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How a Black neighborhood association in Pittsburgh helped shape emergency medicine


This is FRESH AIR. I'm Dave Davies, in for Terry Gross. In most of the United States today, if you have a medical emergency, you can dial 911 and count on an ambulance arriving with a crew who have the equipment and training to perform CPR and provide other critical care before getting you to a hospital. But as recently as the 1960s, that just wasn't the case. Back then, your call for help would at best get you a ride to the hospital, perhaps in a police van or a hearse from a funeral home, but no medical treatment until you reached the emergency room.

Our guest today, Kevin Hazzard, is a writer whose new book is the remarkable story of a community organization called Freedom House Enterprises in a Black neighborhood in Pittsburgh that became an incubator for modern emergency medicine. With the help of an innovative physician, the organization trained a cadre of men as paramedics - a term then just coming into existence - and sent them in newly equipped ambulances on lifesaving missions that earned a national reputation and spawned similar programs in other cities.

Kevin Hazzard is a journalist, a TV writer and author of a previous book called "A Thousand Naked Strangers" that was about his 10 years working as a paramedic. His new book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics."

Kevin Hazzard, welcome back to FRESH AIR. You write about the history of ambulances. I mean, there were ambulance corps in the first and second world wars that were effective at getting medical care to wounded people right away and speeding them to higher levels of care. This story unfolds in the 1960s. And by then, you know, most cities had, you know, services. They had police and fire and sanitation departments with full-time employees. What was the state of ambulance service in America's cities and towns then?

KEVIN HAZZARD: I mean, you could almost describe it as criminal, to be honest with you. In fact, there's a paper that's published in 1965. It's known now in the EMS community as the white paper. Essentially, what it says is that, you know, paramedics are too few to be there when you need them and too unskilled to be much use when they arrive. And, you know, the result of that is that in 1965 alone, more Americans die on highway accidents than had in the entirety of the Korean War.

So you know, people were aware that there was this big problem. And, of course, again, the cause of the problem is a lack of training among the people who are going to arrive, you know, to your emergency. So in many cities, if you call for help, the people who show up are two undertakers in a hearse. I mean, think about that for a minute. You know, these are guys who, you know, are embalming one night, transporting them the next. A call comes out. They, you know, sweep the flower petals out of the back of that hearse. They throw in a stretcher. And they run out, and they get you with really no training or equipment.

That's how it was in a lot of places. And, you know, in others, you might have the police department - again, undertrained, underequipped, little more than a vehicle. Sometimes you might have a volunteer fire department. But in any case, what you had essentially was a ride. And that was it. And people were dying because of it.

DAVIES: Yeah. No treatment on scene.

HAZZARD: Oh, yeah.

DAVIES: Scoop and swoop - get you to the hospital right away. Now, a character who plays a major role in this story was a physician and anesthesiologist named Peter Safar. Interesting history - he was Austrian, survived World War II in Austria even though he was partly Jewish, got to the United States. And he had an interest in emergency medicine - in the 1950s, had an idea about how people should resuscitate someone who had stopped breathing. Before we get to his plan, what was the general practice then for somebody who had stopped breathing? What were people told to do?

HAZZARD: It was entirely positional. So you would take a person who wasn't breathing. You'd lie them face down, which, you know, contradicts everything we understand today about how you would attempt to help someone who's not breathing. But that's what you did. You laid them face down. And then you would press on their shoulder blades and sort of lift their arms. I mean, imagine, you know, you were working a Thanksgiving turkey. That's essentially what this would look like.

And the idea was if we move them around enough that their lungs, just by that movement, will expand and contract. And that, you know, through some sort of magic, will bring oxygen down into their lungs and then bring it through their body somehow. Safar took one look at that. And he knew, you know, instinctively that there was no way this did anything. And all it was really doing was just wasting time until this person died. So he, you know, came up with a plan of his own.

DAVIES: So Peter Safar has this new idea, that you can revive people who've stopped breathing with mouth-to-mouth resuscitation. And he devises this remarkable experiment to prove it. I sort of can't believe this actually happened. Explain what he did. He was in Baltimore at the time.

