Words by Steve (Sunny) Whitfield
At the height of simmering racial tensions in the United States (US) in the 1960s a quiet revolution was beginning. It was an audacious and improbable experiment born out of the racial divide that severely decreased access to prehospital health care. The ensuing years would see this social movement provide the national standard benchmarks for pre-hospital emergency care in the US. The movement became known as the "Freedom House Ambulance Service" and worked to empower a subjugated community of people and embody the racial equality sought by many (1-3).
Racism is a lack of acceptance and understanding that has plagued the historical records of time. Racism is often described as prejudice, discrimination, or antagonism directed against someone of a different race based on the belief that one's own race is superior (4-5).
Although undeveloped in its beliefs, racism creates division between groups. However, this very division is responsible for the creation of social movements. Social movements are often complex networks of people who share a broad alliance and are connected through a shared belief or circumstance, and yet, who can also be divided by differing opinions. Interestingly, social movements often give rise to counter movements within, that can strengthen their core goal. The counter movements are similarly aimed however advocate their support thorough alternative methods.
Prior to the 1970s, ambulance services in the US were rudimentary and largely unregulated. Although ambulance networks existed, they were often using a combination of funeral home hearses, fire departments or even police for prehospital transport. Following the release of the report "Accidental Death and Disability: The Neglected Disease of Modern Society", a concerted effort to improve emergency medical care in the pre-hospital setting in the US was undertaken. Although pioneering emergency medical technician (EMT) programs commenced in a number of states including Pittsburgh Pennsylvania, Charlottesville Virginia and Portland Oregon, the comprehensive emergency medical care we know today was aligned through a counter social movement that set an important example in prehospital care delivery.
A brief outline
At the time in Pittsburgh, the first responders who answered the emergency calls lacked proper medical training or equipment and refused to enter and provide assistance to lower socioeconomic, predominantly African American suburbs (2).
The racism against African Americans and immigrant populations was nationally systemic at the time, creating a complex and unbalanced medical response. In 1967, Phillip Hallen, president of the Maurice Falk Medical Fund suggested the training and development of a structured high-quality emergency medical service. His colleague Morton Coleman suggested the development of an ambulance service that would train the unemployed men and women from the lower socioeconomic suburbs as medical technicians. Together they approached the recently formed Freedom House Enterprises which was an extension of the United Negro Protest Committee. Although it was a provocative suggestion, it was an innovative idea that would provide the foundation for an unprecedented partnership. This partnership would also solve the lack of medical responses whilst empowering the people to rise peacefully and impactfully, putting racial divide into the spotlight. The movements mission was to utilise the so-called “unemployable” locals in a time of unrest, and demonstrate their ability whilst reducing the gap in health care.
Training began from a base in the Presbyterian and Mercy Hospitals in 1968, and they garnered the attention of the political leadership who, having witnessed the services providing high quality prehospital care to their own suburbs, began to model the program for the rest of the city. The Freedom House Ambulance Service became one of the first structured professional ambulance services in the US and it set an example in both racial and medical equality. Although other cities such as Seattle and Miami were developing similar programs, they were largely employing a “white” service who were not trained as highly in prehospital care as Freedom House. In fact, by 1974, the federal government recognised Pittsburgh as having one of the best emergency services programs in the country.
The Freedom House Ambulance Service was formed with just over forty participants who received training from Dr Peter Safar (the father of resuscitation) and they were paid a small wage. The initial program ran for 9 months with the participants working a full-time study load. During this time, Dr. Safar contacted a doll maker in Norway, Asmund Laerdal, to design a training mannequin specifically for CPR training. He was also responsible for the design of the ambulance. Under the careful watch of Safar, there was no room for racism in the emergency room and his acceptance of race and intolerance of racism was both respected and followed by all hospital staff.
By 1968 just over 20 participants had finished their training and although this was used by the opponents to demonstrate its failure, most of the local residents warmly embraced the service. Safar recruited more participants and continued the current medics training in obstetrics, intravenous access, advanced airways, and electrocardiograms (ECGs).
Patients were treated regardless of race, background, or location, however this respect was not always mutual. Despite being abused and mocked, they collectively continued to provide one of the first professional EMT services in the country. In 1973 a young doctor, Dr Nancy Caroline served as the medical director, further developing their core capability.
The end is nigh
The movement advocated for racial equality and challenged the status quo. In fact, it was so effective that it positively affected ambulance delivery across the country as other services modelled their programs from the Freedom House Ambulance model. That said, it was not to survive.
Whilst some movements are successful in gathering political support, others are not. Despite the program’s enormous impact on racial health care equality and the countless lives saved, the program was causing ripples. Although community support had grown it was evident to many of the cities influential people that if the “city negroes” had a better ambulance service staffed with professional paramedics than the rest of the city, they would potentially suffer the consequence at the elections. As such the city official elected to de-privatise the ambulance service citing it as a cost saving measure (3). Although a substantial amount of the Freedom House Ambulance staff were now holding bachelor degrees, the city officials signed declarations that appropriated the Freedom House ambulances and all equipment and then forced its closure on October 15, 1975 (3). In an effort to further remove the movement from the pages of history, the Freedom House station was torn down and all their files were destroyed (1,3). The Freedom House Service had provided over 45,000 emergency responses with highly trained prehospital care professionals, but the racial divide could not be conquered.
Perhaps a lesson to be learned is the notion of political opportunity structure (the connection between social movements and political outcomes). It is paramount for a social movement to secure political endorsement and form a coalition or alliance early on in the political sphere in order to sustain political support for the main goals. Unfortunately, this is where the Freedom House movement was unsuccessful.
Although many members of Freedom House had been involved in demonstrations and movements for equal rights, the unconventional tactics employed through the EMS training program saw a shift in the sentiments of neighbouring communities towards greater acceptance, but this could not overcome the political pressures of the time. In a sense of irony, the National Highway Traffic Safety Administration (NHTSA) reported that immediately following the assassination of Dr Martin Luther King the Freedom House service was the only service in Pittsburgh willing to respond to emergency calls resulting from riots.
Although many practitioners (who were influential people themselves) were familiar with the Freedom House Ambulance Service and the success of the program, they were not acquainted with effective mechanisms to reduce prejudice and as such they provided very limited support during the annihilation of the service.
At its peak it was the most successful EMT service in the US, overcoming racial prejudice, health care inequality and access to health education, however it was reduced to a memory by partiality and divide.
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