Somewhere in Pittsburgh’s Hill District in the late 1960s, a young man with no medical background beyond a demanding training course was doing things in the back of a moving ambulance that were then almost unheard of outside a hospital: managing airways, starting IV lines, monitoring cardiac rhythms and defibrillating. The Freedom House Ambulance Service, which began in 1967, is widely described as the first emergency medical service in the United States staffed by paramedics trained beyond basic first aid. Its training and ambulance-design standards became a national template, and its story was largely forgotten in Pittsburgh for decades.
This is a story about medical innovation, community necessity, and a profound injustice that followed a profound achievement. It belongs in the same conversation as any of the great Pittsburgh contributions to American life.
How Emergency Medicine Worked Before Freedom House
To understand what Freedom House changed, you have to understand what existed before it, which was very close to nothing. In the early 1960s, ambulance service in much of the country was provided by the police or a local funeral home, and offered at most basic first aid and a fast ride. In Pittsburgh, the city police handled ambulance calls inside the city, carrying patients in paddy wagons, while funeral homes served the suburbs. The crews’ job was to load and deliver, not treat. A 1966 National Academy of Sciences paper, “Accidental Death and Disability: The Neglected Disease of Modern Society,” had said up to 50,000 deaths a year might be preventable with better care and ambulances.
In the Hill District the problem was compounded. Wait times were often longer in Black neighborhoods, and tension between the police and the community made many residents reluctant to call them. Meaningful treatment would not begin until a patient reached a hospital emergency room, if they reached it at all.
The case that moved Peter Safar most personally was that of former Pittsburgh mayor and Pennsylvania governor David L. Lawrence, who suffered a heart attack and was taken to a hospital by police; he arrived with no brain activity and died after life support was removed. In Safar’s view as the treating physician, adequate care on the way might have prevented that. Safar’s own daughter had also died of an asthma attack after being taken to a hospital without care en route, according to the Freedom House history on Wikipedia.
Dr. Peter Safar and the Vision of Care in Transit
Peter Safar was an Austrian-born physician who had come to the University of Pittsburgh in 1961 to chair the anesthesiology department. He is best known to medical history as one of the key figures in the development of cardiopulmonary resuscitation: the combination of mouth-to-mouth breathing and chest compressions that has become the most widely taught emergency intervention in human history. CPR as a standardized technique owes a significant debt to Safar’s research and advocacy. He worked at Presbyterian Hospital.
But Safar’s thinking extended beyond resuscitation techniques to the broader question of when and where emergency medicine could be effectively delivered. His central insight, which seems obvious now and was genuinely radical then, was that the period between the onset of a medical emergency and arrival at a hospital was not dead time that had to be passively endured. It was a window during which trained personnel could perform interventions that meaningfully changed outcomes. Airway management. Intravenous fluid administration. Cardiac monitoring and defibrillation. These were not beyond the capability of trained non-physicians. They required training, equipment, and the organizational will to make them available in the field.
What Safar needed was a population of trainees and a community in which to deploy them. The Hill District, and the organization already operating within it, provided both.
Freedom House Enterprises
Freedom House Enterprises, headed by James McCoy, was a Hill District organization that helped unemployed and underemployed residents find jobs and training; it also took part in civil rights work such as voter registration. The ambulance program itself was funded by the federal War on Poverty and the Maurice Falk Medical Fund.
Philip Hallen, president of the Falk Fund and a former ambulance driver, was looking to improve emergency response and create jobs for Black men. When Safar heard about it, he reached out with a plan for intensive paramedic training and a better-designed ambulance, and Hallen brought in Freedom House to recruit. The Hill District needed better emergency medical services. Freedom House needed meaningful, skilled employment to offer its community. Safar needed trainees willing to learn a demanding new discipline. The program that emerged addressed all three needs simultaneously.
The first class was 25 Black men from the Hill District. Local media at the time called residents of the neighborhood “unemployables.” Half the recruits had not finished high school, some had criminal records, and some were Vietnam veterans; those without diplomas were helped to earn GEDs.
What the Training Actually Involved
Safar designed a 32-week, 300-hour course covering anatomy, physiology, CPR, advanced first aid, nursing, defibrillation and defensive driving, taught in hospitals as well as on the street. Later training under medical director Dr. Nancy Caroline added intubation, cardiac care and IV drug administration. Safar worked with Drs. Ron Stewart and Paul Paris on a curriculum that became the basis of the textbook Emergency Care in the Streets.
The rigor of the curriculum was a deliberate statement. Safar understood that the program would face skepticism, and not all of that skepticism would be medically grounded. Black men from a low-income Pittsburgh neighborhood claiming the ability to perform sophisticated medical procedures in the back of a moving vehicle were going to face doubt that had nothing to do with their actual competence. The answer to that doubt was a training standard so thorough that the outcomes would be undeniable.
The trainees passed the evaluations and went into service.
The Service in Action
The program began in 1967 and started officially operating in 1968 with two ambulances. Before they had their own vehicles, the trainees were pressed into service after the 1968 riots following Martin Luther King Jr.’s assassination, riding along with police ambulance crews. The city later contracted Freedom House for the Hill District, Oakland, Downtown, and some other predominantly Black neighborhoods.
The numbers cited most often come from the first year: nearly 5,800 calls, more than 4,600 patients transported, and, by Safar’s own data, about 200 lives saved, with response times under ten minutes in most neighborhoods. I did not find a published controlled comparison of survival rates, so I have not claimed one. In one episode often retold by documentary makers, the paramedics also told local drug dealers how to recognize an overdose and promised help without legal consequences, and fatal overdoses reportedly fell afterward.