HAZZARD: Yeah. So he's a 35-year-old guy. And he has no experience doing this. He's not going to get any help. So he's got to do this entirely on his own. So what he does is - he knows that Baltimore City Hospital does not operate on the weekends. So he has a open OR. He recruits doctors, nurses, med students. And he gives them a very simple pitch. I'm going to sedate you and then paralyze you. And for eight hours at a time, over the course of 40 tests, you're going to lie on the floor. And I'm going to try to revive you using this antiquated rescue technique where we're going to press on your back, and we're going to flap your arms.

I know it doesn't work. You know it doesn't work. It's going to kill you. And when it does, then I'm going to bring over a Boy Scout. And I'm going to give him a 30-second crash course on how to do rescue breathing. And then he's going to keep you alive for the remainder of this test. And he does that. He does that over - you know, over the course of 40 different studies. And the fact that he was able to convince people to volunteer for this is, you know - is really stunning. But it just shows, one, how committed he was, but then also, you know, how persuasive he could be in that moment. I mean, they obviously knew that he was dead on.

DAVIES: What did Safar mean by saying I know it's going to kill you to the volunteers?

HAZZARD: Well, so if I sedate you and paralyze you, you can't breathe. So if I now, while you're unable to breathe, if I use this pushing on the back and flapping of the arms that's supposed to open and close your lungs but doesn't, you aren't going to be breathing. You aren't going to be getting oxygen. You're going to be lying here. And you're going to be dying on the floor. And so that's essentially what he's offering them. We're going to start out with this situation in which you are creeping toward death. And then we're going to pull you back using, perhaps, the least qualified person of all time.

DAVIES: So they weren't actually dying? He wasn't actually killing them, but he was failing to restore their breathing, right?


DAVIES: Do you know if there were any close calls in the experiment where - (laughter) experiments where, you know, things got dicey and it looked like somebody might not restore breathing?

HAZZARD: Yeah. So there was one physician who, while they were reversing his sedation, he vomited. And of course, because he was paralyzed, he was unable to protect his airway. Safar witnesses this happened, immediately rolls him over, suctions him. And the doctor was fine. But, you know, it illustrates just how close to the wire he was working on this, you know? There was no room for error. And had he not seen that happen when he did, it's quite possible that, you know, one of his test subjects dies. And, you know, that's the end of Peter Safar. That's the end of CPR.

DAVIES: So he does this in the '50s when he was in Baltimore. Fast-forward to 1966. He's in Pittsburgh. And he wants to get this process of mouth-to-mouth resuscitation combined, you know, with chest compressions for basic life support and wants to standardize it in - among those in ambulance responses. And it doesn't really go anywhere. He can't get any attention. And then one of those things happens that sometimes spurs innovation and bumps public policy. In this case, it was a tragedy involving a famous politician. Tell us the story.

HAZZARD: So David Lawrence was a former mayor of Pittsburgh. He was a former governor of Pennsylvania. He is supposed to be the keynote speaker at this kickoff event for a gubernatorial election. Speech is a Saturday night. The election is Tuesday.

So he gets in, and, you know, this crowd is rapt. He gets about three words into his speech, and he collapses. By the time he hits the floor, he's already in cardiac arrest. People begin to unbutton his shirt. Somebody calls for help. As luck would have it, there's a nurse in the crowd that night by the name of Karen McGuire. Karen rushes up and begins performing CPR. Now, again, because somebody called for help, that means that the police are going to arrive. So while she's doing CPR, in comes the police-driven ambulance service. They come in. They have, like, a canvas-style or a military-style canvas cot. They come running down. They've got an oxygen tank that's either broken or empty. Either way, it's of no use. They push Karen McGuire out of the way. They grab David Lawrence. They put him on the stretcher, and they start running for the door.

Now, Karen, you know, she knows, hey, wait a minute. If we stop doing CPR, then he's got no chance of survival. So she's running alongside of them, trying to explain, hey, please, stop. You got to allow me to treat this guy. They have no interest. They rush outside. They throw Lawrence into the back of their wagon and begin shutting the door. So she realizes, wait a minute, that this guy is going to ride by himself. He's going to die alone in the back of this ambulance. So she jumps in there with him, and they speed off.

