The Twin Brothers Who Brought America EMTs, 911 Dispatchers - and Saved Millions of Lives

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Send them to ouramericanstories.com, about your family, about the town you live in, about the country you love. Your stories are some of our favorites. Up next, the story of how identical twin brothers, a doctor and a lawyer, collaborated with scores of unsung heroes to modernize emergency medical services, help create the physician assistant profession, help write the model law for organ donation, and develop other programs that save thousands of lives every year. Here's Alfred and Blair Sadler with their story.

Thank you very much. It's a pleasure for Blair and me to have an opportunity to be with you today and tell our story. I'm Alfred Sadler. I go by Fred, and my identical twin brother, who was born four minutes after me in New York City in 1941, is Blair, and I'm a physician, and Blair is a lawyer. Blair and I were medical students and law students respectively in Philadelphia in our early 20s, and this led to the idea that we might actually collaborate together. The first issue that we addressed was the Good Samaritan problem, and what I'm referring to is that Christianity and the American Bible talk about the Good Samaritan who is encouraged to stop at the scene of an accident and help someone who is injured, even if it's someone of another persuasion, but the law may have a different view of the matter. If, for example, we stop and the patient doesn't do well or dies, the family in our litigious society might be encouraged to sue us, so we looked into the laws relating to this. There were different and different states, and that is what launched our collaborative career.

When I reflect back on how did we get started, how did this idea actually take off to collaborate, we talk in the book about four green lights, four green lights, four things that happened that had they not been giving us a green signal, we never would have done this. Fred's already mentioned the first one of those, which was a joint presentation we did at Mass General Hospital as part of his surgical rotation on the Good Samaritan problem, the legal and ethical issues in stopping to render aid and an accident, and the chair of the Department of Surgery afterwards saying, this is one of the best presentations we have had. That really led a spark, and we decided to pursue the idea of collaborating in law and medicine.

We developed a paper describing a variety of medical legal issues, such as informed consent, human experimentation, euthanasia, organ transplantation, and definition of death. I called Anthony Amsterdam, a leading Penn Law professor and a mentor of mine who frequently argued cases before the Supreme Court. I asked if we could meet with him about our idea, and he said, sure, let's have dinner. Fred and I came to the dinner with two questions. First, did our medical legal collaboration idea make any sense?

And second, should we pursue such collaboration now, or should we wait until we're further along in our careers? He reviewed the paper and said, you know, this is a great idea. Even more important, he thought we should pursue it immediately. That provided a major booster shot to proceed.

But where and how? We were aware that the U.S. Public Health Service had opportunities to become commissioned officers, but they were typically for MDs and PhDs in science. So Fred took a chance. He called Dr. Luther Terry, the former surgeon general who had become well known by fighting the tobacco industry over cancer risks and placing the warning on every pack of cigarettes, smoking may be hazardous to your health. Fortunately, he was now dean of the medical school at the University of Pennsylvania, of all places. He agreed to meet with us and reviewed our position paper.

He exclaimed, you know, this is a great idea. I wish I had had a doctor lawyer team working with me on the tobacco issues. He put us in touch with the current surgeon general and the current director of NIH. We soon arranged for three days of interviews in Bethesda and Washington and received invitations to apply for jobs. We did, but just four months had passed with no response.

And I was running out of time. My judicial clerkship in Philadelphia was ending in July and I had to decide whether to accept an offer from a Philadelphia law firm. So I called the office of the associate director of NIH and I said, you know, this is a great idea. I was the associate director of NIH who agreed to meet with me. Just a month later on March 28th, our 26 birthdays, we received telegrams offering us commissions in the U.S. Public Health Service stationed at NIH in the director's office in Bethesda.

We enthusiastically accepted, began work on July 1st. When Blair and I arrived on day one on July 1st of 1967 in the director's office of the NIH, we met with Mr. Joseph Murtagh, who was the outstanding leader of the planning office for Dr. Shannon of the NIH. And he was our boss. And he said, gentlemen, we have a problem and put two newspaper clippings in front of us, one from the LA Times and one from Minneapolis, where pituitary glands were being taken from cadavers who were being examined by the medical examiner to determine the cause of death. And the medical examiner in every state has the authority to do that when there is suspected homicide or foul play, or if there's a pandemic, for example. And he has authority to do that whether the family objects or not.

But there is no authority as part of that statute in any of the states, which allows him or his assistants to take other tissues that have no relevance to the cause of death, in this case, pituitary glands. And you're listening to the unlikely collaboration of identical twins, one a lawyer and one a doctor, who forever changed how we view certain things about the medical and legal professions and the intersection of both. When we come back, more of the story of Alfred and Blair Sadler here on our American stories. Here at Our American Stories, we bring you inspiring stories of history, sports, business, faith and love. Stories from a great and beautiful country that need to be told.

