The First Paramedics
This article was originally written by Randy Cassingham for the now defunct site Every Medic, and moved here as that site was being shut down.
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Military corpsmen go way back, providing special care to soldiers on the battlefield. Hospitals often provided horse-drawn ambulances, staffed by doctors. And we all know that funeral directors' hearses doubled as medical transport vehicles into the 1950s and 60s.
Some areas, notably Toronto, Ont., Canada, pushed for better cardiac emergency field care. There, Medic One was a single ambulance that had a "portable" defibrillator for cardiac calls. The machine was operated by a hospital intern, and it meant bringing the patient to the ambulance, since the defibrillator was powered by lead-acid car batteries -- it weighed 100 pounds.
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But what about true paramedicine for civilians -- comprehensive emergency care from trauma to childbirth to medical emergencies including, yes, cardiac incidents? Where and when did it start, and how? The location was unlikely: Pittsburgh, Pa. And you probably haven't heard of the very first squad of paramedics, since the the squad -- even its history -- was buried.
Putting Together the Pieces
In the mid-1960s, Pittsburgh's United Negro Protest Committee created Freedom House Enterprises Inc. to serve the Hill area of the city. One of their missions was to help build job opportunities for the so-called "unemployable" locals in a time of unrest. The Vietnam War was raging, and there was angst in the streets over the war, civil rights, and more.
Meanwhile at the time, ambulances in the city, like in many cities, were operated by the police department: a "scoop and scoot" service that used essentially untrained officers to give the sick and injured a ride to the hospital.
The vision to change things wasn't the effort of a single person. Freedom House would be the focal point, and would recruit the staff. The money came from Phillip Hallen, president of the now-defunct Maurice Falk Medical Foundation, and a former ambulance driver. The medicine came from Dr. Peter Safar, the Director of Anesthesiology at the University of Pittsburgh School of Medicine, who was considered the "Father of CPR". (Safar, by the way, had also invented another level of care: the Intensive Care Unit.) And the glue to put the two together was Morton Coleman, of Pitt’s Graduate School of Social Work, who suggested combining an ambulance service with a program to train men (and, during the life of the service, at least two women) not just as ambulance drivers, but as professional emergency medical care providers.
In 1967, the Freedom House Ambulance Service was formed; about 44 men were recruited for training, organized by Dr. Safar. The men were paid a small wage, and in return were expected to attend classes eight hours per day, five days per week, for nine months to learn not just the basics of emergency medical care, but get in depth. After class, they observed in the emergency room, or did rotations in various hospital departments. And, of course, they learned the latest in CPR as Dr. Safar did his research at the hospital, and later at the institute he founded, the International Resuscitation Research Center (now the University of Pittsburgh Safar Center for Resuscitation Research). For Dr. Safar, it was personal: the year before, in 1966, his own 12-year-old daughter had died from an asthma attack.
Lft to rt: Mr. Streams, Mr. Davis, Mr. Zepfel, Mr. Ragin, Mr. Clemons, Miss Johnson, Mr. McCoy, Mr. Esposito, Don M. Benson, M.D., Mr. Draper, Mr. Scott.
Standing at Ambulance Entrance, Presbyterian University Hospital, Pittsburgh, Pennsylvania"
Inventing Prehospital Care
There was no such thing as an emergency medical technician, let alone a paramedic, so Dr. Safar went about inventing much of what we do today. He designed the layout of the ambulances (and their design today is still based on his drawings), going away from the "ride in the meat wagon" design to a mobile intensive care unit that enabled ambulance attendants to provide care to patients en route to the hospital. To train the staff in CPR, Dr. Safar called upon a doll maker in Norway, Asmund Laerdal, to design and manufacture mannequins for CPR training; Resusci Anne was born. The face of the doll was modeled on the death mask of an unidentified young woman who drowned in the Seine River in the late 1880s. Her gentle smile was perfect -- and no doubt reminded Dr. Safar of his own daughter. (Laerdal's company still exists, and still makes the training dolls today).
