Healthcare History: Freedom House Ambulance Service
How Modern EMS Systems in the United States Took Root in the 1960’s
Written by: Sarah DiCicco, Molly Hahn, Charles Hurley, and Ken Riddle
Fire and emergency medical services (EMS) agencies play a critical role in providing much needed safety services to their communities. For over 33 years, PCG has been committed to developing practical solutions to help fire and EMS providers, because we understand the unique challenges they face daily. PCG’s EMS cost recovery program allows these agencies to claim the state and federal funding to which they are entitled. To date, we have served over 500 providers across the country and produced over $400 million in new Medicaid funding alone.
For those of us who have never known otherwise, it’s easy to take for granted the advanced level of pre-hospital care offered in the United States. However, this quality of care is a relatively recent innovation; you may be surprised to learn, for example, that the life-saving care administered by EMS providers in transport became standard only about 60 years ago.
In recognition of our Fire and EMS clients’ vital work—and to highlight why this line of business is so important to the PCG employees who oversee it—we wanted to look back at how EMS systems in the U.S. evolved over the past six decades. Keep reading to learn more about the developments that led to the emergency transport system we know today.
U.S. Emergency Medical Care, Pre-1966
By the 1960s, the U.S. had participated in four major global conflicts: The Civil War, World War I, World War II, and the Korean War. At this point in time, the country was only beginning to be more engaged in the Vietnam War, our full involvement would not occur for another five to seven years. Why is this information important to understand?
With our involvement in each of these conflicts came exceptional advancements in medical triage, treatment, and transport of critically injured soldiers. This resulted in improved survivability odds for soldiers who sustained traumatic wounds—such as penetrating trauma, blunt force injuries, concussive head injuries—or contracted diseases. Countless lives were saved because of the outstanding care and treatment soldiers received.
Two important facets of this care quality were advancements in surgical processes and procedures, as well as the invention of medical devices by doctors and nurses who saw a means to save even more lives. But one major contributing factor—the key to any discussion of EMS history—were systems put in place by the U.S. military to rapidly transport injured soldiers from the battlefield to definitive care facilities.
During the 1950s and 1960s, President Dwight Eisenhower oversaw the development of the Interstate Highway system — believing that if a major conflict ever occurred on U.S. soil, our railways would be insufficient to move troops and materials across the country. As these super-highways grew and expanded across the country, more and more people took to the roads in automobiles.
The unintended consequence of this growth and advancement was a dramatic increase in the frequency of car accident-related medical emergencies, as well as in the number of people who died as a result of traffic accidents. In response to this epidemic, the National Academy of Sciences published Accidental Death and Disability: The Neglected Disease of Modern Society in 1966—a landmark white paper that drew attention to the paucity of emergency medical response options in the U.S.
The paper stated that up to 50,000 deaths each year were due to inadequate treatment provided by the ambulance services of the era (often compounded by the long distance to a nearby hospital). Indeed, available ambulance services at that time were run by local police departments or funeral homes and provided no medical treatment beyond basic first aid. They transported the sick or injured to treatment facilities unaccompanied, in the backs of squad cars, paddy wagons, or hearses.
However, that all changed when two deaths that year inspired a trailblazing program in Pittsburgh’s Hill District.
Unmet Medical Care Needs in Pittsburgh
David Lawrence, a four-term mayor of Pittsburgh and one-term Governor of Pennsylvania, collapsed in November 1966 at a campaign rally and died 17 days later, having never regained consciousness. His death was widely attributed to the cramped conditions and lack of medical equipment in the “hearse style” ambulance he’d been transported to the hospital in. That same year, Elizabeth Safar—the 12-year-old daughter of Pittsburgh-based anesthesiologist Dr. Peter Safar—died from an acute asthmatic crisis, for which she was transported to a hospital without medical care on the way.
These deaths inspired Dr. Safar, already known as the “father of CPR” for his role in pioneering the resuscitation technique, to join a collaborative effort aimed at revolutionizing emergency medical response services. The Maurice Falk Fund, a local nonprofit focused on improving health outcomes in Pittsburgh, had already partnered with Freedom House Enterprises, a civil rights organization, to expand their job training program for Black Pittsburgh residents to address medical access disparities.
While available emergency medical transport was insufficient everywhere, the problem was exacerbated in predominantly Black neighborhoods due to structural racism. Private funeral homes often refused calls for their ambulance services to these areas, and the long wait times for police transportation were often fatal for those in need of help. The Maurice Falk Fund and Freedom House Enterprises believed they could save lives by training Black residents to provide ambulance services in their own communities.