Now, performing medicine in the back of a moving vehicle is very difficult. Best circumstance is if there's - people driving it are speeding and paying no attention to what's going on. It's terrible. She gets nothing done. And so from the moment that the ambulance service shows up and to the moment it backs up to the hospital, he gets no care. When it backs up and the doors open, waiting for him is Peter Safar, the father of CPR, the guy who has spent, you know, the majority of his professional career trying to prevent this very thing from happening.

He takes Lawrence inside. They very quickly get a blood pressure back on him. They get a heart rate. They get a respiratory rate. But he's brain-dead. And, you know, the reason for that is this gap in time in which he was not getting treatment. And that gap of time is the time that he was with the ambulance service.

DAVIES: And so people recognized that this tragedy was due, in part, to failures in emergency medicine, right?

HAZZARD: Hundred percent, directly attributable. And, of course, that is the thing that finally provides the political will for Safar to get things moving.

DAVIES: All right. So another guy comes in, a guy named Phil Hallen, who's - heads a foundation that has money. He's also interested in emergency medicine. But rather than trying to, you know, change what police do or establish a municipal ambulance corps, they end up settling on this community group, Freedom House Enterprises. Why there? Why not a big teaching hospital and, you know, a citywide effort?

HAZZARD: Well, Safar had this, you know, great idea, which, of course, is the first, you know, full-spectrum paramedic training course. Nobody had done that before. He designed how they would be trained, how they would be equipped, what drugs they would carry. He redesigned the ambulance. And it's incredibly - in fact, the ambulance that we have today is the one that Safar designed in the early 1960s.

So he's got this fantastic idea, but he doesn't have any people. He knows that throughout history, they've tried to get doctors to do this job. It failed. They tried to get nurses to do this job. It failed. They weren't sure what to do. And so he knew you needed a new brand of professional, which meant that you needed to train people who had never been in medicine before. He didn't know where to get those people.

Well, as luck would have it, you know, as you said, there's a guy by the name of Phil Hallen. He ran the Falk Medical Fund. And, you know, his mandate was sort of to patch holes that had been cut in the public health safety net by racism. And he looks around the Hill District, which, you know, is New York's Harlem. It is Watts. It is the South Side of Chicago. He looks around the Hill District, and he knows that people living in this area have no access to health care. And he had come up with a very lo-fi answer to that.

He was flipping through the newspaper one day, and he came across an article about Freedom House Enterprises, which was started by a civil rights activist by the name of Jim McCoy. And McCoy's idea was, hey, let's just create a job training program for people living in the neighborhood. And as part of that, he set up this vegetable delivery service, where they would just drive around in a little truck and deliver vegetables. Someone wrote an article about it. And Hallen sees a photo in the newspaper of Freedom House delivering vegetables. And it's so, you know, maybe unlikely. But in his mind, this is an aha moment. If you can deliver a vegetable, you can deliver a person.

So he sits down with McCoy, and he says, hey, I've got an idea. This is what it is. And McCoy, you know, looks, and he says, oh, perfect. An ambulance service would take people to appointments. That's great. Let's do it. They go to the hospital to pitch this idea. They are told, hey, talk to Peter Safar. He's been talking about ambulances. Maybe this is a good fit for him. They pitched this idea of, like, hey, maybe we'll take people to the doctor's appointment. We'll take them home from their doctor's appointment. Safar has no interest in this very, you know, modest proposal. He unleashes this, you know, medical revolution that he has cooked up in his head.

Hallen and McCoy listen to it. They know right away, like, wow. A - this is a genius idea. And B - like, we are not equipped to do this at all. We have just ordinary people with no sort of training. And of course, Safar says, no, no, you don't understand. That's what I need. I need ordinary people. I need to prove that this is reproducible in a thousand different cities all across America. I need ordinary people. And they say, great, we've got ordinary. However, when this thing gets off the ground, you know, it absolutely has to be staffed entirely by the people from the Hill District. This world's first paramedic service has to be entirely Black. And without blinking an eye, Safar says it's done.

DAVIES: Let's take a break here. Let me reintroduce you. We are speaking with Kevin Hazzard. His new book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics." We'll talk more in just a moment. This is FRESH AIR.


