Freedom House Ambulance Service facts for kids

The Freedom House Ambulance Service was a groundbreaking team. It was the very first emergency medical service in the United States to have paramedics trained far beyond basic first aid. Started in 1967, this service helped the Hill District in Pittsburgh, Pennsylvania, which was mostly a Black neighborhood. Most of its staff were African-American.

Freedom House changed emergency medicine forever. They trained their staff to amazing new levels of medical care for patients on the way to hospitals. The paramedic training and ambulance designs they created became the standard for emergency care across the country and even worldwide. Despite its huge successes, the ambulance service closed eight years after it began.

Why Emergency Care Needed to Change

Before the mid-1960s, ambulance services in the U.S. were usually run by the police or local funeral homes. These services offered only basic first aid and quick rides to the hospital. If the police handled it, they would often just load the patient into the back of a police van and rush to the hospital.

The U.S. medical system had not yet adopted new ideas from battlefield medicine. After World War II, more people moved to the suburbs. This led to more car accidents and injuries far from hospitals. This made the lack of medical care during transport even worse.

In 1966, a major report called "Accidental Death and Disability: The Neglected Disease of Modern Society" was published. It said that up to 50,000 deaths each year happened because ambulance crews were not well-trained and hospitals were too far away. This report showed how much better pre-hospital care was needed. The problem became very clear in Pittsburgh when David L. Lawrence, a former governor and mayor, had a heart attack. He was taken to the hospital by police. He later died. Dr. Peter Safar, who treated him, believed his death could have been avoided with better care before he reached the hospital.

In Pittsburgh, the city police handled ambulance calls using paddy wagons. Funeral homes covered the suburbs. People in mostly Black neighborhoods, especially the poorer Hill District, often waited longer for help. Also, many people didn't want to call the police because of tension between the police and the community.

How Freedom House Ambulance Started

The Freedom House Ambulance program got its first money from President Lyndon Johnson's "War on Poverty" and the Maurice Falk Fund. Phil Hallen, who used to be an ambulance driver, led the Falk Fund. He wanted to make ambulance services better and create jobs for African-American men in Pittsburgh.

When Dr. Peter Safar heard about Hallen's work, he reached out. Safar had already worked on emergency care, including creating cardiopulmonary resuscitation (CPR) and pushing for regular people to learn it. He shared his ideas for a new, higher standard of care for the ambulance service. His ideas included intense paramedic training and better ambulance designs.

Hallen contacted Freedom House Enterprises to help find paramedics. At that time, Freedom House Enterprises worked on civil rights projects. These included helping people register to vote and organizing NAACP meetings. They also helped Black Pittsburghers find jobs and get training. Freedom House agreed to work on the ambulance program.

Training the Paramedics

The first group of Freedom House Ambulance Service recruits had 25 men from the Hill District. This was a low-income, mostly Black neighborhood. At the time, local news often called people from this area "unemployables." The recruits included men who had been out of work for a long time. Half of them had not finished high school. Some recruits were also veterans of the Vietnam War.

Dr. Peter Safar created and led the paramedics' training. It was a 32-week course, totaling 300 hours. It covered topics like anatomy (how the body is built), physiology (how the body works), CPR, advanced first aid, nursing, and safe driving. Those who hadn't finished high school were helped to get their GEDs (high school equivalency diplomas).

Dr. Safar worked with Dr. Ron Stewart and Dr. Paul Paris to build a training plan that would soon influence paramedic training worldwide. Dr. Safar also met a young and talented Nancy Caroline. While she was still in medical school, she helped Safar, Stewart, and Paris put together the new training plan for the Freedom House paramedics. Stewart and Paris were also trying to create a place in Pittsburgh where people could study emergency medicine.

Making a Difference: Operations and Impact

The Freedom House Ambulance Service program began in 1967. It officially started operating in 1968 with two ambulances.

Before they got their own ambulances, the Freedom House paramedics helped people injured during the King assassination riots in 1968. They rode along with police on ambulance calls. The city then hired Freedom House Ambulance Service to handle emergency transport in downtown Pittsburgh and some mostly Black neighborhoods.

