Paramedics of Freedom House: Empowerment Through Paramedicine

Freedom House Enterprises’ paramedic program was unique as it actively recruited and trained marginalized individuals for the paramedic profession. Under the guidance of Dr. Peter Safar, himself a victim of Nazi persecution, Freedom House benefited both the caregiver and patient. The program was instrumental in the national development of the vocation and was an inspiring and successful experiment in social justice, but it ultimately fell victim to prejudice.

Paramedics occupy a unique space in American society. Paramedics serve as initial liaisons to medical care. They operate within the sphere of public trust. Rare is the profession that is universally accepted in all domains of public and private life. For this reason, the profession has become an icon. Yet the early pioneers of the profession were not as well received as their successors.

Pittsburgh in the post-WWII period was a city divided by racism between a blue-collar African-American urban community and governing white-oriented politicians and policies. Freedom House Enterprises of Pittsburgh was founded by activists and representatives from the African-American community. Its purpose was to quell “rank discrimination” within the city, and it received funding through President Lyndon Johnson’s war on poverty movement and the Falk Foundation.

The program was developed to provide vocational training and serve as a forum for community issues. In the mid-1960s, various members of the community concerned with Pittsburgh’s ambulance program approached Freedom House Enterprises. Pittsburgh’s EMS system was extremely controversial. Municipal ambulances were staffed with police officers. Little to no medical care was provided to patients. The program received particular scrutiny when the 37th governor of Pennsylvania, David L. Lawrence, passed away shortly after being transported by the Pittsburgh police ambulance service. 

Some medical emergencies that included violence or drugs left the police with a conflict of interest. The act of merely transporting the patient and not providing medical care was rightfully considered negligent by the community, as “much harm was done by not treating en route.”¹ This program was particularly ill received among Pittsburgh’s African-American community.

The Pittburgh African-American community approached Freedom House Enterprises—an organization geared toward addressing the concerns of the black neighborhoods. Freedom House devised a unique paramedic program that benefited the well-being of paramedic and patient. Its goal was extremely ambitious: to train the most “unemployable” individuals to provide emergency medical care. 

The program recruited disenfranchised African-Americans from the city. Freedom House specifically sought prior felons, individuals with substance dependency and those who had been unemployed for long periods of time. In some cases, the program “found young men who were languishing in the streets and told them what they could become.”² One commentator stated “moreover, they are Negroes who, only a short time ago, were a part of that large mass of hardcore underemployed or chronically jobless men in Pittsburgh’s black community.”³

Accepting, training and advising such a cadre of young men would not have been easy in Pittsburgh if it not had been for the compassionate nature of a unique physician.

A New Outlook on Life

Dr. Peter Safar was one of the most significant figures in American medicine. Among his many achievements, he is credited for founding CPR and received three separate nominations for the Nobel Prize in medicine. However, it was his unique views on race and institutional barriers that made him the ideal medical administrator of the Freedom House paramedic program.

Safar was born in Vienna, Austria, in 1924. Early in his adult life he experienced racism firsthand. By hiding his Jewish heritage, he was able to evade the Nazis and enter medical school. It was from this perspective that he developed a kinship with the members of Freedom House, “They were handicapped by the times and the society,” he said.⁴ It was from his unique outlook that the Freedom House paramedic training curriculum was developed.

Safar recognized the challenges of transforming the disenfranchised into medical providers. The program operated in a series of tiers. The first tier was called “remedial basic training,” which covered subjects such as algebra, English and other subjects some students had previously not received. This initial step granted the paramedics their high school diploma, which 50% never earned.

After receiving their foundational education, students were required to develop firsthand experience in the classroom, hospital, morgue and field.

Those paramedics who successfully completed the course found their biggest challenge was not the delivery of medicine, but to whom they delivered it. “Street corner blacks became involved with medical whites,” stated former paramedic James Kyte.⁵ After its initiation, the Freedom House paramedic program catapulted its participants into a segment of society of which they had never been a part. This newly found livelihood brought forth unique scenarios for the young men of Freedom House. Some members of the white community who needed emergency care were surprised at their presence, and some openly resented their presence and capacity. This was especially the case during emergency childbirth calls, as African-American medical personnel rarely delivered white children in local hospitals.