DAVIES: This is FRESH AIR. We're speaking with journalist and author Kevin Hazzard, whose new book is about a community organization in a Black neighborhood in Pittsburgh that trained some of America's first paramedics and created a revolution in emergency medicine. The book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics."

So we had this situation in Pittsburgh where ambulance service was haphazard, didn't provide any real help. And this innovative doctor and this guy who headed a foundation decided that they could focus on this community organization, Freedom House Enterprises, train ordinary folks, give them a training to become paramedics, and provide meaningful ambulance service for people in the Hill District, this Black neighborhood in Pittsburgh.

Now, they had some funding, right? This was a time when, after the riots of the '60s, there was the Kerner Commission report, which said there was a need to invest in struggling communities. So there was some federal money. There was some city money. There was some foundation money. They got the ambulances, got these folks out on the street. By 1972, you write, they had 35 crew members running 7,000 calls a year providing CPR, etc. This was not citywide, right? Was it limited to this African American neighborhood, the Hill District?

HAZZARD: Yeah, it was in a couple different neighborhoods. So it's in the Hill, but it's also in Oakland, which was - part of the university was there, so that neighborhood was mixed. But it was also downtown, you know, which was predominantly white.

DAVIES: So you have all these emergency rooms. And suddenly, these - you know, the staff there are seeing this ambulance roll up with Black men as paramedics. That's a new thing for them. I mean, you write about how some of these guys had worked as orderlies, and they saw how they were treated among - by the largely white staff in the medical world. What kind of reputation did the ambulance crews of Freedom House get as they interacted with hospitals?

HAZZARD: Well, it took a second because, you know, there's a ton of skepticism that anybody can practice medicine in the street. There's certainly an extra layer of skepticism because the people who are now practicing med (ph) in the street are Black. So what the hospital is used to is somebody running out, picking somebody up, tossing them in the back, speeding them in. And suddenly, these guys are arriving with - you know, they're on heart monitors. They've been given medications. They've been given narcotics. They've been - they've had very advanced treatments done on them. And the people who have performed these advanced treatments know what they've done, and they know how to hand off a patient. So it's kind of a surprise for the doctors.

But at the hospitals where they are working regularly, which is, you know, all the downtown hospitals that were associated with the University of Pittsburgh, very quickly, the doctors realize, oh, wait a minute, this is a resource. And, you know, nursing realizes, oh, hey, this is a huge resource, to the point where nurses begin riding with Freedom House medics just so they can get an idea of what the patient's world outside of the hospital looks like.

DAVIES: You know, everybody was sort of used, I guess, to a call for emergency help, meaning the dispatch of someone who would basically toss you on a stretcher and get you to the hospital as quickly as possible. Did people notice that these folks were showing up with equipment and skills that in the case - some cases, like of heart attacks or someone who couldn't breathe, actually making a transformative difference on the scene?

HAZZARD: Yeah, absolutely. One of the sort of very famous anecdotes that is told by the guys who worked here - there's a medic by the name of John Moon who was sent out to a person who was down on the floor, not breathing. And he gets out there, and he, you know, does a quick assessment, realizes what's happening. He and his partner are aware of how critical the situation is. So everything is moving very quickly around them. They were in communication with their medical director by the radio. And she says to them, hey, John, go ahead and intubate this patient. And, you know, he is - he kind of freezes in his tracks because he's been through the training, but he's not yet done it out in the field. You know, to his understanding, nobody in Pittsburgh had done it. It's possible that nobody anywhere had done it prior to this moment.

DAVIES: And for - just to clarify, intubation means - what? - putting a breathing tube down someone's trachea?

HAZZARD: Yeah. Yeah. You find a person who's not breathing, and you slide the tube, you know, from their mouth down through their trachea so that you can both get oxygen directly to the lungs but also protect stomach contents from getting into the lungs. You know, it's a - I mean, it's an advance maneuver that is done only in a hospital up until this moment. So, you know, John very nervously gets out his equipment with his partner's help. They get it all set up. He intubates the patient. He checks the tube. And he finds that, yes, it - you know, 'cause it's very easy to accidentally put this tube in the stomach. I've done this many times. It's not an easy skill. And John pulls it off.

