The Forgotten Legacy of Freedom House

Mention the name “Freedom House Ambulance Service” in most departments these days, and you’ll probably get shrugs and blank stares. If this reaction applies to you, it’s no surprise—blame it on forgotten history and likely some institutional racism—but it’d be a loss not to acquaint yourself with these forefathers of EMS who helped pave the way for the job you take pride in today. 

Beginning in 1967 Freedom House was a trailblazer of prehospital emergency care in America. Staffed with black men and women from inner-city areas of Pittsburgh, the program recruited unemployed individuals and trained them as paramedics to deliver better emergency medical care to the community. America’s previous EMS system was virtually nonexistent—medical emergencies were handled by police officers who tossed patients in paddy wagons to be rushed to hospitals or by firefighters who gave basic first aid. After studying the growing problem of car accidents, the National Academy of Sciences published the 1966 document Accidental Death and Disability: The Neglected Disease of Modern Society, better known in EMS as the “white paper.”

“The lack of prehospital emergency care in America became progressively worrisome as the 1950s witnessed a massive flight to the suburbs and increasing interstate travel, so the number of traffic accidents skyrocketed,” says Gene Starzenski, a paramedic, filmmaker of the documentary Freedom House: Street Saviors, and firsthand witness to the rise of Freedom House while working in the Pittsburgh healthcare system. 

Prehospital Pioneers

The development of Freedom House began with Phillip Hallen, president of a local charity, the Maurice Falk Medical Fund. He noticed poor neighborhoods received little emergency care; even the police avoided responding to calls. People were dying in the streets—and Hallen recognized an opportunity to save them.

He contacted Jim McCoy, who ran Freedom House Enterprises (FHE), a nonprofit that helped black people find jobs, register to vote, and organize NAACP meetings. With the Civil Rights movement in full swing, the federal government’s War on Poverty attempted to ease tensions by funding organizations like FHE, which used the funds to train underemployed people for jobs like hairdressing and truck-driving. Hallen suggested to McCoy that they train people to drive ambulances instead of produce trucks. 

McCoy agreed, so Hallen pitched the idea to Edward Norian, an administrator at Presbyterian University Hospital (now the University of Pittsburgh Medical Center). Norian connected him with Peter Safar, MD, who was working on improving emergency care after contributing to the white paper. Safar, the legendary “father of CPR” and inventor of the Resusci-Anne manikin, was designing an emergency transport vehicle that used the same design as modern-day ambulances (he also invented the intensive care unit and designed today’s MICUs). Safar eagerly agreed to train recruits and reached out to Jerry Esposito, who ran a private company, Citizens’ Ambulance, to assist with training at Presbyterian. 

The group linked up with Moe Coleman, who worked in administration for Mayor Joseph Barr and established War on Poverty programs throughout the city.¹ Seeing the value of their plan, Coleman arranged the funding for Freedom House. A mandate required 26 individuals sign up, but with a low number of registrants, Esposito took to the streets of the Hill District, one of the poorest neighborhoods, in his station wagon, promising people hot meals or anything they needed to convince them to join. Some of the recruits were felons, ex-convicts, or Vietnam War veterans, worrying hospital staff about sharing a workspace with them, but Safar was committed to producing a high-quality advanced life support team. He even helped those who hadn’t finished high school earn their GEDs during the program. 

Cutting-Edge Care

In October 1967 the first Freedom House class began training. When the riots of April 1968 broke out in Pittsburgh, the crew wasn’t ready to hit the streets because their ambulances were still being designed. However, with resources lacking and Freedom House members having the most emergency medical training, the city assigned them to ride with police—two per paddy wagon, equipped by Presbyterian to provide care to people injured during the riots. They had to leave the lights on inside the cars at night so people knew they were medics and not cops—otherwise, Starzenski says, they would get bricks thrown at them or shot at.

“That was their first run doing emergency care,” he says. “But after that they went back into training. That’s what was unique about Freedom House: They were based at the hospital, so their training was continuous.”

Starzenski worked for a transport company called Tri River Ambulance at the time. He’d watch Freedom House crews with interest at various hospitals’ ambulance entrances and run up to check out their vehicles. 

