Red Cross Basic First Aid book and pass the test. Meanwhile, he put me in the back of the ambulance with patients because he didn’t trust me to drive.”4 Fortunately, the ambulance position was short-lived.

His father, who had survived the Great Depression, had continually advised his son to find employment in the public sector, as it offered greater job security.  

Heeding the advice of the firefighters from the moving company and his father, he began applying for firefighter positions at local municipal departments.

Monterey Park Fire Department hired James on his 21st birthday, something Page was always proud to note. At that time, it was the earliest day most people could begin their career as a firefighter.5

Page was appreciative of the opportunity to work with Monterey Park Fire Department, however, it became apparent that the department salary couldn’t support him. By this point he had a growing family, which included a foster child and one of his own on the way. The salary at Monterey Park could not compete with that of larger agencies.

Additionally, the small department offered limited promotional and professional growth—a stifling environment for the ambitions of this young man.3

So, shortly after beginning work with the city of Monterey Park, Page took and successfully passed the examinations and interviews for Los Angeles City Fire Department.

However, at the medical clearance stage he was diagnosed with “a deviated septum,” a catchall diagnoses for people that didn’t fit the cookie-cutter mold of what a Los Angeles City firefighter “should look like.”3

Discouraged, but not defeated by the idiosyncratic practices of Los Angeles City, he applied for LACoFD, was hired and began work with the large department in 1959.

Policy Changer

At LACoFD, Page was immensely successful, climbing to the rank of battalion chief in a little over a decade. During this period, he developed his now famous focus of emergency medicine: “It didn’t make sense to rescue someone if you couldn’t resuscitate him.”6

However, Page began to examine the process of changing policy in the fire service and he recognized the limited ability he had to do so. After attending a State Firefighter’s Association meeting in Sacramento, he recognized that those who could make a difference and implement effective change were lawyers.3


Graduation Day in the spring of 1970, Jim Page stands with his mother, Marion in the Monterey Park, California, home he was raised in. (Digital photograph of original Kodak print courtesy Tom Page)

James had begun his academic career by taking night classes at a community college near Menlo Park in the mid-1950s and completed his course work in 1961. Four years later he was accepted to Southwestern Law School in downtown Los Angeles.

Juggling a family, career and now law school wasn’t an easy task, but it was a necessary one. In order to continue taking night classes, Page transferred to the Fire Prevention Division so he could work a 40-hour workweek instead of his normal 56-hour workweek.

At this point in the mid-60s, Page had become the caretaker of the Sandstone Ranchin Malibu hills and had relocated his family there. Commuting between these commitments wasn’t always easy. On evenings when exhaustion got the best on him, he was forced to stay at his parent’s home in Monterey Park.3

Page took the challenges in stride. For him, law school was a means to better his profession. As his colleague Bill Atkinson notes, “Law school was a way to improve the quality of life for those around him in the fire service.”17

Page’s enrollment at Southwestern Law School didn’t go unnoticed amongst his peers. Recognizing that a future lawyer was in their midst, chiefs within the LACoFD sought to capitalize on Page’s legal capability and potential. Their goal was to depute Page to the unofficial role of “executioner.”

At the time, Page was working at fire station 69 in Topanga Canyon. The station is relatively isolated from the rest of the department and the call volume was low.

In other words, station 69 was an ideal location for the placement of problematic personnel. The goal of the chiefs was to place a continual stream of men that had been deemed undesirable by LACoFD under the supervision of Page.

In turn, Page would build “rock-solid” evidence and arguments for the dismissal of the firefighters that could hold up in court and defeat any existing union contract. His role was much the same as a modern day internal affairs officer.

The experience had a profound effect on Page, but not the one that LACoFD had hoped for. The so-called “problematic” firefighters placed under his command had varying records of performance, psychological, legal and dependency issues.8

Page began to dig deep into each firefighter’s case and empathize with the many of the firefighters rather than act as a mechanism for ending their careers.

Many of the firefighters were victims of SOPs and policies that were without a “soul,” according to Page.

Yes, they had deviated from what the fire department defined as acceptable. However, acceptability is subjective.

Page discovered that LACoFD’s conduct regulations were created by policymakers who were removed and unfamiliar with the stressors and trials of the fire service—they had never rushed to a burning building, nor had they ever performed first aid or CPR.8

Many of the firefighters that had been labeled “problematic” were victims of what Page saw as weak policy and a blind bureaucracy. He believed that, with proper guidance and engagement, the firefighters would continue to be a vested asset for the fire department.

So, under the watch of Page, the Topanga Canyon station became a refuge for the “defenseless.”

Based on his experiences in Topanga Canyon, Page took up a part-time practice of defending firefighters from what he called “the mindless bureacreacy.”9

It was a cause that he so firmly believed in that he offered his services to firefighters in need pro bono, meaning that he took on the cases without expectation of pay. In Latin, pro bono publico means “for the public good;” in English we generally shorten the phrase to pro bono.10

Moralist Defender

Page’s demeanor in the courtroom was most telling of, not only his character, but the respect he had for his fellow firefighters. Attorney James O. Page developed a reputation for providing a moralist defense.