However, the Pittsburgh African-American community generally relished the program and considered it a point of civic pride. This same transition occurred among the men involved. “It was interesting to see how you could take someone and place them in this program and give them a new outlook on life,” reflected James Coney, Jr., a former paramedic.⁶

Change in Perception

Many of the paramedics of Freedom House used the program as a springboard to receive a general education or more advanced medical training. Yet it was the change in how these men were perceived in the community that made the position engaging.

All the Freedom House paramedics cherished their new identities and the empowered roles in which they were embraced rather than shunned. “I’ve got an obsession about the job; I want to help people. It makes me feel good and proud that I can sometimes save a life. And for my mother, I’m somebody.”⁷

Yet their background also benefited their profession. During a particularly lethal heroin epidemic, the paramedics were able to reach out to local drug dealers and teach them the signs and symptoms of an overdose and assure them that they and their clients would not face legal repercussions if they called 9-1-1. After these meetings, the frequency of fatal heroin overdoses plummeted in Pittsburgh.

One can only hypothesize the transformative impact that this program had on the personal lives and psyches of the paramedics. In under a year “street corner” blacks could become celebrated medical icons within the communities that only a short time ago rejected them. Safar commented on this transformation, saying, “After demonstration of skills and lifesaving capability, however, the reputation of this team in the community made acceptance possible in most areas of operation, irrespective of the resident’s race or economic status.”⁸

In many ways, the Freedom House program represented an organic return to civic medicine. That is not the social context for which Freedom House has been remembered, however. It is remembered for how its paramedics delivered medicine.

Setting a Standard

As mentioned, the Freedom House paramedic program became the cornerstone for all future paramedic programs. Specifically, two technical aspects of the Freedom House program set the standard nationally for all existing and future paramedic programs: The design of the Freedom House ambulance and the treatment procedures used by the paramedics.

In order to expedite treatment to Pittsburgh, Freedom House revolutionized its most recognizable apparatus—the ambulance. The citizens of Pittsburgh were amazed at the capacity of the Freedom House ambulances. With equipment and technology that could previously only be found in emergency rooms, the capabilities of the paramedics were groundbreaking.

The mobile intensive care units contained oxygen equipment, obstetric delivery kits, electric defibrillators and equipment for burn treatment, chest drainage, drug injection and intravenous fluid infusion. Hospital physicians could direct technicians at the scene of the emergency by two-way radios. Soon to be installed was a radio telemetry system, which allowed physicians at the hospital to monitor a patient’s EKG in the event of cardiac emergency.⁹

Indeed, one newspaper reportedly called the Freedom House ambulances a “hospital on wheels.” Due to the spatial limitations of the equipment, the program could not use the traditional Cadillac hearse and opted for van chassis type of vehicle. Similarly, Freedom House dictated that a paramedic must have uninhibited access to the patient in the prone position.

By prioritizing patient access, the layout provided a predefined amount of space for the rescuer and patient to allow for ease of medical treatment. The federal government recognized the merit of this layout. Freedom House was asked to send its ambulance blueprints to the National Highway Traffic Safety Administration, which adopted them as the official standard for the nation.

Pushing the Boundaries

While some paramedic programs were founded with the intent of aiding traumatic and cardiac injuries, Freedom House sought to meet the full spectrum of medical emergencies that faced the impoverished Pittsburgh black community. This approach functioned as a large-scale trial-and-error medical test for Dr. Nancy Caroline.

Caroline, who had graduated from Harvard and worked as a resident in Pittsburgh, was considered a “super doctor” by her peers. Frequently responding to calls 24 hours a day for weeks at a time, she used the emergency calls of Pittsburgh to push the medical boundaries of what could be accomplished outside the hospital. Under the guidance of Safar, Caroline tested and implemented a wide array of treatment protocols that had traditionally been considered too advanced to be performed outside of a hospital setting. These techniques included intubation and airway care, cardiac therapy and telemetry, and intravenous drug therapy.

Upon request from the Department of Transportation, Caroline compiled her findings, which became the standard national paramedic curriculum. Later she would write Emergency Care in the Streets, the first paramedic textbook, which remains widely used today. Caroline then accepted a position as the first medical director of Magen David Adom, Israel’s Red Cross, where she specialized in treating victims of terrorist attacks.

