Prior to the 1970’s, the idea of a person arriving at your doorstep to administer an IV, intubate you, administer cardiac drugs, and initiate CPR was beyond imagination. Such medical procedures had never been performed outside of a hospital setting. Transportation of critically ill or injured individuals response was left up to police, who responded in a station wagon or cargo-type vans with a bench and space for a military-style stretcher in the rear. Other medical transports were operated by funeral homes who would show up in a hearse to take you to the hospital. Yet the funeral homes often weren’t willing to respond to black neighborhoods. And residents in black neighborhoods couldn’t necessarily trust or count on police. Furthermore, the police or transportation agents had little or no first-aid training. There was no medical attendant by the patient's side. There was no life support equipment.
An Experimental EMS is started
Because of the lack of immediate medical care and on-the-scene a 1966 study estimated that up to 50,000 deaths each year were the result of inadequate ambulance crews and on-the-spot medical care. (Note: The Governor of Pennsylvania and former mayor of Pittsburgh, David L. Lawrence, suffered a heart attack and died en-route to the hospital in 1965). The experimental ambulance service began with the help of Peter Safar, MD, a critical care pioneer considered the father of CPR. With CPR, he was able to demonstrate to the world that you can train people who are not doctors, nurses or other professionals to be first-rate medical technicians and first responders to save a life. Now he was looking to expand that concept with remote medical services provided through Ambulance services. So in 1967, Safar was given the perfect opportunity. He was approached by leaders in the Hill District, a predominantly black community around the Presbyterian University Hospital in Pittsburgh. They wanted to provide better transportation for their residents to receive medical care. Safar saw an opportunity to test out his vision for a national standards in community-wide emergency care.
City of Pittsburgh partners with 25 Black Men from Freedom House
Safar approached the city of Pittsburgh who agreed to fund his new EMS project. (Remember the previous note on Mayor Lawrence? Almost certain his death was influential in the city’s decision) But he needed paramedics. So he approached Freedom House Enterprises to help with the recruitment of paramedics for the new ambulance service. At that time, Freedom House worked on civil rights projects including voter registration and organizing NAACP meetings as well as offering job training and assistance with job searches to black Pittsburghers. Freedom House were eager collaborators and immediately went to work. The first team of Freedom House Ambulance Service recruits consisted of 25 black men from The Hill District, a low income black neighborhood. They were trained for 32 weeks, completing a course that included anatomy, physiology, CPR, advanced first aid, nursing, and defensive driving. The local media put out hit pieces on the recruits… some of the men had suffered long-term unemployment, half had not graduated high school, some had mental or physical challenges as Vietnam vets, and some even had criminal records, including felonies.
But they were game…
Freedom House EMS sets the gold standard that's used today
And beginning in 1968, the Freedom House Ambulance Service (FHAS) launched its EMS program, operating in The Hill District with two ambulances, transporting the critically ill or injured patients with life support. Safar’s department provided the training for 24-hour emergency medical care. The key to its success was that the program met a dual need for the community: It provided desperately-needed jobs needed in the economically-depressed neighborhood Black as well as directly improving (and sometimes saving) the lives of their loved ones and/or neighbors.
The Freedom House EMTs were so well trained that they were often requested to the scene by police officers. A concept that had not been in practice before then. Freedom House medics were among the first to treat cardiac arrest with chest compressions, rescue breathing and intubation outside of a hospital, and to travel with EKG machines and a variety of medications to administer on scene. This unlikely group of “unemployables” were revolutionizing emergency street medicine. Administering drugs for the upliftment of their community… instead of selling drugs to its detriment.
The FHAS came to be known for the high standard of care they provided and they soon replaced the injury or medical emergency calls that were previously made to the police. Freedom House Ambulance Service responded to almost 6,000 cals in their first year, and transported more than 4,600 patients, primarily in African-American neighborhoods in Pittsburgh. According to data collected by Dr. Safar, the paramedics saved 200 lives in their first year of operations! Where slow service to black neighborhoods by the police had been a point of tension, the Freedom House paramedics had a response time of less than 10 minutes in most neighborhoods.
Freedom House became the pilot course for the U.S. Department of Transportation and the White House intra-agency council on emergency medical services, thus setting the national training model for EMS programs in the U.S. Safar would also work with Miami, Los Angeles, and Jacksonville who adopted the impeccable Freedom House model.
Despite its success, Freedom House paramedics faced racism from hospital staff and patients. They were not able to successfully expand their scope outside of the black neighborhoods because white patients were often unpleasantly surprised by or resentful of the black EMTs and would oftentimes refuse to be touched or helped by them.
The biggest challenge to them being able to scale, however, came in the form of the new Pittsburgh mayor who was elected in 1970. He refused to renew their contract Freedom and even went as far as to sign a noise ordinance barring the use of ambulance sirens in the downtown Pittsburgh area.
New Mayor shuts down Freedom House EMS and starts his own
Freedom House abruptly shut down on Oct. 15, 1975 after losing its city contract and funding. As Freedom House was phased out, the Mayor launched the city’s own ambulance system to be staffed by non-police officers trained as paramedics. 26 of the Freedom House EMTs were able to initially transfer to the city’s EMS but some were fired because of their criminal records. Others were dismissed after the city instituted a new Pass/fail exam covering materials the Freedom House paramedics had not been taught. Most of those remaining were reassigned to non-medical or non-essential work. Many were placed in positions overseen by white employees with less experience. Ultimately, only five remained with the city ambulance service, and only one was promoted into a leadership position. By the late 90s, 98% of the Pittsburgh Bureau of Emergency Medical Services were white.
Legacy
It’s terribly sad to see yet another case of Black Excellence extinguished as a result of America’s systemic racism. But we salute the Freedom House EMS of Pittsburgh who trailblazed the emergency medical services in the 1960s and 70s. They pioneered the first responder concept, offering advanced pre-hospital care and their innovative training and protocols laid the groundwork for the modern EMS systems we benefit from today.
Anytime you see or hear the howling sirens of an ambulance, just bear in mind that it rings loudly with the legacy of Freedom House.
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