And they check the tube - properly placed. They get to the hospital. Everything is moving very quickly when you arrive with a critical patient. And all of a sudden, everything screeches to a halt. And all eyes turn to the doctor, who's sort of pointing at this patient with this tube sticking out of his mouth. And he says, who did that? And then, now all eyes turn to John, who's standing in the corner. And he says, well, I did. And, you know, he says, who told you to do that? My medical director told me to do that. And he said, well, who are you? And he says, my name's John Moon, and I'm from Freedom House.

And, you know, that moment is sort of - you know, they are them announcing themselves to the local medical community that, hey, we're here. We're doing advanced things. And be ready because, you know, the world is changing, and we're at the forefront of it.

DAVIES: We're going to take another break here. Let me reintroduce you. We are speaking with Kevin Hazzard. His new book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics." He'll be back to talk more in the second half of the show. I am Dave Davies, and this is FRESH AIR.


DAVIES: This is FRESH AIR. I'm Dave Davies, in for Terry Gross. Our guest is journalist and author Kevin Hazzard, whose new book is about a community organization in a Black neighborhood in Pittsburgh that trained some of the nation's first paramedics and became an incubator of modern emergency medicine in the late 1960s. The book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics."

You know, there's a character in this story, a guy who was not among the first crews but who came along and would be a long tenured paramedic, an important person in bringing this story to life. You mentioned him once. His name is John Moon. Just tell us a little bit about him, his background.

HAZZARD: John was born in Atlanta in a neighborhood dead center of the city known as Buttermilk Bottom, which was, you know, a Black slum through the 1950s. It didn't have running water or electricity, which is kind of staggering to imagine, that there's a major U.S. city that in 1950s didn't have basic services. That's how he was coming up. And his mother died when he was very young. And he and his sister found their way into an orphanage. Their father was not able to take care of them. And, you know, he had to take him to an orphanage.

He's there for several years. And then he's adopted by family he didn't know he had and brought to Pittsburgh, to the Hill District, in fact. This, you know - initially, he thought, oh, this is - you know, this is sort of the miracle that no orphan even dreams of. But then, very quickly, it becomes a frustration because he goes from being completely on his own to being stuck in this house. He has several years where he really, you know, fights existence in a family but then, you know, kind of comes into his own. But he does that during the civil rights movement. So he grows up thinking, hey, you know, the world is changing. Things are changing. We are changing the world. He gets out of high school and realizes, things aren't changing. They're exactly the way they were when his dad was working.

And so he says, OK, you know, I've got to find some way, somehow, to get myself someplace better. He has no idea how that's going to happen. And, you know, one night, he's working as an orderly in Montefiore Hospital, changing beds and emptying bedpans - not exactly, you know, the most thrilling or fulfilling existence. And he - in the distance, he hears the sound of a two-way radio. And he turns around. And he sees two Black men walking toward him. They are in white uniforms. And they have these patches - one says Freedom House, one says paramedic. He's never heard those words. He doesn't know what they mean. But he looks at these two guys. He looks at how people react to them. He looks how they carry themselves. And he says, that's it. That's what I'm going to be for the rest of my life.

DAVIES: And he does it. He eventually enters the program and wears that uniform with pride and exercises his skills efficiently. I know that, from the acknowledgements to the book, that he was one of the first people that you reached out to when you heard about this story and gave you a lot of conversations, interviews, background to fill in details. You know, when the Freedom House ambulances were running, they were run almost entirely by Black men. They did hire one white guy, I think, you write because they needed that to get a federal grant. That's - and he fit in well. But they would inevitably end up answering calls sometimes in neighborhoods where the patients were white. Those interactions could get tricky. What did John Moon tell you about that, what that was like?

HAZZARD: It was all too common, is what he said. You know, here's a sort of perfect example. He and his partner one afternoon are dispatched to a woman with chest pain. She's in a high-rise downtown. They park outside. They ride the elevator up. They're on their way in. They're, you know, pushing their stretcher through this office. And they round the corner. And they find this woman who has sort of hope in her eyes - right? - because she's having chest pain. She's - in her mind, she's in the midst of a medical emergency. And hope is on the way. And when hope rounds the corner and she gets a good look at them, you know, all of that hope goes away. And suddenly, it becomes fear because now she sees two Black men before her.