“Today, the 1977 paramedic course remains the foundation for all prehospital advanced life support education,” says the DOT’s official statement on Caroline. “Countless paramedics and their patients have benefited from this robust curriculum, in part because of the members of Freedom House Ambulance Service.”

From Prosperity to Downfall

Clearly, by setting the national ambulance and curriculum standards, Freedom House was an operational success. During its time, it was considered a model program and one of the best emergency medical programs in the country. It had achieved its goal of saving the lives of both patients and the providers of its services. The program’s downfall came in large measure from an element of its success: the prosperity of the black community.

As communal icons, the paramedics became increasingly busier and were the most frequently requested emergency unit. As citizens of Pittsburgh commonly asked dispatchers, “Don’t send the boys (the police), send them Freedom boys.” White neighborhoods began to protest the agency, as they felt the black community was receiving preferential treatment. Agreeing and attempting to aid his constituents, Mayor Peter F. Flaherty pushed the dismantling of Freedom House to the top of his agenda.

After several attempts to defund the agency failed, Mayor Flaherty passed an absurd law outlawing the use of lights and sirens on Freedom House’s ambulances. This endangered the lives of patients due to increasing response times. However, the final nail in the coffin came from the mayor and city council in a resolution to contract out the city’s ambulance service. Under this agreement, the Freedom House paramedics were allowed to apply for positions with the new ambulance service. Despite their years of groundbreaking experience, the new ambulance services found every one of the Freedom House paramedics to be not qualified for the position. Primarily white employees staffed the new Pittsburgh ambulance service.

Caroline says, “It should of have been the success story of the century. In a way it was. But it is a sad success story because Freedom House is no more, because so many of those who gave so much of themselves during eight years—who cleared the path for the kind of paramedic services now glorified on national television—have been shunted aside, forgotten, left to return to the street corners and watch the parade pass them by.”¹⁰

Conclusion

Safar, Caroline and the paramedics of Freedom House developed the national ambulance and operating procedures for the contemporary paramedic. From this perspective, their contributions live on. However, the goal of dichotomous patient and paramedic prosperity has been lost. Most states and agencies prohibit individuals with criminal records from receiving paramedic licensure, which would make a similar program of empowerment challenging to develop.

Freedom House experimented, pushed the capabilities of the profession and became the nation’s mold for prehospital emergency medicine. The streets of Pittsburgh served as a crucible from which the nationally recognized methods and operations of the profession originated. Furthermore, it rendered care for both patient and, in a unique way, the paramedic.

This article was created thanks to the diligent archival work and dedication of paramedic and documentarian Gene Starzenski. Additionally, the author would like to thank professors Cathryn Carson and Brian Dolan for their encouragement and support.

Jameson Karns, PhD candidate and paramedic, has worked for more than a decade in EMS, and his current scholarship focuses on the history of prehospital medicine with the Department of History at the University of California Berkeley.

References

1. Benson D. Mobile intensive care by ‘unemployable’ blacks trained as Emergency Medical Technicians (EMT’s) in 1967-69. J Trauma, 1972; 12(5); 408–21.

2. Caroline N. Emergency! ‘Freedom House’ saved lives – yours and theirs, Pittsburgh, 1977; 8(4).

3. Cheever G. Freedom House Ambulance Service: revolution in emergency care,” University Times, July 23, 1970.

4. Genastar Productions. Archival interviews, Oct. 2001–Feb. 2005. Genastar Productions Archive, Los Angeles, CA.

5. Mitka M, Safar P. Father of CPR, innovator, teacher, humanist. JAMA; 289(19).

6. Pittsburgh ABKA. 1960s Freedom House interviews stock footage. Genastar Productions Archive, Los Angeles, CA.

7. Safar P. On the history of Emergency Medical Services. Bull Anesth History 2011; 19.

8. Stuart R. Ex-jobless rushing to rescue. Pittsburgh Press, Nov. 17, 1968.

9. Aid may fail to stall end of ambulances. Pittsburgh Post-Gazette, June 7, 1974.

10. Freedom House. Pittsburgh Press, July 25, 1972.

11. Results count: Ambulance service rated tops. Pittsburgh Courier, 1972.

12. Wailing sirens of ambulances may be quieted. Pittsburgh Gazette, 1970s.

Resources

1. Trotter J, Day J. Race and Renaissance: African-Americans in Pittsburgh since World War II. Pittsburgh: University of Pittsburgh Press, 2010.