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Listen to untold stories life with myasthenia gravis on the I Heart Radio app, Apple podcasts, or wherever you get your podcasts. And we're back with our American stories. And we've been listening to the story from Fred and Blair Sadler, identical twin brothers, a doctor and a lawyer who helped innovate and change American emergency medical services. We last left off with Fred sharing the story of how pituitary glands were being taken without consent from cadavers by medical examiners in California and Minnesota.

Let's return to Fred and Blair. That had happened in those two states. The press had found out about it where assistants to the pathologists were taking pituitary glands and sending them back to Baltimore, Maryland, which is where the headquarters of something the NIH was funding called the National Pituitary Agency was located. And they were doing this because although at only $2 per gland, if you send enough of these and the NIH was collecting 72,000 pituitary glands from cadavers from around the country, you can make some money.

The reason that the NPA, the National Pituitary Agency was established was very straightforward. We're all familiar with unfortunate children who are born with a pituitary tumor or a pituitary problem, which prevents them from making adequate human growth hormone that we all need to grow to our full height. And if we don't, we end up being very short.

So by grinding up the cadaver pituitary glands and obtaining human growth hormone, then enough could be administered to the dwarfs by injection over a crucial period of time in their growth. A noble purpose to be sure, but it seemed clear that some people in at least some coroner's offices were not following the law. We were complete rookies on this issue, whether it's medicine or law.

When you are confronted with an issue, step one is do research. We went to the Georgetown Law Library and we read everything available on the variety of state laws dealing with autopsies and organ donation. We also got advice from the leading authorities on this topic, the eye banks, the kidney foundation, the heart association, the tissue banks, even the funeral directors. During our research, we discovered that the commissioners on uniform state laws, now the uniform law commission, had actually created a committee that had been at work for a year on drafting a model state organ donor law.

Amazing. We met with Professor Blythe Stason, the former Dean of the Michigan Law School who chaired the committee. We reviewed the many connections we had already made to healthcare organizations and that we had a mandate from NIH to explore these issues in depth.

He asked us to serve as official consultants to the commissioners. What an opportunity. And then just two months later, Dr. Christian Bernard performed the first human heart transplant in South Africa. Front page news, Time Magazine Man of the Year. There was tremendous public interest and concern.

A Gallup poll showed 70% of people, if asked, would be an organ donor. But two New Yorker magazine cartoons sent a different message. One of a patient in a hospital bed with a large sign on top of him reading, patient asleep, not a heart donor. And another was a bumper sticker cartoon that read, drive carefully. Dr. Bernard may be watching.

While humorous, they revealed an underlying concern. Could people trust the healthcare system not to give up on them prematurely if they were sick and were a potential donor? We worked on multiple drafts over the next several weeks and reviewed them with Stason and his committee and other experts. Ultimately, they approved it and recommended it to the commissioners. At its core, the Uniform Act is a gift statute based on voluntary informed consent. It provided, first, an individual could decide to donate all or part of his body for transplantation or research upon being 18 years of age. Second, if no decision had been made by the individual, the family could make the gift, and it provided a specific definition of eligible family members.

Third, it stated that the donor's physician could not be the same as the recipient's physician to avoid any conflict of interest. It provided permission for definition of death to include brain death, but did not include any specific definition of death because we knew that as science evolved, medical criteria would, too. In June 1968, just less than a year after arriving at NIH, with Blythe Stason, we presented the Uniform Anatomical Gift Act to the full body of the 100 commissioners assembled for their annual meeting in Philadelphia. It was approved unanimously. The American Bar Association approved it one week later. The model law was enacted with little or no change by 41 states in the first year and by all 50 states and the District of Columbia in three years.

We testified before at least 10 different state legislatures during this period, as well as before the U.S. Senate at hearings commissioned by Senator Walter Mondale. The Uniform Donor Card was another key step. The law specifically provided that a gift could be made by any written document, including a card carried on the person.

But what if the cards were different and conflicting? As members of the National Academy of Sciences Ad Hoc Committee, we convened what turned out to be a pivotal meeting of 21 organizations with just one goal, develop a donor card that could be used by all in every state. The meeting was a success and produced a simple legal document the size of a driver's license that streamlined the consent process and could be used by all organizations.

A potential crisis of confusion and conflict had been avoided. We did not really realize it at the time that we were working on the organ transplant law with the Uniform Law Commission and writing the Uniform Anatomical Gift Act, that we were essentially dealing with very important bioethical alternatives. Should we set up a system which we did, which was voluntary, which would allow us to donate and the next of kin can also donate? Or as a pair of professors at UCLA, one of whom was a physician and one of whom was a lawyer, argued that you'll never get enough organs through voluntary donation and therefore we should switch to what some people call presumed consent or opting out, which says that all of us are organ donators unless we object.

