Freedom House
- History Fix Podcast
- 4 days ago
- 18 min read
Updated: 2 days ago
Episode 149: How Black "Unemployables" From the Hood Revolutionized Emergency Medicine
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Nowadays, if something happens to you, you get injured or sick and need immediate medical attention, you call an ambulance right? You call an ambulance and you expect that ambulance to arrive quickly and, if needed, you expect to receive emergency, life saving emergency care in the ambulance on the way to the hospital. Today, ambulances are staffed by emergency medical technicians or EMTs who are trained to save lives during emergencies or while en route to the hospital. They perform CPR, use defibrillators, control bleeding, provide oxygen or intubation if necessary, administer epinephrine for allergies and other life saving medications. In this way, many many lives are saved that would otherwise be lost before reaching the hospital. Everyone recognizes the importance of this service but, did you know it’s actually a very new thing? Did you know that our modern ambulance and emergency medical services have only been around for less than 60 years? That, before that, you would have been picked up by police or even a hearse with much slower response times and no medical treatment en route. That, before that, many people needlessly died on the way to the hospital and that it was a team of Black Americans from Pittsburgh's poverty stricken Hill district who revolutionized emergency response with their Freedom House Ambulance Service. You didn’t? Let’s fix that.
Hello, I’m Shea LaFountaine and this is History Fix where I tell surprising true stories you won’t be able to stop thinking about. Before we get into today’s story I have a quick announcement in case you missed it. I’ve added another episode of History Fix trivia to the Patreon. This one is super special though because in this one my husband Joey, who is notoriously bad at history, faces off against Pablo who is 11 years old and an OG listener of History Fix. When we found out Pablo got almost every question right in the last episode of trivia with Joey, we knew we had to get him on there and he did not disappoint. So please go check that out to find out… is Joey smarter than an 11 year old? Are you smarter than an 11 year old? Because you can totally play along. It’s super fun, all of the trivia questions come from past episodes of History Fix so if you’re a big listener you might actually know the answers. You’ll find that at patreon.com/historyfixpodcast. You can watch the first part of it for free but you will need to subscribe to watch the whole thing. Totally worth it. This show depends on Patreon subscribers to keep going so thank you thank you thank you to everyone who already subscribes for just a few bucks a month you’re making a huge difference and hopefully enjoying all the extra content. The link to the Patreon is in the description of every episode. Come play trivia with us.
Okay back to this week’s episode. It is officially Black History month here in the United States. I love Black History Month and Women’s History Month which is next month, March, because all of the topics are just so perfect for History Fix. Black history, women’s history is lesser known history by nature so I can pretty much pull a topic out of a hat and it works perfectly. This particular topic, the Freedom House Ambulance Service was suggested by Janice on Instagram. Shout out to Janice, thank you, this is such a worthy topic and I can’t believe I didn’t know about it. The Freedom House Ambulance Service completely revolutionized emergency medical response, like, I can’t believe they weren’t doing these things before it. So let’s talk about that. Because the Freedom House Ambulance Service came to be in 1967 but what the heck was happening before that? Like, if you called 911 because you were having a heart attack or whatever, what would happen?
Well, there weren’t really ambulances like there are today. One of two things would happen. You’d either be picked up by police and sort of unceremoniously dumped into the back of a paddy wagon which is a police van and driven to the hospital. Or, even worse, you’d be picked up by a hearse from a local funeral home. Like they had given up on you before they even got there. Either way the response time was not great and you received no life saving services beyond basic first aid on the way to the hospital, or the morgue in many cases. Now this kind of worked okay back in times when people died all the time anyway and also in times where people were concentrated for the most part into urban areas near a hospital. But, after World War II, two things changed. First, there were way more advances in emergency medical care. In some ways World War II was fought in the medic’s tent. I talked about this in my episode about antibiotics, episode 62. Antibiotics were a game changer during World War II, saving countless lives. They started to realize, you know, if we can actually save these guys, get them back out on the battlefield, then we might have the manpower to actually win this war. Antibiotics were hugely helpful there as were new vaccines, treatment for malaria, the development of blood banks, and new surgical techniques. Because of this focus on advanced medical care during World War II, the survival rate for a wounded soldier went up from 4% in World War I to 50% in World War II. So that is significant. It means the technology, the know how now exists to save lives on and off of the battlefield.
