October 2001 Bulletin

Orange Book shines like pure gold

It was a $45 million decision.

When Walter A. Hoyt Jr., MD, scooped up the manuscript for a training manual for people driving ambulances, little did he know that doing so would have a tremendous impact on the Academy’s financial future.

At a meeting with the American College of Surgeons (ACS), the American Medical Association (AMA), the National Research Council (NRC), American Red Cross, the U.S. Public Health Service (USPHS) and the Department of Transportation (DOT), Dr. Hoyt showed them the first manuscript for Emergency Care and Transportation of the Sick and Injured. Intrigued, the participants suggested that he leave the manuscript behind for further analysis.

"I decided we had put so much work into it that I needed to take it back with me," said Dr. Hoyt. "In fact, I had a special place in my briefcase for it, and I never intended to let it out of my hands."

With that decision, Dr. Hoyt maintained control of a publication that has—over a 30-year period—generated more than $45 million in revenues for the AAOS. The book, known simply as the "Orange Book," has turned a substantial profit that has been used for other educational programs and it has made a significant impact on pre-hospital patient care.

In the early and mid-1960’s, the Academy’s Committee on Injuries discussed the absence of training for ambulance drivers, many of whom drove vehicles owned by local funeral homes. These discussions led to a series of three- day courses for training emergency medical personnel.

Still, a standardized educational approach for training both EMS students and teachers was needed and committee members were called upon to compile and write a textbook to provide a standard educational reference. In 1971, with the assistance of national associations of health care providers and other interested groups, the Committee on Injuries published the Academy’s most successful book, Emergency Care and Transportation of the Sick and Injured.

Some 30 years later, the Orange Book’s Eighth Edition —still authored by the Academy, but published by Jones and Bartlett Publishers since 1997—continues to be the definitive textbook for EMS education. More than 3 million copies have been sold.

To celebrate the Orange Book’s 30th anniversary, Dr. Hoyt, the 1973 Academy president, presented the current AAOS president, Richard H. Gelberman, MD, "Copy Number 1" of the first edition during a Finance Committee meeting on August 16.

Dr. Hoyt first applauded the Academy for the ongoing "outstanding education and socioeconomic opportunities" and then shared this story of how the Orange Book came to be.

"In the mid-1960s, the Federal Highway Commission mandated that the states improve their emergency medical services," Dr. Hoyt said. "If they failed to do so, 10 percent of the Federal Highway Grant would be withdrawn. In 1964, Dr. Sam Banks, an Academy member and chairman of a newly formed Committee on Injuries, organized a series of three-day courses for emergency medical technicians. These courses, given throughout the country, were of great value, but they did not meet all the needs of both students and teachers. After much deliberation, the committee agreed that a complementary text comprehensive enough to meet the skill and knowledge requirements was needed. A further goal was to establish a core curriculum to be taught in a community college.

"Work on the text began in 1969, and a preliminary manuscript consisting of 60 chapters was developed and submitted to an editorial advisory board headed by Charles A. Rockwood Jr., MD. The final product was sent to press in 1971. Since then, it has undergone several editorial reviews and updates. The current volume has more than 1,200 pages; the original volume had only 304 pages."

Committee members developed the text with the assistance of the ACS, AMA, NRC, the Red Cross, the USPHS, and the DOT.

"It was apparent that we needed to do something to help ambulance and fire department people," recalls Dr. Rockwood, the 1984 Academy president who worked with Dr. Hoyt on the first edition. "The only people who had such a course were at the Academy. Under the direction of Walter, a ‘great ideas man’, they turned to me to do the work because I was secretary under Walter. I had to coordinate with every person that had anything to do with emergency medicine. We worked four to five years with all of these consultants writing up chapters that were sent to me to edit and put into the book in final form. But it if hadn’t had been for the Academy, there wouldn’t be any textbook. And if it hadn’t had been for Walter, there wouldn’t be one either. We owe an awful lot to Walter."

Concerned about the Academy’s budget, Dr. Rockwood kept his eye on the book’s printing and binding costs. "One printer gave me an estimate of $8.50 per book and that seemed like a lot of money," he recalls. "But George Banta Co., Inc. [Menasha, Wis.] gave me a price of 85 cents per book. We took them up on it.

"The book got its nickname because the color of emergency medicine was orange. However, the very first edition had a black, hard cover."

The Orange Book adheres to the U.S. Department of Transportation’s EMT-Basic National Standard Curriculum, which was first developed in 1973, based largely on the Academy’s book. Continually updated and refined both educationally and medically, the book includes detailed case studies, expanded skill drills, practical field tips, integrated technology resources and more for the Instructor’s Resource Kit, Instructor’s Slide Set and Student Workbook. It is also used in the largest military EMS training program in the U.S., where up to 10,000 corpsmen rely on the book to prepare them for their National Registry examination.

The eighth edition, published in September, includes the latest CPR guidelines. A preview is at http://www.emtb. com. A mobile EMT-B field guide for a PalmPilot™ or other handheld device, also is packaged free with the Eighth Edition, and it has distance-learning solutions including Blackboard and WebCT.

"This book is a labor of love," says Dr. Hoyt. "It’s a major, major contribution to the Academy. I give due credit to all of the various organizations that helped, but also to the Academy’s early presidents and Board of Directors. We told them we needed money to do this book and they gave us $5,000 and that money took us to where we are now—leading the way in emergency medical training.

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