Safar, who was Austrian, left no room for racism. When hospital nurses demanded the students get out of delivery rooms, he quickly showed up and ordered them to accept the students -- and teach them the ropes.
About 25 of the students made it all the way through training, and they hit the streets in 1968, operating out of Pittsburgh's Presbyterian and Mercy Hospitals. Their pay: $42 per week. The police department was happy to turn over the job of ambulance services in the "black areas" of town -- the Hill and half of an adjoining precinct in the city, North Oakland. Residents were happy to have their "own kind" provide help, and thanks to the training they had received -- and their advanced equipment, including more-portable defibrillators, purchased by the Falk Foundation -- the crews very quickly started to save lives. They managed airways, started IVs, delivered babies, and interpreted EKGs. They were the first paramedics. But training didn't end when they hit the streets: in addition to bringing on more and more medics, current medics were continually trained in new skills, and refreshed on everything.
These first street paramedics didn't care whether their patients were black or white or other: they were just there to do a job. The respect didn't always go both ways: they reported that patients or families would sometimes spit in their faces; they just "kept smiling" and did their jobs the best they could.
Before long, when people called for an ambulance in Pittsburgh, they started asking for the "Freedom Boys" rather than the police meat wagons. You didn't have to be a doctor to see the difference in care between untrained "ambulance drivers" and highly trained prehospital care professionals.
Documenting it All
When a new, young, female doctor came to Presbyterian hospital in 1973 for her residency, Dr. Safar suggested she might want to work with the Freedom House to help train the street medics. The doctor was Nancy Caroline, who not only worked with the paramedics but also served as their medical director. She also documented the training they received -- and put it all in a textbook. The result, Emergency Care in the Streets, was literally the textbook to train new paramedics for a decade. She became known as "The Mother of Paramedicine" -- and she learned it all at Freedom House. (Dr. Caroline died from multiple myeloma in 2002, at 58.)
Successful? We Better Kill It
But despite the program's enormous success and lives saved, it was not to last. Pittsburgh's longtime mayor Joe Barr was an enthusiastic supporter of the service, but a new mayor, Pete Flaherty, was elected in 1970. Flaherty claimed that citizens complained that the sirens on the Freedom House ambulances bothered them, so he ordered that they not use the sirens when downtown. Over time, it became clear that "the negroes" had great ambulance service staffed with paramedics, but everyone else in town had terrible throw-and-go ambulance service from the police. Freedom House offered to expand and offer service city-wide, but the city decided to take over EMS. Flaherty ran on a platform of "deprivatizing" and controlling all services, which he claimed would "cut costs."
New medics were trained -- and all were white. Freedom House medics were allowed to apply for jobs too, but despite promises to respect their certifications, they were later told their pioneering training was not valid: they had to take classes and tests to prove their knowledge. By then, a "substantial number" of Freedom House medics had earned their bachelor’s degrees, and a few even had master’s degrees; three were in pre-med. Yet somehow, most of these street-experienced medics who had been doing the job for years failed the tests, while brand-new medics trained by the city had no trouble passing their tests. The city literally took the ambulances and all equipment from Freedom House, which ran its last call on October 15, 1975, after about 45,000 emergency responses. Freedom House's dispatchers, who had also been promised jobs, were also turned away.
Freedom House's building was torn down, files were lost, and history was forgotten, until....
Documenting the Past
When Gene Starzenski got out of the Marines in 1970, he went home to Pittsburgh, where he worked as an emergency room orderly, and later an ER technician. He wanted to do more, and the only paramedic program available locally was at Freedom House. He applied, but there were no openings. He moved to California, and in 1975 was certified as the 972nd paramedic in Los Angeles County. Due to his location, Starzenski ended up working for film studios as a paramedic on TV and movie sets. After retiring, he wanted to learn more about the history of his profession, and was shocked that Freedom House was never mentioned. Yet he knew they had been pioneers: he had seen them while working in Pittsburgh emergency rooms.