John and his partner, George McCarry, don't hesitate. They just get in. They start working. And very quickly, they're getting pushback. And, you know, John is trying to explain to her, hey, look; here's what we need to do. We need to put you on a heart monitor. We need to know what's going on, which is going to require us to unbutton your shirt. It's going to require us to touch you. She doesn't want them to do that. She says, no, can't you just take me to the hospital? And so he has to explain to her and, you know, as he did many, many times, look; there are two options here. We can do nothing, in which case your chances of dying or becoming, you know, significantly sicker go up exponentially. Or you suffer the indignity of us touching you, you know?

And after sort of a moment of consideration, she consented. But, you know, this was not an uncommon experience. It was something they had to go through quite a bit. You know, there are instances in the suburbs of Pittsburgh of people selling - you know, of white families selling their homes to Black families just to spite their neighbors. So you know, it wasn't a southern city, but it was a complicated city. And they were trying to provide medical services to people who were at best ambivalent to them touching them and in some cases outright hostile.

DAVIES: The Freedom House Ambulance Service rolled along for years. But it ran into trouble in the form of a fight with city hall because a new mayor was elected, Pete Flaherty, who was of a more conservative, budget-cutting mentality. He reduced municipal funding for Freedom House, which made it harder for them, you know? So they were really struggling. And he really championed the ambulance service which was run by the police department, which had, you know, basic if any training at all, tended to just scoop people and take them to the hospital. And you write that there was frequently circumstances where the Freedom House ambulances would be, essentially, racing the police to get to a scene. And there were times where they got there and had some disagreements - right? - about what to do.

HAZZARD: Oh, yeah. So the cops were - all dispatch at that point went through a central location and then would be sent out to its specific - you know, its specific service once they realized what the emergency was. Well, Freedom House realized that, you know, the police officers, who very much did not want them to exist, one, they were afraid they were going to lose their jobs. And two, these guys were from a community which had, you know, a longstanding acrimonious relationship with the police department. So they were not sending them on critical calls very often. So they went and they stole a police scanner.

DAVIES: (Laughter).

HAZZARD: And they were listening in. And so what they would do is - a call would go out. And the moment it hit police dispatch, they would just sprint out to their ambulance and go speeding down there. And, of course, they would arrive, you know, at the scene trying to look casual, even though everybody could smell the brakes smoking on their ambulance, and say, oh, no. We were just around the corner. But, you know, they did this quite often. And on instance after instance after instance, when they would get there, there's - you know, sort of John has this great moment where there's a guy speeding through town. He swerves off the side road. And he smashes his car into a telephone pole. He gets there. And he finds that the police have beaten him by about 30 seconds. So he jumps out, and he runs over. And he sees the cops grabbing the guy and just dragging him out.

So John is worried about the myriad of injuries that can happen from someone who runs head-on into a telephone pole. He forgets for a moment that he's a young Black man and that these are white police officers. So he goes over and starts screaming at them to stop what they're doing because they're treating his patient wrong. And this cop just spins on him and tells him, you know, you need to shut the hell up. One more word out of you, and I'm taking your ass to jail. And it is given to him just that flatly and just that matter-of-factly.

And he's standing in the middle of the street, and now he has to just stand there and watch this cop mistreat a critical patient and then drive off with him. He's left empty-handed. It was an incredibly frustrating experience. But, you know, that was why they got the police scanner and that was why they began racing 'cause they said, you know, enough of losing. We're going to go ahead and beat these guys.

DAVIES: Let me reintroduce you. We are speaking with Kevin Hazzard. His new book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics." We'll continue our conversation after this short break. This is FRESH AIR.


DAVIES: This is FRESH AIR, and we're speaking with writer Kevin Hazzard. He has a new book about a community organization in Pittsburgh that, in the 1960s, trained some of America's first paramedics and created a revolution in emergency medicine. The book is "American Sirens: The Incredible Story Of The Black Men Who Became America's First Paramedics."