So the burden is on the citizen to object to donating and we felt that this approach went against all American values, particularly altruism, autonomy, and trust. We argued our position in law review articles and law review articles and in New England Journal of Medicine articles and this helped support the movement in all the states and in the District of Columbia to pass the Uniform Anatomical Gift Act. And we've been listening to the story of Fred and Blair Sadler, one a doctor, the other a lawyer, and how they collaborated and innovated and changed all of our worlds forever. That organ donation card that we all take for granted, my goodness, without that idea, without that work that they did, what a different world we'd have and how many less people would be alive. And by the way, what a thing to do, that dialogue about getting the citizen to opt out of organ donation, what a terrible idea. It would have ruined everything and there would have been great resistance, this assumption that we're just giving away our organs, but to fight to do it right and to get people to voluntarily do this and make this the status quo, what a remarkable achievement by these twin brothers. And by the way, you can pick up Fred and Blair's book, Pluck, Lessons We Learned for Improving Healthcare and the World and you can get it at your local bookstores, at Amazon, or any place you buy your books.

When we come back, more of the remarkable story of Fred and Blair Sadler, twin brothers, a doctor, and a lawyer who changed how we live and how we die here on Our American Stories. You wouldn't settle for watching a blurry TV, would you? So why settle for just okay TV sound? Upgrade your streaming and sound all in one with Roku Stream Bar. This powerful two-in-one upgrade for any TV lets you stream your favorite entertainment in brilliant 4K HDR picture and hear every detail with auto speech clarity. Whether you're hosting a party or just cleaning the house, turn it up and rock out with iHeartRadio and room-filling sound. Learn more about Roku Stream Bar today at roku.com.

Happy streaming. For each person living with myasthenia gravis or MG, their journey with this rare neuromuscular condition is unique. That's why Untold Stories Life with myasthenia gravis, a new podcast from iHeartRadio in partnership with Argenix, is exploring the extraordinary challenges and personal triumphs of underserved communities living with MG. Host Martine Hackett will share powerful perspectives from people living with the debilitating muscle weakness and fatigue caused by this rare disorder. Each episode will uncover the reality of life with myasthenia gravis. From early signs and symptoms to obtaining an accurate diagnosis and finding care, every person with MG has a story to tell. And by featuring these real-life experiences, this podcast hopes to inspire the MG community, educate others about this rare condition, and let those living with it know that they are not alone. Listen to Untold Stories Life with myasthenia gravis on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. And we continue with Our American Stories on the story of Fred and Blair Sadler.

Let's continue where we last left off. We've talked a lot about organ transplantation and bioethics, but emergency medical care as well was a similar, remarkable experience. We were now at Yale running the Yale Trauma Program, and it's remarkable to reflect on where emergency care was in 1970. As hard as it is to believe, there was no 911 number to call. There were no EMTs or paramedics. Ambulances were glorified station wagons, sometimes doubling as hearses. There were no residency programs in emergency medicine. There was no system of trauma centers. Every day on the battlefields of Vietnam, well-trained medics were taking wounded soldiers to well-equipped trauma centers. Their cardinal rule was the golden hour, the golden hour. Get the patient to a well-equipped trauma center in one hour, and they had a chance.

Ironically, no such goal existed back home in the States. It was scoop and haul. Pick up the trauma patient, take them to the nearest hospital, and hope for the best. No wonder that a 1966 study by the National Academy of Sciences called accidents the neglected disease of modern society. We began our comprehensive study in Connecticut by learning everything we could about EMS in the state. Working with nine MPH students, we canvassed the state. Connecticut had 35 hospitals and 179 ambulances, but there was no coordination between them. In 1968, a presidential commission had recommended a single telephone number, 911, and AT&T declared it was available, but only a few systems had been established.

In Connecticut, for example, it served only 14% of the population. So we created and co-chaired the state's first EMS advisory committee and developed a 700-page report, which we distilled to a 52-page summary, submitted it to the governor, entitled Emergency Medical Services in Connecticut, a blueprint for change. Key legislative support followed and funding, and in just five years, 6,000 ambulance personnel, 6,000, completed the new 81-hour EMT course in Connecticut. Our next problem found us, and that was that the assistant secretary for health wanted someone to look into the legal issues of the fact that there were new types of health professionals called physician assistants being trained to help the problem with the acute doctor shortage that existed at that time.