The Founding of Freedom House Ambulance Service
Freedom House Ambulance Service began in 1967 with an initial trainee class of 26 residents of the Hill District, a predominantly Black neighborhood made famous by the works of American playwright August Wilson. The Hill District, once a cultural center of Black life in Pittsburgh, was partially demolished in 1956 for construction of a sports arena, leaving many residents displaced and businesses destroyed. The construction isolated the once well-connected Hill District from surrounding areas, which in turn disconnected its residents from many city services, including emergency transportation. The Freedom House Ambulance Service aimed to step in where city services were failing the area.
Under the direction of Dr. Safar, the trainees (who largely had no prior job experience – some also lacking high school diplomas) spent nine months rotating through emergency rooms, operating rooms, and other hospital departments all over the city. They took defensive driving courses, learned advanced first aid, and practiced cutting-edge resuscitation techniques. Doctors even rode along on early calls to coach the trainees through patient treatment.
“It was so far ahead of its time,” says John Moon, a Freedom House medic and eventual assistant EMS chief in Pittsburgh. “It was inconceivable at that time for someone to come to your door and start an IV on you or intubate you and give you cardiac drugs and start CPR. Outside the hospital, this had never been done.”
Quote from 99% Invisible, Episode 405
In its first year of operation, Freedom House responded to 5,800 calls, provided transportation with treatment to 4,600 people and saved, by Dr. Safar’s evaluation, 200 lives that may have been lost had they been transported without treatment.
Nancy Caroline, part of Dr. Safar’s critical care medicine program for physicians, became the first medical director for Freedom House. Through this work, Dr. Caroline developed standards for emergency medical treatment, which culminated in her writing the first paramedic training manual. Additionally, the ambulances Safar designed for Freedom House were adopted as the industry standard by the National Traffic Safety Administration (NTSA).
Ultimately, Freedom House Ambulance Service was so well-regarded residents of other neighborhoods— including those in more affluent, predominantly white areas—began complaining that they received worse emergency transportation services than the low-income areas in Pittsburgh.
In 1975, eight years after its inception, Pittsburgh’s new mayor froze funding and withdrew support for Freedom House Ambulance Service. Funding was reallocated to a new, city-run ambulance program, staffed largely with white males from suburban areas who lacked the training and experience of the Freedom House paramedics. Though an agreement was made to include the Freedom House paramedics in this new city program, they were largely driven out through reassignment to menial administration roles or being deemed “unfit” by the new program administrators.
While Freedom House Ambulance Service only lasted for eight years, its legacy looms large in the modern EMS field.
EMS in the U.S. Today
An estimated 240 million calls are made to 9-1-1 in the U.S. each year, with the Centers for Disease Control and Prevention (CDC) reporting that 15.7 percent of total emergency department (ED) visits involve the use of an ambulance. In 2018, there were over 30 million ambulance transports in the U.S.
The National Association of State EMS Officials (NASEMSAO) recently released their National Emergency Medical Services (EMS) Assessment 2020, outlining the current state of EMS in the U.S. Some of the findings highlighted by the report’s authors include:
- More than 18,200 local EMS agencies respond to 911 calls across the country.
- More than 750 services are licensed by state EMS offices to fly patients using helicopters and fixed-wing aircraft.
- More than 9,300 local EMS services have physician medical directors.
- Sixty percent of 53 state EMS offices participated or expected to participate in mass casualty exercises involving a biological threat in 2018 or 2019.
Put into its historical context, the current EMS system’s critical role in our society takes on a deeper meaning. Pre-hospital care saves lives, every single day!
Given the importance of PCG’s EMS cost recovery program efforts to both our clients and our company, it’s crucial to understand and appreciate the modern EMS system. We hope this article has been an informative overview of its history and PCG’s work in this space.
If you’d like to learn more, you can find links to the references used in writing this article below. We’ve also included a few additional resources that we highly recommend, such as a recent podcast about Freedom House Ambulance Service.
Learn More About Freedom House!
Listen to episode 405 of the podcast 99% Invisible about Freedom House, including interviews with John Moon:
Freedom House Ambulance Service – 99% Invisible
Watch the trailer for a documentary about Freedom House Ambulance Service:
Photo/trailer clip courtesy of Freedom House Street Saviors Documentary
Check out news coverage of an event honoring Freedom House’s legacy:
How Freedom House Ambulance Service in Hill District became national model | Pittsburgh Post-Gazette