#135 American Sirens: The Amazing EMS Origin Story
Review of ‘American Sirens: The Incredible Story of the Black Men Who Became America’s First Paramedics’
Author Kevin Hazzard tells the tale of the Freedom House Ambulance Service, a community organization in inner-city Pittsburgh that in 1968 became the first emergency medical service with advanced paramedic training.
The wide availability of emergency medical services is one of the miracles that Americans take for granted as we speed down highways, cook dinner and power walk through our parks. The notion that within minutes of a person suddenly passing out at their home, a pair of highly trained paramedics (who carry an array of monitors, a defibrillator, airway equipment and medicines) would arrive at the scene to start lifesaving treatment is a marvel that began in a most unlikely place and under the most difficult of circumstances.
Before 1967, if you suffered a life-threatening medical emergency or illness, the chances of survival were minimal. A 911 call might bring police or even the local funeral home. Patients received basic first aid and then were transported to the hospital. In the Hill District of Pittsburgh, like many inner-city neighborhoods, citizens could not get transport at all.
Author Kevin Hazzard tells the story of the Freedom House Ambulance Service, a community organization in the Hill District, a predominantly Black area in inner-city Pittsburgh. In 1968, the Freedom House Ambulance Service became the first emergency medical service with advanced paramedic training.
Hazzard’s 2022 book, “American Sirens: The Incredible Story of the Black Men Who Became America’s First Paramedics,” is a spectacular piece of research and nonfiction storytelling that reads like a suspenseful novel. It is a great book to highlight in June as the nation celebrates Juneteenth; it provides important education on an overlooked story in Black history in the U.S.
Hazzard’s narrative revolves around John Moon, a hard-working hospital orderly who experienced a difficult childhood. Moon one day saw two proud and confident Black men in white uniforms bring a sick person into Pittsburgh’s Presbyterian Hospital. The men worked for the Freedom House Ambulance Service; as Moon learned this, he became inspired by their swagger. He began the arduous journey of training to become a paramedic. The problem was that the year was 1968, and at this time there was not yet a curriculum for him to train with or a job title for him.
Below, I’ll break down some of the main themes of this book and why I found it entertaining and enlightening.
Journey to creating change
Readers are introduced to maverick physician and innovator, Peter Safar, MD. He was an Austrian immigrant who came to the United States to train in surgery and anesthesiology. He is credited with discovering and refining the steps of cardio-pulmonary resuscitation (CPR) and demonstrating how it could be taught and used effectively by members of the public.
The account of Dr. Safar’s very public demonstration of rescue breathing during his employment at Johns Hopkins in Baltimore will fascinate and amaze each reader. No institutional review board of today would ever allow such a dangerous experiment to be performed on human subjects. Before the refinement of CPR and rescue breathing, nearly all arrest victims died. CPR has become the vital first method treatment for cardiac and respiratory arrest patients while they await more definitive care. One study from 2017 found that 26% of patients who received CPR survived to hospital discharge.
Dr. Safar established the first intensive care unit (ICU) at the Baltimore City Hospital in 1958, then moved to Pittsburgh to establish a critical care training program. He had recognized a gaping void in the medical care that existed during the time that it took to transport a critically ill patient to the hospital. Sick or injured patients were placed into the back of a police car, station wagon or hearse, and were provided with little more than basic first aid on the scene. Many critically ill patients arrived at the hospital either dead or near death.
Dr. Safar envisioned that much more could be done to start medical care at the scene and during transport. His ideas included intense emergency medical training and improved ambulance design. His highly trained “paramedics” would be qualified and sanctioned to begin advanced medical care wherever the sick or injured person was found.
He collaborated with Phil Hallen, a former ambulance driver who was seeking to improve responses to medical emergencies, as well as create employment opportunities for African American men in Pittsburgh. A training program was established at Freedom House Enterprises, an existing community organization that worked on civil rights projects, voter registration drives and offering job training to black Pittsburghers. Hallen and Safar wanted to train undereducated and underemployed Black men to serve a largely ignored, sick and underserved inner-city community.
Hazzard writes of the program’s founders’ intentions for the medic training program to serve as a source of local pride:
“… if Freedom House faced overt opposition, whether from the start or later on down the road, it would be over the question of race. Nevertheless, more than an innovative jobs program or a revolution in emergency medicine—and it was definitely both of those things—the Freedom House ambulance corps was to be first and foremost a beacon of pride. In a place like the Hill District, where the world took a whole hell of a lot without ever giving back, where crime and poverty were at all-time highs, where people were referred to as ‘unemployables,’ the sight of a young Black man stepping from an ambulance in service of his community would restore a measure of dignity even to those who witnessed it.
“And as he blazed a trail for others to follow, that medic’s achievements would reach far beyond the Hill, helping to stamp out the racist notion that it was a lack of ability—not inequality—that held African Americans back.” (p. 100)
Standing up to racism
In 1967, 25 Black men from the Hill District entered a 32-week, 300-hour course designed by Dr. Safar. The curriculum included anatomy, physiology, CPR, advanced first aid, nursing and defensive driving. The service saved hundreds of lives and became the prototype for paramedic training and advanced emergency medical services in the United States as well as the rest of the world. The road to success, however, was not smooth.
The Freedom House paramedics had to deal with racism and nonacceptance from the public, hospital staff and city government. Turf wars ensued between the mostly white police force, the mayor and the medical director of Freedom House, Nancy Caroline, MD. The Freedom House paramedic service and training program, which became a nationally and internationally recognized success, could not make it in the very city it so faithfully served—the eventual closure of the Freedom House Ambulance Service in 1975 signified a major loss for Pittsburgh and the community at large. An important institution of Black excellence and empowerment was lost.
The history of emergency medicine
For those of us who have trained and worked in emergency medicine, the origin story of CPR and emergency medical services will surprise and delight. The author is a journalist, novelist and screenwriter; he also worked as a paramedic for 10 years in urban Atlanta. His memoir, “A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back,” is also an eye-opening and enjoyable read.
Hazzard spent three years researching the topic, including interviews and first-person accounts when he could get them. The origin emergency services story was largely forgotten as modern services and paramedic care have become a ubiquitous part of American life and popular culture. Just dial 911 and there they are.
At the end of the Freedom House Ambulance Service, emergency medical services for all of Pittsburgh were taken over by the Police and Fire Departments. A unique and pioneering service was lost and nearly forgotten. Dr. Caroline, the medical director, said to her paramedics,
“You have taken a dream and made it real … You have profoundly affected thousands of lives: The young and the old, the wealthy and the indigent, the prominent and the anonymous … If you take with you into the future the dedication, spirit and pride which you have shown in your work here, you will keep alive all that is meaningful and important about Freedom House.” (p. 248)
Thanks to Hazzard’s research and creative storytelling, “American Sirens” is an intricate tale of heroes, villains and innocent victims. The drama plays out during a turbulent time of civil and racial unrest in our nation’s history. Now, the legacy of the Freedom House Ambulance Service can occupy its very rightful and respected place in American history.
