From our February 2004 issue. See all our past issues here.
John Moon was a young paramedic eager to increase his professional skills and confidence when he walked into the emergency room at Allegheny General Hospital. He’d performed a physical exam on the patient en route from downtown. He’d even rehearsed presenting the patient to the emergency room staff until he had it down to a T—blood pressure, pulse, history, and more. At that time, in 1974, sophisticated ambulance service was practically unheard of. Throughout Pittsburgh and the entire nation, ambulance attendants routinely brought critical accident victims and the gravely ill to the hospital with little or no medical attention. Few people even knew what a paramedic was. Police officers with no specialized training and no equipment drove ambulances like they were driving delivery trucks,
The first Freedom House ambulances hit the streets in the summer of 1968. By October, Safar was writing to the mayor, describing the success of the service and urging that Freedom House’s contract with the city be expanded.
But despite its unqualified success in demonstrating and delivering cutting-edge ambulance care, Freedom House was in for a bumpy ride. It relied on grants, and financial stability was difficult to achieve. City police continued to run ambulances throughout the city, frequently rushing in to transport accident victims without any stabilization before Freedom House could arrive. Freedom House began racing police ambulances to the scene. Hallen says that racism prevented elements of the police and city government from appreciating Freedom House for the unparalleled asset it was.
One paramedic told filmmaker Gene Starzenski, who is producing a documentary on Freedom House, “We were determined to succeed because everyone told us we would fail.”
Their successes were many, from small personal victories to individual lives saved, and, eventually, to the shaping of national standards.
A 1971 study found that 62 percent of patients received inappropriate care from the police, while 11 percent received inappropriate care from Freedom House. Eventually, police officers in need of an ambulance for themselves or a family member would call the Freedom House dispatcher instead of the police.
When Nancy Caroline came on as medical director in 1974, she instituted a rigorous system of monitoring, or, as she called it in Pittsburgh magazine in 1977, “an Orwellian reign of terror.” She went on ambulance runs with the paramedics, even when she’d already worked so many hours that most people would have gone home. She monitored radio traffic and picked up the microphone at all hours to “question, chastise, harangue.” Given a chance, she would catch a few hours of sleep on the cot in the ambulance.
John Moon says that Caroline was “warm, gentle, kind, and intimidating.” She developed a close camaraderie with the paramedics, many of whom would have followed her anywhere. She made sure they got the training and support they needed. “There were many times,” says Moon, “she’d be walking down the hall with five Freedom House paramedics walking right with her, going into the ICU to look at a particular patient.”
Caroline, who died of cancer in 2002, remembered with particular pride Moon’s struggle for respect in the emergency room. Describing the scene in Pittsburgh magazine, she picked up the story after the nurse turned her back on Moon, writing that he then cornered the ER physician and with “military precision” said, “We have a 19-year-old man who experienced a dizzy spell without syncope while lifting some cartons at work. His past medical history is negative except for a heart murmur present since childhood. His pulse was irregular, ranging from 38 to 110, his blood pressure was 110/70 and his respirations 20. The rest of the physical exam was negative except for a short systolic murmur. His EKG shows evidence of bradytachy syndrome.”
With a smile, Moon then handed the EKG strip to the physician and proceeded to help the nurses move the patient. Caroline said they laughed all the way back to Presbyterian.
In 1975, Freedom House paramedics presented a disaster drill for an international symposium on critical care medicine. They were judged among the most sophisticated and skilled in the nation. Drawing heavily on lessons learned with Freedom House, Caroline would go on to write Emergency Care in the Streets—for years, the only textbook for paramedics. Under Safar’s direction, Freedom House EMTs tested and implemented the U.S. Department of Transportation’s standards for ambulance training and equipment eventually adopted by 40 states.
In 1975, the City of Pittsburgh ended its contract with Freedom House and instituted its own modern ambulance service— Emergency Medical Services (EMS), which exists to this day. There was anger and bitterness within Freedom House, whose paramedics were assured they could be hired by the city if they passed a test. Many felt that the city should have committed to expanding Freedom House into a citywide operation. One of the more outspoken paramedics was quoted in the Pittsburgh Post-Gazette saying, “If this was a mostly White organization, I don’t think this thing would be happening.”
About a dozen Freedom House paramedics did go to work for the city. John Moon is currently an assistant chief with EMS, and one of its longest-serving employees. Mitchell Brown moved from Freedom House to the city and is now public safety director for the City of Columbus, Ohio. Many pursued advanced degrees and careers in health services like these two. Some became unemployed or drifted back to unskilled work. Philip Hallen notes that at a memorial service last year for Peter Safar, amid all the descriptions of his achievements, there was no mention of his work with Freedom House. John Moon still laments that the vast majority of paramedics, even in Pittsburgh, know nothing about Freedom House. He considers the organization one of the greatest blessings in his life. So would many others, paramedics and patients alike, if only they knew.