Another thing happened after World War II that affected emergency medicine, but in a bad way. Many people moved out of those urban centers and farther away from hospitals. This was really the invention of the nuclear family, Dad, Mom, brother and sister in their own little house with a white picket fence. This was a big shift in the way Americans were living. Before that, you know, they were living in apartments in big cities in multi-generational households. Now everyone sort of moves off on their own into suburbs farther from cities and farther from hospitals. But what that meant was that the time it took for the police paddy wagon or a hearse to actually get to someone out in the suburbs and then get them to the hospital back in the city was way too long and many people were dying before they ever got medical care. In 1966 a paper was published by the National Academy of Sciences titled “Accidental Death and Disability: The Neglected Disease of Modern Society.” This paper stated that as many 50,000 deaths each year were the direct result of inadequate ambulances and a lack of hospitals close enough to where people were living. They could not get people to the hospitals in time and they could not help them adequately on the way.
In Pittsburgh, Pennsylvania this emerging crisis really came to light when their former mayor David L. Lawrence, who was also a former governor of Pennsylvania, had a heart attack and was transported to the hospital by police. Upon arrival, he had no brain activity. They kept him alive on life support before ultimately deciding there was nothing they could do and he died after being removed from life support. Lawrence was treated at the hospital there in Pittsburgh by a physician named Peter Safar and Dr. Safar was outspokenly convinced that Lawrence would have survived if he had received adequate care on the way to the hospital, if som eone had been working on him en route. Now, to be fair, someone was trying. There happened to be a nurse who was actually trained by Dr. Safar, in the audience when Lawrence collapsed and she tried to do chest compressions on him on the way to the hospital but she was like bouncing around the back of a fast moving van and couldn’t do it effectively. This is not an isolated incident for Dr. Safar, unfortunately. That same year, 1966, his 11 year old daughter Elizabeth died of an asthma attack. Same situation, it took them too long to get her to the hospital. Before she reached it, she had fallen into an asthma-induced coma and suffered fatal brain damage. Once again, Dr. Safar was convinced that if she had received proper pre-hospital care, her life would have been saved. After losing his young daughter so tragically, Dr. Safar began focusing on advancing technology that would prevent these types of deaths from happening. He helped to develop cardiopulmonary resuscitation AKA CPR. Yes, you guys, there was no CPR before the 1960s. Dr. Safar helped develop it and sort of get the knowledge of it out there to the people.
But this problem of inadequate pre-hospital care continued and people continued to die unnecessarily en route to the hospital. This was especially bad in predominantly Black neighborhoods like Pittsburgh’s impoverished Hill district. Wait times for paddy wagons and hearses were often longer in Black neighborhoods. They took their time getting to them. Sometimes they refused to transport them altogether. Mitchel Brown, who eventually became a Freedom House paramedic recounts in an article for EMS1 when his mother suffered a cerebral hemorrhage when he was 17. He says quote “We called the police to come and take care of her. The two white police officers refused to carry her — they said she was drunk. I carried her myself and put her in the paddy wagon. We took her to St. Francis Hospital. I never saw her alive again,” end quote. Also, many Black residents of the Hill neighborhood were afraid to call police due to tension between the police and their community which was notoriously pretty crime ridden. Residents of the Hill district were very low income. Many had criminal records and many were unemployed. In fact, the media at the time referred to residents of the Hill district as quote “unemployables.” But there was a reason for that that wasn’t entirely their fault. In the 1950s, the city of Pittsburgh demolished hundreds of homes and businesses in the Hill district to make room for a sports arena and office buildings which displaced many families who were forced to essentially start over from scratch.
So we kind of have two problems brewing right now. We have this lack of proper ambulances and pre-hospital care leading to unnecessary deaths all over Pittsburgh. And, we have this neighborhood full of low income Black residents who are being called “unemployable.” These two problems are about to combine and conquer. The Maurice Falk Fund was this sum of money endowed by a guy named Maurice Falk in 1929. So Maurice Falk was a steel tycoon. He founded Weirton Steel Company in West Virginia. And so he had a lot of money. And he put ten million dollars of it in this Maurice Falk Fund. This was back when rich people actually did good things for the world. And so the Maurice Falk Fund, this ten million dollars, was supposed to go towards grants in the fields of economics, politics, education, medicine, and social welfare. The Falk Fund also happened to be headed by a former ambulance driver named Phil Hallen. So Hallen is like, I know what we need to use some of this money for. He’s like “if we play our cards right, we can use it to improve emergency medical response and we can create employment opportunities for some residents of the Hill district, the ones they’re calling unemployables.” So this program gets funding from the Falk Fund and also from President Lyndon Johnson’s War on Poverty.