This is 1969. Medicare and Medicaid had been passed in 1966, which enfranchised millions of additional Americans for health care, be it the elderly or be it poor people below a certain poverty line. However, there were nowhere near enough physicians and nurses to do so and to do so and to train additional doctors would have taken seven to 10 years to do. So very bright and creative physicians and nurses decided to solve this problem. And at Duke, Professor Jean Stead and Professor Thelma Ingalls from the nursing school got together to teach nurses to learn a lot more about medicine and give them a certificate as specially trained. And the plan at Duke was to, this was in the late 50s and early 60s, was to train additional nurses at Duke and then hopefully this would become a national model. There was one thing that had to be done to make this happen and that was that the program had to be accredited by the accrediting body of nursing, which was the National League for Nursing.

The NLN arrived at Duke and surveyed the program and did not accredit the program. They said there was too much medical input. It was more of a medical program than a nursing program and therefore refused to grant its stamp of approval. Naturally, Dr. Stead was deeply disappointed as was Professor Ingalls.

Professor Ingalls left Duke and went to the Rockefeller Foundation and did marvelous work over the next 40 years around the world. Dr. Stead looked for an alternative to nursing and found it with the returning military corpsman. There were 6,000 very well trained military corpsmen who over a year and a half of training at major medical hospitals were working in Vietnam and on the battlefield helping to save lives with bullets often flying over their head.

They were starting IVs, giving blood and stopping major injuries and helping to transport these wounded soldiers back to the base hospital as well as then helping out at the base hospital. So Dr. Stead decided to use four of these returning corpsmen in 1965 to start a new program called the Physician Assistant Training Program and it was highly successful. We were asked by the Assistant Secretary of Health was this a solution to the national shortage of healthcare practitioners in the face of the increased demand and we were asked to travel and got a chance therefore to see these programs in action but he specifically wanted to know what the law should be. How would these people be allowed to practice and after thorough study and working with our colleagues at Duke who were looking at the same issues we came up with a simple amendment to the Medical Practice Act which is the law that allows a physician to practice in each state and the Medical Practice Act defines that a physician can operate, diagnose, treat and prescribe which no other health professional can do but there's nothing in the law and this was our amendment which would prevent a physician from delegating to specially trained nurses or physician assistants those tasks for which the assistant was well trained and that fell within the scope of practice of the physician and finally that both the assistant and the physician would be responsible for that care. This law took off and was passed in most all of the states within a matter of a couple of years and allowed physician assistants or PAs as they are known in the vernacular to practice under the auspices of the Medical Practice Act. So from trained 911 dispatchers to highly skilled EMTs and paramedics to thousands of emergency care physicians and nurses to sophisticated ambulances that transport patients directly to trauma centers emergency medical care in the U.S. today is really a jewel in our crown. And a terrific job on the storytelling and editing by Greg Hengler and a special thanks to Fred and Blair Sadler their terrific book Pluck Lessons We Learned for Improving Healthcare and the World is available in bookstores on amazon.com or wherever you get your books and my goodness it's unimaginable to think that back in the 1970s when these guys were just getting going that there were no EMTs no system of trauma centers ambulances well they were just glorified station wagons that passed for hearses. Scoop and haul well that's what they did with trauma patients scoop and all the idea of treating them well one groundbreaking study in the 70s called accidents the neglected disease of modern society and into the breach stepped these two men and kudos to all the state legislators who fight back and forth left versus right to get together and solve this problem and solve it fast. A great story about the intersection of law and medicine and problem solvers two great problem solvers twin brothers both the Sadlers and the called accidents the neglected disease of modern society and into the breach stepped these two men and kudos to all the state legislators who fight back and forth left versus right to get together and solve this problem and solve it fast a great story about the intersection of law and medicine and problem solvers two great problem solvers twin brothers both the Sadlers here on Our American Stories most TVs are smart nowadays but with busy home screens and remotes with too many or too few buttons smart shouldn't mean complicated that's why Roku TV is the smart TV made easy the customizable home screen puts your inputs streaming favorites like iHeart and free live TV all in one place from simple settings anyone can understand automatic updates with the latest features and much more Roku TV is more than a smart TV it's a better TV learn more today at roku.com happy streaming hey this is Paris i downloaded all my favorite things into my new Roblox experience it's called slipping it's got everything i love discovering shopping collecting partying with my friends and now celebrating her new podcast series the history of the world's greatest nightclubs on iHeartRadio come slip it up and jump through the portal to iHeartland for a quest to unlock a limited edition UGC item it's going to be epic now you're starting slipping land on Roblox loves it NFL Sunday Ticket is now on YouTube and YouTube TV which means that it just got easier to be an NFL fan like maybe you like the bears but you're hibernating in panthers territory but with NFL Sunday Ticket you can watch your favorite teams out of market Sunday afternoon games no matter where you live NFL Sunday Ticket now on YouTube and YouTube TV go to youtube.com slash nflst to get 50 off terms and embargoes apply offer ends 9 19 no refunds subscription auto renews you