As a battalion chief, EMS advocate and lawyer, Page had the keen ability to disarm arguments that were technical and based in arcane municipal disciplinary procedures. In doing so, he shifted the courtroom discussion to the “humane perspective,” the recognition of the firefighter as an individual rather than a cog in the machine.9           

His practice also extended to areas in which the LACoFD was severely lacking. As emergency medicine developed and evolved, it lacked a presence in the courtroom. Firefighters who provided medical care frequently faced lawsuits from former patients and odious ambulance chasers.

At the time, LACoFD didn’t provide counsel or support for such cases—a challenge and charge that Page placed on himself.

In one particular case, Page defended a firefighter who was being sued by a former patient who had been successfully resuscitated by CPR. The charge was negligence, with the patient accusing the firefighter of having cracked “too many ribs.”8 Page won the case and laid the groundwork for the defense of countless other similar lawsuits that would surface during the early days of CPR and EMS resuscitation practices.

An analyst of Page’s earliest litigious exploits allows two major themes to emerge. First, the limitless compassion he had for his colleagues. His colleague A.J. Heightman succinctly summarizes Page’s mentality and contributions to his emergency service colleagues, “He considered himself indebted to help people that couldn’t help themselves.”5

The second theme serves as a gauge on the field of emergency services as a whole. A sector of public service that awkwardly, and with great difficulty, began to lend itself to emergency medicine.

What would Page want the emergency management community to learn from his early work? He was an adamant defender of his client’s privacy,3 so we will never know the idiosyncrasies of each trial. However, his court cases and defendants live on in Aesopian translations. The trials and obstacles faced by those he defended live on in Page’s speeches and books.11–13

The characters of his narratives are generic in name, but not in circumstance. They are placed in morale and ethical dilemmas that challenge them as individuals and as emergency management professionals.

Often, they make a wrong decision. Page’s anecdotes share a common ending: the character’s situation is elevated when they appeal to the help of their brethren—those that share the same firehouses, ambulances and circumstances as they do.

Making a Difference


Page, age 44, is shown waiting at Newark International Airport to board one of hundreds of flights he would take during his career.

When we analyze the young James O. Page outside of the glowing spotlight of his role as a technical advisor on Emergency!, (the epic 70s TV show that introduced paramedics to the public) and notoriety of JEMS—the journal he founded in 1980 to bring a voice to EMS—we’re confronted with a man who was resolute in his conviction to improve his profession. He recognized that to make a difference in a profession, one must also be willing to venture outside of it and view it from a different lens.

I believe that, way back in the 1950s, when Page sat in the cab of his father’s moving truck hearing stories of the fire service, he espied an opportunity, an awareness that became a compulsion that defined much of his career.

It was a cause that he strove to maintain and sacrificed much for. Page was emboldened by it when he refused the moniker of “executioner” in lieu of “moralist defender.”

Page worked tirelessly to help labor and management understand each other better. He championed this philosophy in court, his profession and in his written work.

James O. Page understood that to move emergency services forward and to be able to meet the increasingly complex demands of modern America, a culture of loyalty, support and rapport must come from within the profession.

Author Acknowledgements: I would like to thank Dr. Cathryn Carson of University of California Berkeley, Russell Johnson and Teresa Johnson of the UCLA Biomedical Library and James O. Page Collection, the time spent with Douglas Wolfberg, Tom and Andy Page, A.J. Heightman, and Dr. Bill Atkinson. Access and information to the James O. Page Collection can be found here.

References

1. “The Life of a Fireman, LACoFD recruit training notes.” James O. Page Collection, UCLA Biomedical Library Special Collections.

2. “Recruit training schedule, LACoFD recruit training notes.” James O. Page Collection, UCLA Biomedical Library Special Collections.

3. Interview with Andy Page. June 2017.

4. James O. Page interview with Emergency! Fans. 1998.

5. Interview with A.J. Heightman. April 2018.

6. Bayout J. (Sept. 21, 2004.) James Page, advocate of emergency services, dies at 68. The New York Times. Retrieved Nov. 14, 2018, from www.nytimes.com/2004/09/21/obituaries/james-page-advocate-of-emergency-services-dies-at-68.html.

7. Interview with Bill Atkinson. April 2018.

8. Interview with Tom Page. April 2018.

9. Interview with Douglas Wolfberg. April 2017.

10. “Autobiographical sketch.” James O. Page Collection, UCLA Biomedical Library Special Collections.

11. “Collection of speeches.” James O. Page Collection, UCLA Biomedical Library Special Collections.

12. Page J: The magic of 3am. Jems Publishing Company: Solana Beach, Calif., 1986. Purchase here.

13. Page J: Simple advice. Mosby/JEMS: St. Louis, 2002. Purchase here.

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