There came a point at which, you know, Freedom House had gotten a national reputation. And this doctor who had helped get it started, you know, Peter Safar, had been appointed to a commission by the White House, which was going to pick one city to create and field test a new standardized paramedic curriculum. And he was hoping that Freedom House would be picked.

You write that at that point, the place had become a little disorganized. It needs some shaping up. And a new medical director was appointed, a woman named Nancy Caroline, a 31-year-old critical care physician, a white woman who came in to try and supervise this crew of Black men, many of whom had - who had worked together for years. She really took it seriously. How did this go?

HAZZARD: Not well. Not well. You know, Nancy is kind of a force of nature. And she gets essentially tricked into doing this job. Safar kind of corners her and, you know, really, you know, really gives her the full-court press in trying to get her to accept it. She finally accepts, realizes instantly that, A, she has no idea what she's doing. She's never heard of an ambulance or - you know, never been on an ambulance, never heard of a paramedic.

She's a little intimidated by the guys, to be perfectly frank. You know, she's honest about that. She's, you know, this white Jewish woman from the suburbs of Boston. She arrives here in this - you know, in the Hill District and finds herself surrounded by Black men. And she's, you know, a little intimidated. And so she says, well, look, there's only one way to do this, and that's to throw myself into it.

And, you know, as you said, she takes it very seriously. She - you know, she listens to what they're doing on the radio. And she says, OK, one, this is totally different kind of medicine than I've ever heard of, and I'm going to have to figure it out, which means I'm going to have to start going out on the street. But two, there's a way that I can make these guys better. There's a way I can bring my professionalism into this, you know, kind of chaotic world of pre-hospital medicine.

So she's listening in on every call. She's butting in on every call. She's on the radio. She knows where they are. She starts talking to them on-scene. They reach a point where all of them say every time their radio chirped, they would flinch because they were afraid they were going to get yelled at. She basically gives up her apartment. She moves into the crew room, puts a cot in there, sleeps in there every night. She's on all their calls. So everything that they're doing, she shadows them.

And, you know, something sort of remarkable happens. This group of guys who had every reason to be skeptical of her because all the doctors who had come through up to that point had definitely remained at a remove and had never tried to connect with these guys - suddenly, they see that, one, she's clearly committed to the job. Two, she's here with us. She's eating with us. She's sleeping with us. She's working with us. She's living with us. This trust begins to form, and they realize, oh, wait a minute. Like, she actually wants us to succeed. And so maybe, you know, this sort of, you know, horrible period that we're going through is going to get us somewhere.

And so they buy in, and they begin to see results very quickly. They're getting different responses from doctors, different responses from nurses. They see that their skill level is going up. She's taking them to class every day. She's literally kicking open doors in the hospital, places that they're not allowed to go. She's forcing her way in so that these guys can be brought in to all the wonderful things that exist inside of a teaching hospital 'cause she wants them to be better.

DAVIES: So the Freedom House paramedics, they got better. They had more advanced training. They had some real successes. And there's one story that I just love after they've gone through a lot of this improvement where both the police and Freedom House ambulances were chasing a call of a patient. They end up finding this guy on the Fort Duquesne Bridge. Your friend John Moon was the Freedom House paramedic there. You want to just tell us what happened when they were there and the police were there?

HAZZARD: So they both are walking across the street - or on the bridge toward where this patient is. And he's on the other side of the cyclone fence, this 12 - eight - 10 - 12 of (ph)...

DAVIES: Like, there's a walkway on the bridge. Is that's what it is? And...

HAZZARD: Yeah. Yeah. So he's on a pedestrian walkway. And what separates the road from this walkway is this huge cyclone fence. So John was walking over. And he looks, and he sees a cop is also walking over. So, you know, they've been racing one another to this call. And (laughter), you know, the final leg of the race is going to be a foot race. So he takes off running, and he climbs the fence, gets to the top. It's very shaky and wobbly. And, of course, it's on top of a bridge.

He jumps off and gets to the other side. Cop jumps down behind him. And this guy's in full cardiac arrest. So he - his partner is throwing equipment over the fence. They're trying to figure out how to get their ambulance around the corner to where they can get this guy out. It is a very, you know, complicated, difficult situation. But it is one of the ways in which these guys wind up working together. And again, it's sort of proof that the police department comes to see - despite how acrimonious this relationship is, they come to see the value that these guys provide.

