Freedom House Ambulance Service
It’s funny what pieces of information, or fun facts we remember from the first few weeks of any class or program. For some reason, I distinctly remember the chapter in our EMS textbook that discussed the formation of EMS and its humble start in Napoleon’s army. From Napolean, EMS stayed a primarily war-time endeavor until the 1960’s. It was here, at least according to my textbook, that EMS was birthed in the United States. During this time period, the general public was shocked to learn that citizens of the United States had a higher chance of dying in a car crash at home than a soldiers who had been shot in Vietnam. This data contributed to a call to action in which pre-hospital care began to take shape.
Before moving on in this post, you should check out the book American Sirens by Kevin Hazzard. This book is incredible and serves as the inspiration for this post, Kevin does an incredible job breaking down the history of EMS in the United States while paying tribute to the men and women who paved the way for modern-day EMTs and Paramedics.
While it is true that a report in the 1960s did lead to the advent of modern-day EMS systems in the United States, my EMS textbooks seemed to gloss over how these systems were created. Freedom House Ambulance Service, located in Pittsburgh, Pennsylvania, was the first true EMS system in the United States. Before the inception of Freedom House Ambulance Service, medical emergencies were handled by police, firemen, or mortuary assistants. Essentially, if you called 911 at home, one of these groups would show up at your house, grab your loved one, and throw them in the back of a vehicle speeding towards the closest hospital. Medicine was only done inside of a hospital and the patient would have to hold on until they reached the healing touch of a physician.
History
Dr. Peter Safar realized that this system was broken. Tragically, Dr. Safar’s daughter died from an asthma attack that happened at home. This incident inspired Dr. Safar to make remarkable changes to medicine in the United States, with one of his crowning achievements being the formation of Freedom House Ambulance Service.
While working to jump-start his groundbreaking EMS program, Dr. Safar ran into multiple problems. Ultimatley, Dr. Safar lacked support from physicians, politicians, and even the general public. The solution to this problem came in the form of Freedom House, a nonprofit started to support the poor, predominately black residents of the Hill District of Pittsburgh. Freedom House worked to provide basic needs to residents of this district, including employment opportunities. I am overly simplifying this aspect of history (seriously go read American Sirens) but Dr. Safar found future paramedics and an area to serve, all in the same district. Once paramedic candidates were identified, they were trained in groundbreaking medical procedures, including intubation and medication administration. In a trial by fire, Freedom House ambulance began operations during the MLK riots that occurred after his assassination in 1968.
Freedom House Ambulance Service continued to operate until 1975 when it was forcefully absorbed by the City of Pittsburgh EMS system (more on this later.)
During their tenure, Freedom House Ambulance paramedics practiced medicine at the highest level of their time. Intubation, medicine administration, and IV access were all skills pioneered in the pre-hospital setting by these individuals. Their training was intense and covered the basics of pathophysiology as well as anatomy. These paramedics paved the way for EMS operations within the United States. This point isn’t speculation either, dozens of cities across the U.S. reached out to Freedom House Ambulance Service to request their paramedics as advisors. It is no exaggeration to claim that Freedom Ambulance Service created the foundations of modern-day EMS.
Legacy
So where is Freedom House Ambulance today? It should go without saying that the legacy of Freedom House is far-reaching. Complicated and chock-full of injustices, but at the same time incredible and inspiring. Freedom House Ambulance Service was born out of necessity, injustice, and, as is so fitting for EMS, a little bit of insanity. Freedom House Ambulance Service can take credit for the first documented field intubation in the United States. A skill typically done by a physician in a sterile, safe environment, was done prehospital by a black paramedic in the back of an ambulance on the side of the road in Pittsburgh. I mean, this reads like an action scene out of a hit TV show! These medics did incredible medicine and received no recognition, in fact, these medics usually received pushback from physicians, police, nurses, politicians, and sometimes even the patients they treated.
And here is the part of this blog where I talk about the injustices done to the members of Freedom House Ambulance Service. If you google Freedom House Ambulance you will quickly find that this agency no longer exists. I alluded to the fact that this service was forcefully shut down but it is much more egregious than that. City officials not only absolved this incredible agency but then utilized aggressive tactics to either fire or cause Freedom House paramedics to quit Pittsburgh EMS. (The book goes much more in-depth than I ever could.)
One of the most egregious failures of carrying forward this incredible history is its absence from EMS education. It was never mentioned in my class. What’s even. more embarrassing about this fact is that almost every paramedic and EMT in the United States received a book titled "Emergency Care in the Streets by Nancy Caroline. Would you like to guess where Dr. Caroline spent an incredible amount of time as a medical director? I find it criminal that the literal medical director of Freedom House Ambulance wrote the most widely distributed EMS text book and yet most providers in the United States have no idea about the history of EMS.
Concluding Thoughts
It is impossible to talk about Freedom House Ambulance without discussing race. I think it is also important to note that this is not my story, but one I still feel necessary for me to tell. I have loved working as an EMT since day 1. As I am currently taking a break from EMS to pursue nursing I continue to miss it. What I am trying to say, is that I find a sense of duty to let others know about Freedom House Ambulance.
The men and women who started and worked for this agency were the definition of EMS professionals. They expertly toed the line between evidence-based practice and pushing the limits of pre-hospital medicine. And most impressively, this all-black EMS service, which faced incredible levels of racism and bigotry continued to provide life-saving care to their patients.
We need to continue to tell the story of Freedom House Ambulance. EMS has always been and will continue to be the meeting ground of misfits. Individuals who chose a profession to help others and serve something bigger than themselves. We need to continue to tell this story because there are thousands of EMTs and paramedics who look like me and significantly fewer who look like our black coworkers. EMS is an incredible equalizer. Looks, personality, and financial well-offness mean nothing in the back of the ambulance.
Telling the story of Freedom House Ambulance brings pride to the shining moments of EMS while still highlighting the work that remains to ensure all of our patients receive the same care we would wish for our own families.