Now, Dr. Safar finds out that Hallen is working to improve ambulance services in Pittsburgh. He’s already super passionate about this after losing his daughter and witnessing the death of the former mayor slash governor. He reaches out to Hallen. He’s like “I have some ideas.” His ideas were basically training the ambulance staff as paramedics, teaching them how to actually save lives, and improving the design of the ambulance itself so that you could actually save a life in it. Which to me it’s like honestly insane that it took until 1967 for us to figure this out.
Hallen hears Dr. Safar out and he’s like “love it, makes so much sense.” He reaches out to Freedom House Enterprises to recruit these paramedics for the new ambulance service they’re dreaming up. So, Freedom House Enterprises worked on civil rights projects. For some context, 1967, this is the year before Martin Luther King Jr. was assassinated. Civil rights are a big deal still, this fight for equality. And so Freedom House Enterprises helped with voter registration, they organized NAACP meetings, and they offered job training and help finding jobs for Black people in Pittsburgh. So Hallen goes to Freedom House Enterprises and he’s like “I need paramedics and your dudes need jobs, let’s team up.”
The first Freedom House Ambulance Service recruited 25 Black men from the Hill District. These men had been unemployed for some time for various reasons. Around half of them had never graduated from high school. Some had criminal records, felonies that kept them from being able to get jobs. Quite a few were also veterans of the Vietnam war who likely suffered from lingering issues like PTSD which resulted in drug and alcohol abuse. So this was a rag tag bunch. But they were exactly who Hallen wanted. He recruits them to work as paramedics in this ambulance service. Meanwhile, Dr. Safar designs this 32 week training program. Cause they’re not just gonna throw these guys from the hood in the back of an ambulance and be like “good luck.” Right, they are going to properly train them in a way that no one has ever really been trained before. These guys are test subjects. They are the prototype of the modern day EMT. So they start this 300 hour course designed by Dr. Safar where they learn anatomy, physiology, CPR, advanced first aid, nursing, and defensive driving. The ones who never finished high school also complete their GEDs during this training.
While working on this, while developing this course, Dr. Safar meets Dr. Nancy Caroline who, at the time, was just an ambitious med student working in his hospital. She’s intrigued by this concept and determined to help Dr. Safar, eventually becoming Freedom House’s first medical director. In that role she took it even further, training the paramedics in intubation, cardiac care, and administering IVs. She literally wrote the book on paramedic training which was adopted by the federal government in 1975.
So the program, the Freedom House Ambulance Service program began in 1967 and by 1968, after the guys were trained up, it started operating with 2 ambulances in Pittsburgh. Before that though, before operating their own ambulances, they rode along with police officers on ambulance duty during the King assassination riots in 1968. These were riots after the death of Martin Luther King. People were so upset over his death that they completely forgot everything he ever said or believed in and began rioting in the streets, using violence to try to combat inequality. And this caused a lot of injuries that police were having to respond to and honestly the police officers were white and they were afraid they were going to get shot by the mostly Black rioters. So the Freedom House guys rode along with them to assist and to use their newly gained knowledge of emergency medicine. But they also served as a sort of protection for the police officers. They were much less likely to be attacked if they had Black people with them during these very racially charged riots. Then the Freedom House guys got their own ambulances after that and they started operating the downtown area as well as in predominantly Black neighborhoods.
So we have these 25 Black guys from this impoverished neighborhood, some are criminals, some are war veterans, half didn’t finish high school. They’ve been trained up as paramedics and let loose on the city in new and improved ambulances. What happened? Well it was a smashing success. They absolutely knocked it out of the park, these guys. It got to a point where callers would request Freedom House over the police. According to data collected by Dr. Safar, the Freedom House guys responded to 5,800 calls, transported more than 4,600 predominantly Black patients and saved 200 lives in their first year alone. They had a response time of less than 10 minutes in most neighborhoods which was way quicker than the police.
