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Pittsburgh and the birth of modern-day emergency medical services

Sirens, unpredictably wailing at all hours, are part of living near a busy hospital. Undergraduate students residing in Oakland complain of this noise from ambulances racing down Fifth Avenue. Few know of the confluence of sociopolitical events and individuals driven to make a change in the 1960s to create what would become the modern-day ambulance service, placing Pittsburgh at the forefront of emergency medicine. Recently, this legacy was tested during the shooting at the Tree of Life Synagogue, where the emergency medical system, partially pioneered in Pittsburgh, was credited with saving lives.

Pittsburgh suffered from problems typical of other large cities in the 1960s, and inhabitants of racially and economically segregated neighborhoods such as the Hill District resented failed attempts at urban renewal. When it came to medical emergencies, police and funeral home directors held exclusive domain but ran services a far cry from what we now know as an ambulance company. Police responded to the vast majority of medical emergency calls in stripped-down vehicles, while privately owned funeral homes responded to calls only in certain neighborhoods. Often, the patient would ride unsupervised. In addition to segregation and poverty, black neighborhoods lacked access to what little emergency medical care existed. Stories of poor experiences with both outfits circulated widely.

Nationally and locally, events established the foundation to change this paradigm. U.S. President Lyndon B. Johnson’s “War on Poverty” brought considerable financial and administrative resources to bear, while a report published by the National Academy of Sciences in 1966 entitled “Accidental Death and Disability: the Neglected Disease of Modern Society” drew attention to unnecessary deaths occurring from a lack of quality emergency medical services. This report’s findings manifested itself locally with the death of a prominent Pittsburgh politician, who collapsed during a speech in the city and died despite the best efforts of police transporting him and a nurse, one of the first to be trained by Dr. Peter Safar in CPR, performing compressions.

Independent of this, Phil Hallen, president of a local charitable organization, partnered with James McCoy Jr., founder of a Hill District civic-improvement organization, to create a professional ambulance company to train Hill District residents to provide emergency medical care in their own neighborhood. The men sought funds from the “War on Poverty” campaign to start the organization, conceived partly from Mr. Hallen’s experience driving ambulances in New York City. Dr. Safar, driven by the death of his 11-year-old daughter, used the publicity of the politician’s death to bring his vision for pre-hospital care to reality through this new ambulance company.

The union of Dr. Safar, Hallen and McCoy convinced the city to contract with the newly created “Freedom House Ambulance Service” to provide emergency services to the Hill District and downtown Pittsburgh. This organization proposed to do three things, each a paradigm shift: provide good medical care where it was not provided; transform the ambulance from a mere vehicle of transport into a fully realized mobile treatment center; and make African-American men and women deemed “unemployable” the first trained paramedics in the United States.

After hundreds of hours of training, the Freedom House medics earned their first stripes working alongside a largely white Pittsburgh police force during riots occurring in the wake of Martin Luther King Jr.’s assassination in April 1968. Their profile rose as they responded to more calls in affluent areas, sometimes prompted by police specifically requesting their assistance. During the dozen-or-so years the Freedom House medics ran, they developed innovative techniques now employed by today’s ambulance crews. Their ambulances carried battery-powered ECGs that could print out ECG strips, defibrillators and intubation equipment, leaps ahead of contemporary ambulance companies’ bare-bones arsenals of cots, bandages and oxygen.

Unfortunately, the Freedom House medics’ expertise led to other Pittsburgh residents questioning why they lacked a similar ambulance company. After a newly elected mayor declined to renew the city’s contract with Freedom House to create a city-run ambulance corps in 1975, the service shuttered. Some of the employees served in the new Pittsburgh Emergency Medical Services, while others drifted away from the medical field. They largely were forgotten until recently, when Gene Starzenski, a former emergency room worker from Pittsburgh, produced a documentary called “Freedom House: Street Savors” to honor their memory.

The Freedom House Ambulance Service not only provided some of the first advanced life support in the prehospital setting, but it also broke down racial barriers. The National Highway Traffic Safety Administration awarded the Freedom House Ambulance Service a Public Service Award in 2009, and a reunion and ceremony to honor former Freedom House staff was held in 2014.

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