And John is - you know, finds himself directing two police officers, you know, here's how you do CPR. I want you to hold this. I need you to carry that. Pick up the patient this way. They get him to the hospital, and, you know, they drop this guy off. And, you know, unfortunately, oftentimes someone who's in cardiac arrest, they're going to remain in cardiac arrest. You're not going to get a save. But everybody's watching as the doctors take over. And one of the cops turns to him and says, you know, this was really - this was great. We need to do this more often. And he and Nancy are just sort of dumbstruck because they have spent years fighting this department. And now one of these guys is saying, hey, this is really fun. This was great. You guys did a great job. I liked being a part of this. We should do this more often.

DAVIES: You know, in the end, the Freedom House Ambulance Service dissolved in circumstances that are not exactly a happy ending. I'll just say, I think people should read the book. I mean, there are a lot of terrific stories and interesting characters, and it's worth getting this in some detail. But basically their paramedics got absorbed into a new citywide ambulance service that was run and funded by the city, although many of them faced racism and discrimination after they went to work for the city. So it wasn't exactly a happy ending. And Freedom House as an ambulance service, you know, didn't endure. What was the ultimate impact of what they did in Pittsburgh and elsewhere?

HAZZARD: They laid the groundwork in the city of Pittsburgh for what an ambulance service would look like. When the city decided to absorb what had been Freedom House, they needed Nancy Caroline to do it. And so, you know, the woman who had helped bring Freedom House to its professional peak then went and helped the city of Pittsburgh design and perfect their own EMS service. But that's a tiny - you know, the tiniest piece of it. To this day, if you say the name Nancy Caroline, people know it because they've read her book. And her book was written with the help and through the work of the Freedom House paramedics. "Emergency Care In The Streets" is the text for EMTs in the United States.

So in the mid-1970s, there's this heroin epidemic in Pittsburgh. People in white neighborhoods are dying at record numbers. People in black neighborhoods suddenly are surviving. The reason for it is because Peter Safar, as an anesthesiologist, knew that this drug called Narcan could reverse the effects of a heroin overdose. And so he trains his medics how to do it, and he gives it to them. Well, of course, today, you know, everybody and his brother has Narcan in their car. Like, the design of the ambulance, the equipment that they carry, all these things that they were doing, these innovations that Safar was making along the way, he was making through them.

So, you know, what they did over this very short period of time goes on to quite literally be the foundation of paramedic work today. But, you know, it's not as if in 1975 there was a poof and these guys went away. They continued to, you know, have very long careers, very big careers. There were people who went into EMS management. There were people who went off to be doctors. John Moon himself stayed with the city of Pittsburgh and retired as an assistant chief. So, you know, they continue to have big effects, both in Pittsburgh and around the world. And it was, you know, an incredibly short period of time that they were working, and yet it's an instrumental piece of history.

DAVIES: So why did the name Freedom House get lost? Why does nobody remember it?

HAZZARD: I mean, I think for all the normal reasons. One, it was a service in a city called Pittsburgh. If it had been New York, I think, you know, maybe it probably has a different ending. I think also, you know, let's be honest. This is a group of Black men in the 1970s. This was not a piece of history that we generally, you know, shine a light on. You know, we have all watched Tom Hanks go to the moon many times. It took someone writing "Hidden Figures" for us to see who was doing the math. You know, that is just not a part of our history that we have, you know, spent much time trying to celebrate.

DAVIES: Kevin Hazzard, thanks so much for speaking with us.

HAZZARD: Oh, thanks, Dave. I appreciate it.

DAVIES: Kevin Hazzard's new book is "American Siren: The Incredible Story Of The Black Men Who Became America's First Paramedics." Coming up, our critic at large, John Powers, highlights five films and TV series he didn't review in 2022 that he thinks are worth your time. This is FRESH AIR.

(SOUNDBITE OF GABRIEL MERVINE'S "PEOPLE") Transcript provided by NPR, Copyright NPR.

Dave Davies is a guest host for NPR's Fresh Air with Terry Gross.

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