There was something else about these Freedom House guys, though that made them more efficient in the role. They had relationships with the community. They had rapport with these people. Where there was all this friction between the police and the Black communities, that didn’t exist with the Freedom House guys. According to Valerie Amato in the documentary “The Forgotten Legacy of Freedom House” quote “Freedom House [paramedics] had compassion for the community .... 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,” end quote. They also understood the factors that kept people from calling for emergency services. They knew that a lot of these people were involved in illegal activity and that, by calling police to their homes, they were putting themselves at risk. For example, during a huge surge in heroin overdoses, the Freedom House guys started contacting drug dealers and telling them, teaching them how to identify signs of an overdose, what to do. The police would have just arrested these guys. The Freedom House paramedics trained them to respond instead. They also tell them that they won’t get them in trouble. They will provide medical assistance to anyone who needs it without legal repercussions, without arrests for buying or selling drugs. After that there was a dramatic drop in heroin overdoses across the city. Imagine that.
This was working so well, the Freedom House Ambulance Service, that it became the model for other similar ambulance services all across the country. Everyone started copying what they were doing in Pittsburgh. They started training paramedics and they started using Dr. Safar’s ambulance design. His design was adopted by the National Highway Traffic Safety Administration as the official ambulance design. But despite all this success, the Freedom House guys faced issues with racism all the time, from hospital staff, from the local government, and even from the patients themselves. Some patients refused to be touched or helped by them because they were Black. And I’m like, at that point, you’re on your own dude. Survival of the fittest. Good luck with that. There was a shift in government in 1970 that didn’t help either.
In 1970, Peter F. Flaherty became mayor of Pittsburgh, this guy. Flaherty was against the Freedom House Ambulance Service from the start. He claimed it was because he opposed public-private partnerships. Freedom House was this private program thing that was being contracted by the government and he wasn’t cool with that. He felt like the government should fully control and oversee all of the services it used and not contract them out. Phil Hallen believed racism played a part in Flaherty’s dislike of Freedom House too though. And then there were some who believed he was trying to get rid of Freedom House to pander to the police union. Dr. Safar agreed. He believed Flaherty was trying to get rid of Freedom House because of quote “racial prejudices with white police officers eager to maintain control of ambulances city-wide,” end quote. And so it seems like it became this control thing. The city wants to control the ambulances. The white police officers want to control the ambulances. They’re so desperate to be in control it doesn’t even matter that the Freedom House guys are doing a way better job than they ever did and saving lives left and right. It’s all about control.
So the way this all went down was that Freedom House eventually tried to expand their contract with the city to cover a larger area and this was denied by the new mayor. They were hoping to start serving more affluent parts of the city where their ambulance fees might actually get paid. Then the city started paying them late and then cut their operating budget in half. So Flaherty is essentially strangling them financially. He also, get this stupidity, Flaherty also signed an ordinance banning the use of ambulance sirens downtown because of noise complaints. So now they can’t turn on their sirens downtown to alert people to get out of their way, which slowed their response time down tremendously and allowed the white police officers to reach people first. He’s literally gambling with people's lives over this need for control. In 1974, Flaherty announced that the city was going to start its own citywide, city controlled ambulance system staffed by police officers who would be trained as paramedics. He’s essentially trying to completely replace the Freedom House guys here. Thankfully, this plan faced a lot of resistance from city council members. Ultimately, Flaherty agreed to a compromise. He agreed to fund the Freedom House Ambulance Service for one more year and then after that it would switch to a city wide ambulance service but the paramedics didn’t have to be police officers. This meant that the Freedom House guys could, in theory, keep working in the field. In theory.