Callers frequently asked for Freedom House by name instead of the police. One documentary maker said the paramedics told him that entering a home meant being a guest, so they addressed people by name and asked permission before treating them.
The Resistance They Faced
The paramedics met racism in daily work: hospital staff sometimes assumed they were orderlies and asked them to mop floors, and some white patients refused to be touched by them. The larger fight was with City Hall. Peter Flaherty, who became mayor in 1970, opposed public-private partnerships and refused Freedom House’s request to expand its contract to wealthier neighborhoods where fees would have been easier to collect. The city paid its contract late and cut its share of the operating budget by 50%, and a downtown ordinance barring sirens slowed the ambulances. Hallen and Safar both said racism was a factor. Flaherty’s stated position was that services paid for by the city should be overseen directly by the city; I did not find his own later account.
The model spread anyway. Miami, Los Angeles and Jacksonville followed it, and the ambulance design Safar developed was adopted as the national standard by the National Highway Traffic Safety Administration.
1975: The City Takes the Model and Leaves the Workers
In 1974 the mayor announced a citywide ambulance system staffed by police trained as paramedics; after City Councilman Eugene DePasquale objected, he agreed to fund the Freedom House contract one more year. At the end of that year the mayor instead announced a citywide service staffed by non-police paramedics, ending the Freedom House contract. Freedom House Ambulance Service closed on October 15, 1975.
The new service’s first paramedics were all white. Dr. Nancy Caroline, Freedom House’s medical director, accepted the new service’s medical director job on the condition that the Freedom House paramedics and dispatchers be hired and kept together.
Twenty-six Freedom House employees did join the city service, but according to the Wikipedia account of the closure, the crews were broken up despite the agreement, those with criminal records were fired, and new pass/fail exams covered material they had not been taught. Many were moved to non-medical work or placed under less experienced supervisors. Half were gone within a year, and eventually only five remained, one of whom was promoted into leadership. John Moon, hired in 1972, went on to become assistant chief of the city service. In the late 1990s, 98% of Pittsburgh’s EMS bureau was white.
Historians and the participants themselves describe this as discrimination layered on a major achievement.
The story largely disappeared from Pittsburgh’s public memory for decades.
The National Legacy They Left Behind
While Freedom House’s local story was being forgotten, its influence was spreading in ways that the crews themselves may not have fully tracked. Freedom House received a major grant to develop the first national standards for paramedics. Caroline’s paramedic training curriculum became the basis of the federal national standard curriculum in the mid-1970s. Her research also shaped practice at Israel’s Magen David Adom.
Claims that every American paramedic works from the Freedom House template are common but impossible to prove; what can be said is that its training model and ambulance design were adopted nationally and copied by other cities.
The Recognition That Finally Came
For most of the decades following Freedom House’s closure, the program existed primarily in the memories of the men who had served in it and the community historians who understood its significance. Mainstream Pittsburgh largely moved on without fully accounting for what had been accomplished and then discarded.
That began to change in recent years. Kevin Hazzard’s 2022 book American Sirens and a 2023 WQED documentary, Freedom House Ambulance: the FIRST Responders, were followed by the 2025 documentary Heroes on Call and by a storyline on HBO Max’s The Pitt. John Moon, a former Freedom House paramedic, has spent about a decade telling the story at events in Pittsburgh and at universities. In February 2026, Rep. Summer Lee introduced H.R. 7623 to award the service a Congressional Gold Medal; as of the sources I checked it had bipartisan co-sponsors but had not become law. The Hill District community that had produced Freedom House gradually reclaimed the achievement as part of its own complex and often underappreciated history of innovation under adversity.
Dr. Peter Safar, who died in 2003, is remembered as a foundational figure of emergency medicine.
Timeline
| Date | Event |
|---|---|
| 1966 | National Academy of Sciences “Accidental Death and Disability” report |
| 1967 | Freedom House program begins in the Hill District |
| 1968 | Official operations start with two ambulances |
| 1970 | Peter Flaherty becomes mayor |
| 1974 | Dr. Nancy Caroline becomes medical director |
| Oct. 15, 1975 | Freedom House closes; city EMS takes over |
| 2022–2026 | Book, documentaries, The Pitt episode, Gold Medal bill |
What It Means
Pittsburgh has a long list of things it contributed to the world: steel, aluminum, commercial radio, pop art. The Freedom House Ambulance Service belongs on that list. It showed that emergency care could begin in the street, and it did so with a crew drawn from one of the city’s most neglected neighborhoods.
They did not get the credit at the time. History is slowly correcting that.
Frequently Asked Questions
Was Freedom House really the first paramedic service in the U.S.? It is widely described as the first emergency medical service staffed by paramedics trained beyond basic first aid.
When did it close, and why? On October 15, 1975, when the city ended its contract and launched its own EMS. Critics, including Safar and Hallen, cite racism in city government.
Did the Freedom House paramedics keep their jobs? Twenty-six joined the city service, but only about half remained after a year and eventually five.
Where was it based? In the Hill District; see our Hill District history.
Sources
Wikipedia, “Freedom House Ambulance Service”; 90.5 WESA, “Congressional Gold Medal proposed for Pittsburgh’s Freedom House” (Feb. 20, 2026); GovTrack, H.R. 7623; Kevin Hazzard, American Sirens (2022).
