A little over two weeks ago I was leaving the ED after a 12 hour shift. It had been a particularly grueling one. The drive home is often a time I’ll put on the radio for background noise and get lost in my thoughts. This drive started the same way but very quickly I started to listen more intently. I had heard the words Freedom House.
Now as some of my friends, and perhaps some of my readers know, I’ve had a keen interest in the history of paramedicine. I had watched Emergency! growing up and loved it. It wasn’t until years later I started to learn some of the history of it and how it mirrored the development of paramedicine in general. Later I learned of what’s know as “The White Paper“. This was a landmark 1967 report that among other things concluded a soldier in Vietnam who was shot was more likely to survive than someone shot in a city inside the United State.
Back then the idea of an ambulance was often the local police, or even the undertaker, simply transporting the patients to the hospital as fast as they can. (An undertaker may seem like a strange choice until you realize they had vehicles designed to onload and unload people in horizontal positions, such as tied to a stretcher.). Actual treatment until hospital arrival was often a quickly tied bandage at best. If the patient was lucky someone on the ambulance might have had a first aid course, but that was it. There were no standards and a definite lack of equipment. Beyond that, it was a matter of how fast they could get the patient to the hospital. And to say that what little quality in service did exist was very likely based on the area of the city lived in would be an understatement.
This was the state of emergency medicine on the streets in most places until an interesting confluence of events in 1967 happened in Pittsburgh Pennsylvania.
There a doctor, Dr. Peter Safar, the father of CPR, Phil Hallen, the head of The Falk Fund, which among its goals had one to create employment opportunities for African-Americans in Pittsburgh, and Jim McCoy, the head of Freedom House, a grass roots organization in the Hill District that among other things delivered food to locals, were all in the right place and the right time. Initially Hallen approached McCoy with the idea of a basic ambulance service similar to what was in existence elsewhere at the time, but this one run and controlled entirely by folks from the neighborhood. Basically an African-American run ambulance service for African-Americans. But, when they collaborated with Dr. Safar he had far bigger plans. Combined with a grant from the DOT of all places (because of their interest in reducing deaths due to highway accidents) they started with two ambulances and a 300 hour training program. Thus began Freedom House Ambulance Service, the first real modern paramedic program in the United States.
I had known they were “among the first” I didn’t realize they basically were the first. And I didn’t realize in how many ways they were first. Dr. Safar literally designed the first modern ambulances as a current EMT/Paramedic would recognize them and created the first training program. And these men (the first few trainees were all men) were the first paramedics.
The NPR radio program I was listening to was an interview with Kevin Hazzard who was talking about his book, American Sirens. I knew I had to order the book as soon as I got home. In fact, I ordered two copies, one for myself and one for a close friend who is a paramedic. I started reading it as soon as I got a copy.
The focus of the book is on several of the key players, the ones mentioned above as well as Paramedic John Moon who started in the program after a few years and survived the end of the program and Dr. Nancy Caroline, who literally wrote the textbook on paramedic training: Emergency Care in the Streets.
American Sirens is well written and easily accessible by anyone. You don’t need a medical background to appreciate it. It also answered a question I had had about Freedom House since I had heard about it; namely what happened to it?
I’d love to say it was still around and thriving and that it had a strong name recognition among modern paramedics and EMTs. Sadly that’s not the case. From its start it faced opposition from the local police and politicians. In 1975 it was facing a complete shutdown due to underfunding when Dr. Safar convinced the mayor to fund it one more year and brought in Dr. Caroline. But the writing was on the wall. Within the year, it was replaced by a city-run, city-wide ambulance service staffed almost exclusively by white paramedics, all who had far less experience than the Freedom House Ambulance Service paramedics and who had taken classes developed by Drs. Safar and Caroline. Dr. Caroline was initially brought over as Medical Director with the understanding that all Freedom House paramedics would be brought over and given jobs. And initially they were, but very quickly racism raised its ugly head and they literally were often left holding the bags while their much less experienced team members took over.
Meanwhile, in Los Angeles, in 1972, Jack Webb (also of Adam-12 and Dragnet history) had created the show Emergency! which was a fairly fictionalized, but also fairly accurate, portrayal of the development of the EMS/paramedic program in Los Angeles. One can’t underestimate the impact this show had on popularizing EMS in America. I know a number of folks who got into paramedicine because they watched this show. It deservedly has a place in the history of EMS in the US. However it’s just one part of the history. Sadly a key part literally has been white-washed. As of the late 90s, 98% of the paramedics in Pittsburgh were white.
I wrote a few days ago that I wanted to read more this year. Well this book is the first.
For anyone interested in a more complete understanding of the history of paramedicine in the United States, including the racism if faced, I highly recommend this book.