The Freedom House Ambulance Service officially closed in October of 1975. This new city wide ambulance service starts up and guess what? Every single paramedic hired to work it was white. Yeah. Predictable no? Don’t get the guys who started this whole thing, who revolutionized it, who invented it. Just get some white guys to try to copy what they were doing. That’ll be better. But then Dr. Nancy Caroline comes back on the scene. Remember her? She was the medical director for Freedom House who literally wrote the book on emergency medical response. They want her to come be the medical director for the new city ambulance service now. She agrees only if they also hire the Freedom House guys and let them stay together and keep working together. So they honor part of this agreement. They hire the Freedom House guys. But, their crews are broken up. They don’t get to stay together. On top of that, they fire the ones with criminal records, they’re out. Then they make them take these pass fail exams but it had all this stuff on it that the Freedom House guys were never taught during their training. So in this way, they’re sort of setting them up to fail. And many of them do fail the exam and are fired. Even the ones who do pass, most are reassigned to non-medical roles. They’re put in positions overseen by white employees with way less experience. In the end only 5 remained and continued to work for the city ambulance service and only one was ever promoted to a leadership position, John Moon, who we’ll hear from soon. By the 90s, 98% of Pittsburgh medical responders were white.
This is how systemic racism works you guys. It’s not overt. It’s not overt discrimination. It’s not “I’m not hiring you because you're Black.” That’s not how it’s done. It’s casually, covertly placing obstacles in the way, twisting and manipulating and loopholing until it’s just downright impossible for these guys to continue in the citywide ambulance service. But, it’s not our fault. He had a felony, he couldn’t pass the test, he just wasn’t cut out for it. And in this way these guys were systematically kicked out of the roles that they had pioneered and forgotten. No “thank you for changing emergency medical response forever,” no “thank you for saving countless lives,” no “good job defying incredible odds and succeeding in a critically important field that no one else seems to get.” Just, you can’t pass the test I made up that I knew you couldn’t pass? Goodbye. Not because they weren’t good enough but because white people wanted to be in control. And control, power, was more important to them than saving lives.
This is why we need to ensure diversity and inclusion. Because systemic racism like this exists. It’s built into the system, has been for a long time, still is. It has to be actively and consciously combatted. It doesn’t just go away because we pretend it doesn’t exist. If you don’t think it exists it’s because you’re lucky, nay privileged, enough to have never been on the receiving end of it. But we have to think of what’s good for all. Flaherty, the mayor of Pittsburgh, he wasn’t doing what was good for all. He was blinded by a need for power and control, as many politicians are, and he made decisions that probably cost people their lives. No ambulance sirens downtown, give me a break dude.
I mentioned John Moon was the only Freedom House guy to ever reach any sort of leadership position within the city ambulance service. He eventually became assistant EMS chief in Pittsburgh until his retirement in 2009. Moon said in an article for EMS1 about the Freedom House Ambulance Service quote “It was so far ahead of its time. 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,” end quote. John Moon was actually the first person to ever perform an endotracheal intubation outside of a hospital in human history, that we know of. He said of the systemic dismantling of Freedom House by the city quote “Despite a written agreement that our previous training would be accepted, it was not. As a result of constant belittling and additional needless class sessions, a great number of Freedom House personnel were systematically eliminated from employment with Pittsburgh EMS. When you eliminate the history makers, you essentially eliminate that part of history,” end quote. Amen to that John Moon. “When you eliminate the history makers, you essentially eliminate that part of history.”
This is the reason why almost no one knows about Freedom House Ambulance Service. Almost no one knows that our modern day emergency medical response, our ambulances, our EMTS, our paramedics, how we respond to medical emergencies, how we save lives every single day, came from a group of unemployed Black men scooped up off the streets in the hood. What a remarkable story and what a shame that these inspiring men and eventually women too never got the acknowledgement or the respect that they deserved. It really makes you think how this might have all been different if they had been white. If the Freedom House Ambulance Service employed white people instead of Black people, would we know about it today? Would we remember? Would we honor the work they did to revolutionize pre-hospital care? To save countless lives in the decades since? History has a way of forgetting the contributions of marginalized groups. Of overwriting their stories in a way that diminishes their accomplishments. This is why we have Black History month. This is why we have Women’s History month, Native American heritage month, Latin American heritage month. Because without a conscious and intentional effort to include them, their stories get forgotten. That’s unfortunately the way the system is designed. “When you eliminate the history makers, you essentially eliminate that part of history.” Well, we can’t afford to eliminate any of our history, the good, the bad, the ugly, we carry it forward with us. It inspires, it informs, it warns. It reminds us of where we’ve already been so we can clearly see where to go next. And, you know, where I want to go when facing a life threatening emergency, is to the hospital as quickly as possible. And thanks to the Freedom House Ambulance Service I might just make it there alive.
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