The History of Paramedics – The Chief’s Desk

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Friends of mine recently read a book that takes a deep dive into the history of paramedics in the United States; they enjoyed it so much that they bought me a copy. I have to say, it’s been a long time since I picked up a book that I could not put down. While I’m not through it entirely, I’m fascinated with the story. It’s called American Sirens: The Incredible Story of the Black Men Who Became America’s First Paramedics by Kevin Hazzard.

Most organized medical treatment and transport has its origins on the battlefields of various wars throughout the centuries. Despite strides forward on battlefields, e.g., triage, treatment, and transport, the concepts never seemed to take hold in the civilian world. There were attempts through hospitals in some early cities to use surgeons riding in a horse-drawn wagon to provide street-level advanced medical care; however, most of these faded over time giving way to what was known as “meat wagons.” They had ambulance drivers, usually two per unit, but no attendants or real training. No treatment or triage was provided in those days. As you can imagine, most people succumbed to their illness or injury.

It wasn’t until 1968 – ‘69 in a low-income community called The Hill in Pittsburgh that there was a push to move advanced care from the hospital to the field, and it all started in the most unlikely way. The Hill was an African American community largely lost to the rest of Pittsburgh. The folks who lived there were mostly unemployed, with little hope for a life removed from poverty, drugs, and crime.

So, how did a community in the depths of despair become the birthplace of modern EMS? Let’s start with a brief look at Dr. Peter Safar. Dr. Safar was born in Vienna, Austria. His parents were both physicians who spent a lot of time with their children introducing them to culture, history, and a good education… that was until the Nazi invasion and the start of World War II.

Around 1948, Dr. Safar moved to America to study medicine at Yale University, and, upon graduation, he went to work at a hospital in Baltimore. He’s credited with starting the first Intensive Care Unit in the United States while there. Dr. Safar was an anesthesiologist by training, however at the time, anesthesiology was a new discipline, so his actual background and expertise included a wider array of medical training.

In 1956, Dr. Safar was evaluating life-saving techniques used in the field for patients who were found not breathing. At the time, the accepted method to attempt resuscitation was to turn the patient on their stomach, put the rescuer’s knee into the patient’s back, put the patient’s arms above their head, and then move the arms back and forth – kinda like a turkey flapping its wings. Dr. Safar was convinced that this method not only didn’t work, but that it actually made the patient’s condition worse. After reading a study that concluded a human exhales more oxygen than they use, he developed a new rescue method. He called it cardiopulmonary resuscitation (CPR).

He eventually contacted a doll maker in Norway named Asmund Laerdal and convinced him to develop manikins that could be used to train people in CPR. I think we all know how that story ends, given a large majority of medical equipment and training supplies today carry the Laerdal name.

Dr. Safar eventually moved to Presby Hospital in The Hill area of Pittsburgh. Never one to sit still and always looking for ways to improve health care delivery to communities, he started developing a plan to provide intensive care level services outside the hospital. Rather than meat wagons, he felt he could train laypeople to provide advanced care under the direction of a physician. But how, and who, were the questions.

In 1966, Dr. Safar’s 12-year-old daughter died of a significant asthma attack while en route to the hospital. He felt that if someone with advanced training had been able to render aid, including intubation, his daughter may have lived. Dr. Safar had ideas, but no financial backing or source for trainees to get the concepts off the ground.

Enter Phil Hallen and Moe Coleman, a former ambulance driver and owner of Freedom House Enterprises, respectively. Hallen thought produce vans could be equipped to safely transport patients, and Coleman had a passion for lifting Hill community members out of poverty by creating and supporting black-owned businesses. By 1967, Dr. Safar and Freedom House had developed the first true paramedic training program in the country. In 1968, the first class of all-black students graduated and were on the street serving Hill residents. The program was nine months long and consisted of 300 hours of intensive training. It wasn’t long before the program proved a significant success with data to support claims that paramedics in the field changed the outcome for thousands of patients.

The Freedom House Ambulance service is credited with saving the first patient outside of a hospital environment by using a defibrillator and advanced cardiac life support drugs. Dr. Safar was also the first physician to provide Narcan outside the surgical suite for paramedic use in the field. Again, Freedom House being the pioneers of paramedicine were the first paramedics in the country to save an overdose patient using Narcan. This was in the early 1970s during the early years of the heroin epidemic. Freedom House paramedics were also the first in the country to intubate a patient in the field. Dr. Safar and his colleagues also created the National Registry System still in use today.

I’ve only scratched the service. If you want to know more, grab the book. Personally, as a former paramedic of 24 years, reading this makes me wish that my license would’ve transferred from MO. Had it transferred, I wouldn’t have dropped my cert. I loved my job as a paramedic and if I had to go back, I’d do it all over again.

My first fire department, the City of St. Charles, boasted the first paramedics in MO in 1974. I obtained my license just 20 years later in 1994. Until now, it never hit me that in many ways, paramedicine was still in its infancy when I graduated. My focus was being a Firefighter/Paramedic, so I looked more at the hundreds of years of Fire Service tradition instead of the 20 years of true EMS delivery. Today, I’m grateful to have been part of the ongoing development of EMS delivery in St. Charles – even if I didn’t realize it until now.

There’s one part of the book I’m just getting to that reminds me of our struggles in the State of Arizona today. It seems politics has played a central role over the years in either providing quality care and transport in U.S. communities, or it has played a central role in preventing it. In Pittsburgh during the early 1970s, politics were changing and challenging the delivery of medical services by trained paramedics. The argument? Public entities had no business disrupting private enterprises, even if the private enterprises were not actually providing services. Fifty years later, we’re still battling the same shortsightedness that plagued EMS in its infancy.

The upside is that through pure grit and commitment, the patient finally became the priority over profit and politics in Pittsburgh and other places across the country. So, we still have a fight ahead, but rest assured our push to put the patient first will win over the shortsightedness we see from bureaucrats at the State and some other private interests. We’re not Dr. Safar, nor are we those that fought alongside Freedom House for the best interest of the patients, but we have a very similar drive and determination to ensure our constituents receive quality EMS care and transport.

Don’t forget to apply for paramedic school. I’m telling you from my own experience, it was one of the best decisions I ever made.

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