I once sped along in the back of an ambulance, over the rolling hills leading to one of Pittsburgh’s many hospitals. Beside me was a patient with COPD exacerbation, and I was reading his oxygen levels to the paramedic across from me. “82%… 81% now.” It was my first ride-along as an EMT student. The patient was breathing in the maximum of oxygen we could give him, but he was still alert and oriented.
I couldn’t tell if the lurch in my stomach was from reading his dropping oxygen saturation, or the winding roads of Pittsburgh. Either way, the paramedic was unphased. He started an IV on the patient in the bumpy road, hung medications I couldn’t even pronounce at that point. “What is it now?” he asked calmly. “83%.” I responded. The patient gripped my hand tightly, fear in his eyes.
The story of my ride-along started long before I climbed into the truck. It began decades earlier in Vienna. There, Dr. Peter Safar evaded Nazi persecution by hiding his Jewish lineage. Using a dangerous tuberculosis ointment, he self-induced a rash to avoid mandatory conscription in Hitler’s army. He moved to the US in 1949, completed medical school, and led multiple anesthesiology departments. He eventually founding the nation’s first official ICU in Baltimore. He also is considered the father of modern CPR, solidifying the methods that are still used today. In 1961, Safar moved to Pittsburgh to head their anesthesiology department, and brought his talents along with him.
Medicine was changing through not only Safar, but in reaction to the needs of the country. Discussion of a national emergency medical response was in the works. The cause? Highways. The Federal Aid Highway Act of 1956 proposed over a billion dollars in funding for 40,000 miles of new highways by 1966. By 1967, there was discussion of creating national emergency transport services for highway accidents, but with little progress in the way of medical intervention on the way. In a time where most vehicles didn’t have seat belts or air bags, accidents were quick to become catastrophic.
While all this national discussion on prehospital care was occurring, one girl’s tragedy influenced medicine forever. While at a medical conference in 1966, Safar’s 11-year-old daughter Elizabeth died from an asthma attack. Safar was convinced earlier intervention could have saved her. By this point, he was the father of modern CPR, but felt new motivation to go further.
Safar, on his self-reflective 70th birthday, said, “Death is not the enemy but occasionally needs help with timing.”
Philip Hallen, a former ambulance driver, was interested in expanding the minimal interventions ambulances were able to provide. He also was interested in providing employment to marginalized groups, especially young black men in Pittsburgh. Through funding from Lyndon Johnson’s War on Poverty and the Maurice Falk Fund, the cogs were turning. Hallen chose to partner with a new group founded by Pittsburgh’s United Negro Protest Committee: The Freedom House.
Freedom House is best known for its ambulance services, but before that, it offered many other community services. It served as a site for mutual aid, food distribution, and civil rights protest organizing in Pittsburgh’s Hill District. Prior to this ambulance service, people were brought to the hospital by local police officers with no medical intervention. This was the height of the Civil Rights movements in the US, and tensions between law enforcement and black communities such as the Hill District were at their peak. Separating medical first response from the untrained police was a radical and necessary change to the community.
Safar chose to assist Hallen, giving the program medical clearances necessary to expand the role of ambulances. Following another tragedy, the 1966 death of former Pittsburgh mayor David Lawrence after being transported by police, Safar had had enough. As Safar once said, “If you can’t win, change the rules.” Not only did he change the rules, he wrote the rules.
What could be done in the field? How can a “paddy wagon” be outfitted to be a functioning ambulance, with oxygen ports and space for a paramedic? It was trial and error, with ever increasing success.
By 1968, the year Martin Luther King Jr. was assassinated, the young black men of Freedom House Ambulance were intubating, starting IVs, and giving medication under the supervision of Safar. However, according to interviews in Pitt Med magazine, racism still held the program back.
Police tended to rush to accident sites to be the first to pick up patients, without the vital stabilizing intervention of Freedom House. Receiving nurses would sometimes ignore the report paramedics attempted to give. The Hill District was more welcoming to these early paramedics, but in documentary interviews, paramedics reported economically privileged neighborhoods often resisted their interventions. This conflict crescendoed with the 1970 election of Mayor Peter F. Flaherty. As Safar put it, “racial prejudices with white police officers eager to maintain control of ambulances city-wide.”
The Freedom House ambulance service ended in 1975, under the mayoral term of Flaherty. Their tenuous public funding ended, and Flaherty founded the modern Pittsburgh EMS, with their paramedics copying the training and scope of the Freedom House medics. I’ve driven by the original site of Freedom House: 2027 Center Avenue. What’s left is an empty lot between a credit union and a beauty salon. However, the impact the first members of the ambulance service is felt throughout the US. Many of its members, such as John Moon, became leaders in Pittsburgh’s first response teams, while others left the service. Freedom House’s final medical director, Dr. Nancy Caroline, wrote the first paramedic training book: “Emergency Care in the Streets.”
These powerful foundations led to my ride-along. It was one patient of many, in one city of many who relied on emergency medical services. The EMT drove quickly into the ambulance drop-off lane, and we rushed the patient to their admitting bay. As the paramedic rattled off the report to the emergency nurse, the patient grabbed my hand again as he was being put on a BIPAP breathing mask.
“Thank you,” he said, his hand quaked with his strong grip. The paramedic put a hand on his shoulder and smiled at him as we turned to walk out of the room. “They’ll take it from here, buddy.”
