The Freedom House Enterprises Ambulance Service was born in 1967. Designed in part to create jobs for black Pittsburghers, it also pioneered new techniques in emergency medicine. In his new book "The Ambulance: A History," Ryan Corbett Bell devotes a chapter to Freedom House. Here's an excerpt, focused on its founding.
I first came across a reference to Freedom House in an old issue of The Modern Hospital that I found in the basement of my medical school library. The article was from 1969, and wasn't much more than a squib, but it was clear that something unprecedented had happened in Pittsburgh. What fascinated me was that here was the birth of an entire medical specialty -- the paramedic -- and aside from a brief article in a crumbling old magazine there was virtually nothing (at the time) in any journal, book, or online to tell its story.
That's when I first believed there was enough lost material out there to justify an entire book on how our emergency services evolved.
The story of Pittsburgh's path-breaking ambulance service had its origin in upstate New York, where the man who originated the idea of training the chronically unemployed to staff a top-of-the-line ambulance service had his own introduction to the realities of mid-century emergency care.
In 1952, Phil Hallen was a doctoral student in English at Syracuse. He had been supplementing his income with a variety of jobs at Syracuse's Crouse-Irving Hospital. When he learned that the hospital gave its ambulance drivers rent-free lodgings above the garage, Hallen polished off his driver's license and applied. A few years piloting Crouse-Irving's beige, hearse-style ambulance gave Hallen a pavement- level look at how what happened in the hospital was limited by what did, or didn't, happen in the field. He drew the logical conclusion that better care in the ambulance saved lives, and a subsequent turn at Yale's School of Public Health gave him the training and the credentials to do something about it -- someday.
In 1960, after graduating from Yale and holding administrative posts at several Boston hospitals, he joined Pittsburgh's Hospital Planning Association. He found a racially divided city depending on mortuary rigs for routine transfer while medical emergencies were covered by a police ambulance service with well-intentioned officers crippled by poor training and inadequate equipment. Years later Hallen recalled, "I came to Pittsburgh and saw things that were 25 years behind the times. They were using police vans and canvas stretchers ... and the white-owned funeral homes didn't want to go near what we used to call 'the ghetto.' "
By then Pittsburgh's hospitals had long since abandoned their ambulance services and the Hospital Planning Association provided Hallen no leverage to shift the status quo. A few years later, however, he was named the president of the Maurice Falk Medical Fund, a foundation with a reservoir of community program dollars. At last Hallen had resources to commit to health care reform, and circumstances soon inspired him to look, once more, at the dismal condition of local emergency services.
The opportunity came when David Lawrence, the former governor and Pittsburgh's legendary mayor between 1946 and 1959, paid the ultimate price for his city's failure to provide adequate ambulances.
On Nov. 4, 1966, the 77-year-old Lawrence was at the Syria Mosque delivering a spirited address at a Democratic fund-raiser when he was felled by a massive heart attack. A quick-acting nurse in the audience initiated CPR, keeping his body alive while a police emergency wagon careened to a halt outside the hall. The officers raced inside with their stretcher, heaved Lawrence onto the canvas, and bolted back to their rig while the nurse tried frantically to keep up, watching helplessly as he slipped into pulseless respiratory arrest. Reaching the police wagon, she squeezed in back alongside her patient, only to find the inhalator/resuscitator was broken. When the cruiser began its swaying, rocking race to the hospital, she was continually thrown off balance and was unable to continue her resuscitation efforts. For too many critical minutes, Lawrence went without oxygen or circulation, and although he was swiftly resuscitated at the hospital the delay caused by the inadequate vehicle and poor equipment left his oxygen-starved brain permanently damaged.
When he died two weeks later, without ever regaining consciousness, his death became a minor catalyst in the reform of his city's ambulance system.
LAWRENCE'S DEATH, and the publicity it received, worked on Hallen's mind. The backwardness of the city's ambulance services was an affront to the young reformer, but he was also troubled by the dismal condition of the inner city, where economic stagnation and restricted city services conspired to create a culture of futility. In his mind the two seemingly disparate issues swirled together until, in February 1967, influenced by the mayor's death and recent initiatives to bring new businesses to the African-American community, Hallen sat down at his typewriter and banged out "Preliminary Thoughts on the Development of a Private Ambulance Service in the Hill District." This memo became the founding document for the world's first comprehensive civilian paramedic service
In a city whose ambulance service was disgracefully out of date, Hallen knew that the Hill District was singularly ill-served. Hallen envisioned his proposed ambulance service as providing both medical help and economic opportunity to a community with few examples of either.
He saw ambulance work as the kind of exciting job that would appeal to men in particular, believing the service would target that "segment of the male population that does not ordinarily get touched by the typical work programs or social welfare programs in the slum areas," and that the medical training provided would ultimately put trainees in line for better jobs elsewhere, such as hospital work. As he wrote in his first memo, he hoped the service would create "a new kind of business personality in the group," and he wanted the program to be owned and operated by local residents as an entrepreneurial exercise creating jobs for ambulance crews, managers, clerks -- and given the likelihood the service would begin with second-hand ambulances, plenty of work for local mechanics, as well.
Finally, he believed working on ambulances saving lives would give the crews dignity and pride, make them leaders in their community, and ultimately help eradicate racist beliefs that it was lack of ability keeping impoverished African-Americans segregated in economic sloughs.
Hallen took his idea to the University Hospital, obtaining an audience with the hospital president who, apparently seeing something in the idea, referred Hallen to Dr. Peter Safar, chairman of anesthesia and already a nationally known figure in the effort to introduce better resuscitation techniques into the emergency services. After several meetings, Dr. Safar, looking for a demonstration project for his ideas on out-of-hospital emergency care, agreed to sign on.