With the original Freedom House paramedics growing older and starting to die off, Starzenski had to work fast. He filmed interviews with many of the original Freedom House paramedics, as well as Dr. Safar (who died shortly after being interviewed, in 2003). By then, Nancy Caroline was already dead, but others spoke for her, praising how she worked long hours on the ambulances, and even when she went home, she made herself available for consultation day and night.
In 2009, Starzenski completed a documentary, Freedom House: Street Saviors, to tell the story.
Starzenski showed his documentary at the Colorado State EMS Conference in Keystone, Colo., this weekend, and brought along two of the original Freedom House paramedics to answer questions. They got a warm and enthusiastic response, even though few in the room had ever heard of Freedom House.
Starzenski is a now-retired studio medic, not a professional film director. Sometimes the film's background music drowned out the interviews, and (for instance) text crawls along the bottom were so small and blurry they were difficult to read. But the compelling story overcame those technical failures: it's amazing to see where some of the big names in emergency medicine, from Dr. Safar to Dr. Caroline to Laerdal, intersected with the street to produce a spectacular result -- and how overt racism nearly destroyed the legacy they helped create.
"Young people look at athletes with $30 million contracts as their heroes, but athletes and actors are not the real heroes," Starzenski said. "The people at Freedom House weren't in it for the money. They wanted to help others. They are the real heroes." And like a lot of real heroes, they were almost forgotten.
(Story continues after documentary trailer.)
The Documentary, Essentially, Also Failed
Whether the result of continued racism or, more likely, technical issues and money, Starzenski's documentary has never found a distributor. In four years, it has only been shown at a few film festivals and EMS conferences. Starzenski won't release it on the Internet, since then it will be pirated and he'll have no chance of getting distribution or recover his investment to make the film. That is a horrible shame: the story needs to get out to a wider audience. The record needs to be corrected.
It was a true honor to meet the two representatives from the original paramedic squad -- the pioneers who did the work to create a true profession in prehospital care, only to be forgotten.
George McCary III was the first we got to meet. After he was discarded by the city, he became a taxi driver -- some irony! "I didn't realize we were making history," he told a reporter for the Pittsburgh Post-Gazette. "I had a job to do, so I just focused on doing my job."
Walter Brown Jr. was the other Freedom House pioneer who attended the screening in Colorado, despite feeling ill from Keystone's 10,000' altitude. He remains bitter about being discarded, but declined to tell stories about that because "Peter [Starzenski] doesn't like controversy as much as I do." He did, however, tell me that "I had more fun in Vietnam," where he served before he returned home and joined Freedom House.
In August of this year, the National Highway Traffic Safety Administration -- which we know as the agency that codified prehospital medical training in the United States starting in the 1970s -- honored Freedom House for their ground-breaking ambulance service with the agency's Public Service Award.
"Starting in Presbyterian and Mercy hospitals in 1968, they became the first paramedics in the United States," the agency says on their web site, "and a bold initiative was born, funded in part through a grant from [the U.S. Department of Transportation]."
The NHTSA also notes that "after the 1968 assassination of Dr. Martin Luther King, Jr., in Memphis, the Freedom House paramedics were the only emergency medical resources in Pittsburgh willing to respond to calls resulting from riots that broke out in the city."
"Those men and women," they say, "faced many challenges, but we have all benefited from their participation as pioneers in the field of EMS. Their contribution went beyond the streets of Pittsburgh when Freedom House field-tested the first ever standard paramedic curriculum that the Department of Transportation published in 1977."
"With the NHTSA Public Service Award to the Freedom House Ambulance Service, we reaffirm our acknowledgement of those pioneering members of Freedom House Ambulance Service -- as well as its staff and supporters -- for their significant contributions to emergency medical services education."
The documentary has had some success, though, since it's quite inspiring. Freedom House has a new life: in 2010 the city of St. Paul, Minn., created an EMS Academy in an old firehouse -- and named it Freedom House in honor of Pittsburgh's pioneering program. They also renumbered the fire department building "Station 51" after the Emergency! TV show's station.
If you get a chance to see the documentary, do whatever it takes to see it. Meanwhile, you now know how the modern era of emergency medical services really got started.