Pittsburgh's Freedom House: The Pioneers of Modern EMS

The Unsung Origins of the Paramedic Profession

Many EMTs and paramedics assume prehospital medicine was designed in military hospitals or wealthy suburbs. A large part of the blueprint was drafted in the Hill District of Pittsburgh, by people the rest of the city had written off as unemployable.

In 1966 the White Paper had just documented that about half the country's ambulances were run by morticians and that there was no standard for training the people in the back. Pittsburgh was no exception: city police ran ambulances, often scooping and running with no stabilization. Freedom House Ambulance Service was built to do something different for a mostly Black neighborhood that the existing system served badly.

How It Started

Freedom House Enterprises was a young Hill District nonprofit, founded by James McCoy Jr., that was creating Black-owned businesses and jobs; one of them sold produce from trucks in a neighborhood without grocery stores. Philip Hallen of the Maurice Falk Medical Fund suggested the same model could move patients. Hallen connected the board with Ed Noroian, director of Presbyterian-University Hospital, who offered the hospital as a base and asked [Dr. Peter Safar](/safar-resuscitation) to train the crews.

Safar was the right person. He had already published on ambulance design and equipment for resuscitation in 1965, and had shown that Boy Scouts and firefighters could be trained to provide basic life support. Now he wanted to prove that trained laypeople could deliver advanced care.

McCoy recruited trainees off the street the day before class began. According to the University of Pittsburgh's account, nearly half had not finished high school, and some needed help with reading and math before the medical training could start.

Designing Modern EMS

• Training far beyond the standard of the day: 300 hours of classroom and clinical work in anatomy and physiology, first aid, resuscitation, medical ethics, and legal issues, with rotations through the OR, recovery room, ICU, ED, morgue, and maternity ward. At the time, the White Paper had found no accepted national standard for ambulance attendants at all.
• Ambulances built as treatment rooms: the vehicles were designed to Safar's specifications and carried ECG monitors, IV supplies, intubation kits, blood pressure cuffs, and defibrillators, a long way from the hearse-style vehicles the public knew. Crews radioed monitoring data to the hospital in transit.
• On the street from 1968: the first Freedom House ambulances began running in the summer of 1968 from Presbyterian-University Hospital, serving the Hill District, Oakland, and Downtown. The Heinz History Center credits the five ambulances with nearly 6,000 calls and more than 200 lives saved in the first year.
• Medical direction with teeth: Dr. Nancy Caroline, a University of Pittsburgh critical care physician Safar handpicked, became medical director. She rode along on runs, monitored the radio, and reviewed calls with the crews relentlessly. She later published "Medical Care in the Streets" in JAMA (1977) and wrote Emergency Care in the Streets, for years the only paramedic textbook.
• A national test bed: under Safar's direction, Freedom House crews tested and implemented U.S. Department of Transportation standards for ambulance training and equipment that were eventually adopted by 40 states.

How It Ended

Freedom House ran on grants, and the city kept police ambulances on the street alongside it. In 1975, under Mayor Pete Flaherty, the City of Pittsburgh ended its contract and created its own EMS service. The paramedics had been assured they could join the new service if they passed a test; about a dozen went to work for the city. John Moon was one of them, and he rose to assistant chief with Pittsburgh EMS.

A 2019 history in the Journal of the History of Medicine and Allied Sciences describes the program as a social and medical experiment that succeeded in demonstrating national standards for paramedic training and equipment, and documents that both Black and white newspapers in Pittsburgh read the city's withdrawal of support in racial terms.

A Legacy of Excellence

The next time you pull a laryngoscope or start an IV in the back of a moving rig, remember where a lot of that standard came from: a crew from the Hill District, trained to a level no one else required, proving it worked on the streets of their own neighborhood.

Sources

• Pitt Med (University of Pittsburgh School of Medicine) — Send Freedom House!
• J Hist Med Allied Sci (PubMed) — Pittsburgh's Freedom House Ambulance Service: the origins of EMS and the politics of race and health
• Heinz History Center — The history and legacy of the Freedom House
• Archives of Surgery (PubMed) — Safar, Ambulance design and equipment for resuscitation (1965)
• JAMA (PubMed) — Caroline, Medical care in the streets (1977)
• National Academies Press — Accidental Death and Disability: The Neglected Disease of Modern Society (1966)