They became known for their excellent care. People often asked for them instead of the police. In their first year, Freedom House Ambulance Service responded to almost 5,800 calls. They transported over 4,600 patients, mostly in African-American neighborhoods in Pittsburgh. Dr. Safar's data showed that the paramedics saved 200 lives in their first year. While slow service to Black neighborhoods by the police had caused problems, the Freedom House paramedics usually arrived in less than ten minutes in most neighborhoods.

In 1975, Dr. Nancy Caroline became the medical director of Freedom House after Dr. Safar asked her to join. She set up ongoing training for the paramedics in new areas. These included intubation (helping someone breathe), heart care, and giving medicines through an IV. The training Dr. Caroline provided became the basis for the very first national paramedic curriculum. The U.S. government adopted it in 1975. The information and studies Dr. Caroline collected also helped shape emergency medical practices for Magen David Adom, Israel's emergency service.

The Freedom House paramedics' strong connections with the communities they served also helped them be effective. A filmmaker who told their story said:

Freedom House [paramedics] had compassion for the community... They told me when you walk into a person’s home, you’re a guest. That’s the No.1 thing they brought to the table: They cared. They addressed everybody by their names. They respected them and asked permission before providing treatment.

Freedom House Ambulance Service became a model across the U.S. and around the world. They received a big grant to create the first national standards for paramedics. Cities like Miami, Los Angeles, and Jacksonville all followed the Freedom House model. Also, the ambulance design created by Dr. Safar and proven by Freedom House paramedics was adopted by the National Highway Traffic Safety Administration as the official ambulance standard.

Despite their successes, the Freedom House paramedics faced racism from hospital staff and patients. They also faced unfair treatment from the city government. Hospital staff sometimes thought the paramedics were just cleaners and asked them to mop floors. White patients were often surprised or upset to be treated by Black paramedics.

Challenges with the Mayor

Peter F. Flaherty became Mayor in 1970. He was against the Freedom House Ambulance Service. The mayor did not like public/private partnerships. He believed that services paid for by the city should be directly controlled by the city. Phil Hallen of the Falk Fund believed that racism also played a part in Mayor Flaherty's opposition. Newspaper articles at the time accused the mayor of trying to get rid of the ambulance service to please the police union. Dr. Safar agreed, saying that "racial prejudices with white police officers eager to maintain control of ambulances city-wide" were behind the efforts to end Freedom House's services.

Even though Freedom House Ambulance Service had a great record, the mayor denied their request to expand their contract to cover more parts of the city. This meant they couldn't serve richer neighborhoods where they might have been able to collect more fees for their services. During Flaherty's time as Mayor, the city started paying for the ambulance contract late. They also cut their share of the ambulance service's operating budget by 50%.

The Mayor also signed a rule that banned ambulance sirens in the downtown area. He said it was because of noise complaints. This made it slower for paramedics to take patients to hospitals and slowed their response times. This allowed the police to get to more calls before them.

In 1974, the Mayor announced plans for a citywide ambulance system. It would be staffed by police officers trained as paramedics. City council member Eugene DePasquale resisted this plan. So, the mayor agreed to fund the Freedom House Ambulance Service contract for one more year. At the end of that year, the Mayor announced a new citywide ambulance service. This new service would be staffed by non-police paramedics, and the contract with Freedom House would end.

The End of Freedom House Ambulance Service

The Freedom House Ambulance Service closed on October 15, 1975.

At first, all the paramedics hired for the new city ambulance service were white. Then, Nancy Caroline, the former medical director of Freedom House Ambulance Service, accepted a job as medical director of the new city service. She agreed only if the Freedom House paramedics and dispatchers were also hired, and if the Freedom House ambulance crews stayed together.

While the Freedom House paramedics were hired, their crews were broken up. This went against the agreement. New pass/fail exams were given. These tests covered things the Freedom House paramedics had not been taught. This led to many of them being fired. Most of those who remained were given non-medical or less important jobs. Many were placed in positions overseen by white employees with less experience. Of the 26 Freedom House employees who joined the city ambulance service, only half remained a year later. In the end, only five stayed with the city ambulance service, and only one was promoted to a leadership role. By the late 1990s, 98% of Pittsburgh’s paramedic program staff were white.