Freedom House Ambulance Service

Freedom House Ambulance Service, community-based sociomedical program that became the first emergency medical services (EMS) provider in the United States. The Freedom House Ambulance Service was founded in Pittsburgh, Pennsylvania, in 1967 and was staffed mostly by Black residents of the Hill District, a predominantly Black neighborhood east of the city’s downtown. The service operated until it was abruptly shuttered in 1975.

Before Freedom House

Before 1967, emergency medical response in Pittsburgh—like in many American cities—was fragmented and often inadequate, particularly for low-income and Black communities. Individuals who could not afford private ambulance services typically relied on the police or morticians for emergency transportation to hospitals. This ad hoc system provided minimal to no medical assistance en route. Former Freedom House Ambulance Service paramedic John Moon described such situations as “swoop and scoop,” in which “you’d call the police and they’d pick you up, throw you in the back of a paddy wagon, and rush you off to the hospital” while the two officers sat in the front seat and no one attended to the injured person.

Pittsburgh police often refused to respond to emergency calls in Black neighborhoods or took so long to respond that people died preventable deaths while waiting for transportation to the hospital. Regardless of response time, the disproportionate rates of arrest and incarceration in Black communities coupled with a long history of police violence against Black people in Pittsburgh meant that it could be unsafe for these residents to call police in medical emergencies. Before the Freedom House Ambulance Service, according to Ralph Proctor, Jr., a historian of the civil rights movement in Pittsburgh, approximately 2,000 Black residents of the city died each year because of inadequate emergency response.

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Origins and success

In response to widespread inadequacies in emergency medical care for Pittsburgh’s Black residents, a coalition of Black and white community leaders sought assistance from Peter Safar, a University of Pittsburgh anesthesiologist widely recognized as the “father of CPR” (cardiopulmonary resuscitation). Their initial goal was guidance on acquiring and equipping ambulances to transport Black patients to their hospital appointments. Safar agreed to lend his expertise and requested, in exchange, an opportunity to train Black Hill District residents to provide effective prehospital care and transportation.

The community leaders identified Freedom House Enterprises, an initiative by the local civil rights group United Negro Protest Committee that offered job training in the Hill District, as a possible umbrella organization for their project. The federal government provided initial funding.

To staff the Freedom House Ambulance Service, Safar and Donald Benson, the program’s first medical director, recruited individuals from the Hill District, including people with criminal records, those who had experienced chronic unemployment, and Vietnam War veterans. The rigorous training covered general education, emergency medical services, and advanced first aid. After their approximately 300-hour classroom course, trainees spent nine months learning in the field. The first class of paramedics began training in June 1968, serving the Hill District area as well as the adjacent Oakland neighborhood.

In its first two years Freedom House responded to more than 5,800 calls, the vast majority of which involved transportation to a nearby hospital. The service quickly established itself as a superior alternative to existing ambulance options. A 1971 study of over 1,400 patients taken to three Pittsburgh hospitals found evidence of “inappropriate” prehospital care in just 11 percent of patients transported by Freedom House, compared with 62 percent of those transported by police and 78 percent of those transported by volunteer fire departments and private ambulances.

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By the end of its tenure, Freedom House had drastically expanded the scope of ambulance-based care to include procedures such as intubation, cardiac care, and intravenous drug administration.

Challenges and closure

Among the many challenges faced by the fledgling program was opposition from the local police, who often sought to manage or curtail Freedom House’s involvement in emergency response. Although Freedom House was eventually contracted to respond to calls in three districts, the police mostly involved them only in low-stakes situations. Benson’s successor, Nancy Caroline, purchased a police radio, and Freedom House ambulances began to appear uninvited at emergency scenes, shrugging off their serendipitous presence as mere coincidence. According to Caroline’s published writings, the police would come to appreciate the services offered by Freedom House.

Lack of stable funding was also a persistent challenge. The city of Pittsburgh was reluctant to permanently fund the Freedom House program, sometimes claiming that emergency medical services were the financial purview of the county. Financial support from the county, however, was considered unlikely because of coordinated opposition from suburban fire departments concerned that Freedom House’s higher training standards would force fire departments to retrain their volunteers. In the early 1970s the program’s $100,000 funding from the city under Mayor Joseph Barr was halved by his successor, Peter Flaherty.

This cut, along with the withdrawal of the city’s support for Freedom House’s Community Council on EMS—which sought to raise the standards of prehospital care throughout the region—and the fast-approaching end of the federal government’s provisional funding, triggered a political fight between the city and Allegheny county leadership over the extent to which either entity would help Freedom House’s funding gap. None of the agreements reached were sufficient to support the program when its federal funding was phased out in 1975. Anti-Black racism was widely understood as a major factor in officials’ unwillingness to financially support Freedom House.

Rather than the citywide expansion of Freedom House that Safar proposed, city and county officials favored the creation of an ambulance network run by volunteer fire and police departments and refused to adopt the national EMS standards that Freedom House helped create. The Freedom House Ambulance Service stopped operating because of lack of funds in the fall of 1975. Shortly thereafter the city of Pittsburgh implemented a “superambulance” network run by police and fire departments that closely resembled the Freedom House model, except that most of its paramedics were white. Freedom House was able to negotiate paramedic positions in the city network for 26 of its trainees, but only 12 were still city employees a few months later.

Impact

The Freedom House Ambulance Service demonstrated that high-quality prehospital care, when delivered by rigorously trained paramedics, could significantly improve patient outcomes and save lives. Its community-based model proved not only feasible but also exceptionally effective. The ambulance networks established after Freedom House were very similar to the pioneering program, which set national standards for EMS training and greatly improved prehospital care for vast swaths of the population. Many observers find in the Freedom House Ambulance Service an inspiring story of a community-driven solution to address racial inequalities in health care, as well as a cautionary tale of how racism can obstruct interventions to support the health of Black people.