“I’d look inside their ambulances and see all the sophisticated advanced life support equipment—defibrillator, suction unit, like a modern-day ambulance. They were decked out to the max,” Starzenski says. “I wanted to talk to them to find out more about it, so I applied as an orderly for the ER at Southside Hospital,” where he eventually became an ER technician. Since Freedom House had no openings and no other paramedic programs existed in Pittsburgh, Starzenski moved to California and became the 972nd licensed paramedic in Los Angeles County.

The training Freedom House medics received was cutting-edge. Safar, along with other doctors, rode in the ambulances to guide and improve their quality of care. Even more unique were the training opportunities: Safar brought his providers to The Johns Hopkins Hospital in Baltimore and hospitals in New York City to learn new techniques and perform CPR demonstrations. He eventually brought some to medical conferences in Europe to showcase his new lifesaving technique.

Nancy Caroline

Another notable figure who advanced Freedom House was Nancy Caroline, who arrived in Pittsburgh in 1973 for her residency in critical care medicine (a program developed by Safar that created the role of emergency medicine physicians). Safar assigned her to supervise Freedom House, and she quickly grew passionate about the team, working 24/7 with them, sleeping on gurneys in the ambulances. Caroline is credited with expanding the ALS care Freedom House provided. Using her clinical learning experiences, she authored the seminal Emergency Care in the Streets and about two years later wrote the first paramedic training manual (she later moved to Israel and was the first medical director for its national emergency medical service, Magen David Adom). Her dedication to the advance of paramedicine and Freedom House medics mirrored their dedication to their patients.

“Freedom House [paramedics] had compassion for the community,” says Starzenski. “They told me when you walk into a person’s home, you’re a guest. That’s the No. 1 thing they brought to the table: They cared. They addressed everybody by their names. They respected them and asked permission before providing treatment.”

Preserving the Past

Freedom House was disbanded in 1975 when the city took over the program. It had encountered increasing difficulties under Barr’s successor, Pete Flaherty, whose actions impeded operations—for instance, prohibiting the use of sirens downtown because of alleged noise complaints and not expanding Freedom House’s jurisdiction when wealthier communities protested that poorer neighborhoods were receiving better medical care. While funding had always been difficult, Barr always made sure monies were available. Flaherty never had anything good to say about the service, says Starzenski—and didn’t hesitate to use racial slurs. Flaherty eventually froze Freedom House’s funding and seized its assets to be used for the city’s new EMS agency.

The entire EMS system was redesigned. New tests were written that didn’t encompass what Freedom House medics were taught, resulting in some of them failing or quitting because the city brought in new doctors who changed their protocols. Those who had criminal records were fired because they were ex-convicts. The arbitrary punishments and poor excuses for the city’s neglect were generally perceived as lame attempts to hide blatant institutional racism. Others left in disgust because eight-year veterans of the service were rejected for promotions that went instead to white men from the suburbs with no experience in emergency services. Walter Brown, one of the Freedom House medics, told Starzenski that for them, it was like living in “Pittsburgh, Mississippi.” Ultimately only five of the original 26 Freedom House members remained in the field, and only one, John Moon, earned a position in leadership as assistant chief, but even he was never offered a promotion to become chief.

Despite its short run, Freedom House influenced how the rest of the nation developed EMS, setting the bar high with its novel use of ALS treatment in the streets. While cities like Seattle and Miami were implementing EMS systems around the same time, “what set Freedom House apart from the other programs was how they were intubating in the early days, since Dr. Safar was so big on ventilation as an anesthesiologist,” Starzenski says. “Freedom House was the leader, and because of them Pittsburgh developed into one of the leaders in EMS.” 

Visit www.freedomhousedoc.com for more information on the documentary. To inquire about organizing a public viewing of the film, contact Starzenski at 310/722-2297 or e-mail genastar@msn.com. 

References

1. Schackner B. Obituary: Morton ‘Moe’ Coleman/social worker was ‘connective tissue’ of Pittsburgh. Pittsburgh Post-Gazette, 2019 Jan 28; www.post-gazette.com/news/obituaries/2019/01/29/Obituary-Morton-Moe-Coleman-University-of-Pittsburgh-Pitt/stories/201901290061.

Valerie Amato, NREMT, is assistant editor at EMS World. Reach her at vamato@emsworld.com.