Given the proposed location in the Hill District, the logical community partner was the neighborhood's Freedom House Enterprise Corporation, founded by James McCoy Jr., in January 1967 (only a month before Hallen committed his proposal to paper). McCoy wanted to use Freedom House to foster self-sustaining African-American businesses in Pittsburgh, and he quickly saw the tremendous potential in Hallen's plan and became an eager participant.
Hallen's trips to the University hospital had also gotten his name into the social work department, where a part-time professor named Morton Coleman heard of, and approved, the idea -- which was significant because when not teaching undergraduates, Coleman was an aide to Mayor Joseph Barr.
In the space of two months, then, Hallen's idea had attracted a quorum of motivated individuals who each saw in his scheme something they could use:
• For McCoy, the community activist, the ambulance service represented a novel minority business opportunity of the kind he had founded Freedom House Enterprises to support and develop.
• For Safar it was a chance to put into action his proposals for improved out-of-hospital resuscitation technique.
• For Hallen and Coleman it was a chance to address racial disparity while creating a model for community and personal development, while for Mayor Barr it looked like a way to leverage an opportunity to improve services in a decrepit corner of his city.
The need was acute, the enthusiasm genuine, and, three months after the idea first occurred to Hallen, the Freedom House Ambulance Service Committee held its inaugural meeting on April 15, 1967. In addition to the principals, the meeting was attended by representatives of the Mayor's Office, the County Medical Society, the Pittsburgh Police Bureau, and Presbyterian-University Hospital.
Perversely, with the sole exception of the university, each of these well-wishers would ultimately conspire to destroy the ambulance whose inception they so amiably witnessed: the mayor and the police bureau ultimately saw it, rightly, as a threat to the patrol jobs staffing the police ambulances, and the county starved the service of vital revenue by opposing its expansion outside the Downtown core, lest it compete with suburban providers.
FREEDOM HOUSE set up shop in the Presbyterian-University Hospital's Emergency Room. While an early grant proposal envisioned a fleet of ambulances the more austere reality was that the service went into business with just two second-hand police wagons donated by the city. As the material side dwindled, enlistment ramped into high gear while the summer of 1967 boiled off into the mists of autumn. Recruiting was done principally through the minority-targeted Opportunities Industrialization Center, but as October wound down and the first day of classes drew near there were so many vacancies that enthusiastic program personnel went into the neighborhoods to approach anybody who appeared to be African-American and unemployed -- or who just didn't run away fast enough.
Of the 25 recruits who entered the rigorous program, 20 graduated from the first section and started nine months of on-the-job training under a $100,000 city contract to provide ambulance services to Downtown and the Hill.
The first call came on July 15, 1968, when the ambulance switchboard at Presbyterian's ER took a police call for a Freedom House Ambulance: a woman had gone into convulsions on a city bus, apparently slipping into unconsciousness. Jumping into their squadrol-style ambulance, the crew raced to the 3900 block of Forbes Avenue, swiftly loaded the seizure patient, and whisked her back to Presby's ER: with her complete recovery, the Freedom House Enterprises Ambulance Service was in business.
In its first year Freedom House made 5,868 runs, transporting 4,627 patients--an average of 15 calls a day, with an enviable DOA record of 1.9 percent. For their part, the ambulance crews had discovered that sense of purpose and esprit de corps Phil Hallen had hoped for when he sat down and typed up his vision for an ambulance service 18 months earlier.
BY 1972, the regional reputation of the Freedom House ambulance service was so great that the Downtown service was getting emergency calls from one end of Allegheny County to the other, even as it struggled to wring increased funding from the city and county commissioners. At this critical juncture the towering figure of Dr. Safar became a liability -- his passion did not suffer fools, and his lack of diplomacy quickly turned opponents into enemies.
By 1973, Freedom House, fueled by a series of grants, was running five orange and white vans with 35 paramedics on staff. The program had become fully integrated, with increasing numbers of women and white paramedics joining the crews since nearby Community College of Allegheny County had started offering a course for Emergency Medical Technicians (modeled on Safar's original work at Presbyterian-University Hospital). With its new inclusive hiring practices and willingness to respond countywide, the FHE ambulance service was becoming a stand-alone ambulance operation rather than a sometimes awkward blend of jobs program and inner-city medical service. Maturity brought no relief from its brittle finances, however.
Ultimately, after answering more than 40,000 calls in seven years of operation, the end for the Freedom House Enterprises Ambulance Service came on Oct. 15, 1975. A week later Mitchell Brown -- one of the earliest program graduates and who became an operating manager -- gave an impromptu eulogy in a Pittsburgh Press interview: "We were the first. We developed a little known area -- emergency ambulance care by trained technicians -- into a successful model which has been copied by other municipalities across the country. ... People always try to say crazy things about us, that we ran crap games in the vehicles or even that we sold dope in them, but the charges were unfounded. We were good, and the people -- all the people -- came to recognize that fact."
From "The Ambulance: A History," (C) 2009 Ryan Corbett Bell. Reprinted by permission of McFarland & Co., Inc., Box 611, Jefferson NC 28640 (www.mcfarlandpub.com).
The documentary "Freedom House" by Gene Starzenski will be shown during the Three Rivers Film Festival on Nov. 11 and 12. See www.3rff.com for details. Ryan Corbett Bell, a former district attorney in Alaska, is a clinical psychiatrist in Rochester, N.Y. ( firstname.lastname@example.org ).