Did you know that modern emergency medical services owe their origins to an all-Black paramedic team in Pittsburgh in the ‘60s? Author and former paramedic Kevin Hazzard tells the story in his new book “American Sirens.” Abdul reflects on the stories we tell — and the ones we don’t — about American healthcare. He sits down with Hazzard to learn more about the Freedom House Emergency Medical Services.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: COVID cases, hospitalizations and death tick upwards. Meanwhile, an analysis of COVID deaths shows that the majority of deaths is now among vaccinated people. That’s right, seniors who aren’t up to date on their vaccine. Speaking of seniors, a record number are aging alone with terrible consequences for mental and physical health. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Today I’m bringing you a story from the history of public health, the birth of paramedics. But first, a note on what we actually even talk about when we talk about the histories of medicine and public health. See they’re chalk full of lore about this or that great discovery, Semmelweis or Koch and germ theory. Fleming and diabetes. John Snow and the cholera outbreak. But that telling tends to frame history as an endless series of triumphs and victories for one particular group, dead old white dudes in Europe. What gets discounted, though, are the contributions of so many other traditions, such as those from ancient China or the Muslim world or anywhere in Africa. But so many others deserve a starring role in the history of medicine and public health. Take Rosalind Franklin, the co-discoverer of the shape of DNA alongside Watson and Crick, who got all the credit, including a Nobel Prize. Today’s episode is about exactly that kind of a set of heroes, a group of Black heroes that revolutionized emergency medical services. Everything from modern CPR to the ways ambulances look and operate. They had their origins in an all Black paramedic team from the 1960s, in a marginalized community in Pittsburgh. Until I read American Sirens, the book that recounts that story, I had no clue about this history. And look, I’m a public health nerd. And that’s because history itself chose to forget about them. They were the kinds of heroes too much of our history has so often ignored. But the history we choose to tell matters even today. And that’s because too often, health care providers don’t look like the communities we serve. And that’s because too often people from those communities don’t see themselves represented in the stories we tell ourselves about who gets to do these jobs, who gets to be these kinds of heroes. Kevin Hazzard is a paramedic and the author of American Sirens, which tells the story of the team that took on racism, Pittsburgh City Hall, and the odds to serve their community and in the process revolutionize their field. Here’s my conversation with Kevin Hazzard. 

Dr. Abdul El-Sayed: And we’re good, you ready to go? 

Kevin Hazzard: Yes. 

Dr. Abdul El-Sayed: All right. Can you introduce yourself for the tape? 

Kevin Hazzard: Kevin Hazzard. 

Dr. Abdul El-Sayed: So, Kevin, I know that you have a background as an EMT, and I uh also know that you’re a journalist who writes on these topics. But this book, um it’s really quite unique because it speaks both to the history of the EMT profession, the history of a particular community in Pittsburgh, and, of course, the history of racialized oppression in our country. And I think you did a great job um sewing all three and teasing apart the legacy. Now, I can imagine writing this kind of a book um is both frustrating and cathartic and would love to understand you know why you set about writing it. 

Kevin Hazzard: Uh. Thanks. I appreciate you saying I stitched them together well, it was a it was a task at times. You know, it was both frustrating and cathartic because, look, I wrote this in the wake of George Floyd. So there’s a lot happening in that regard. I wrote it in the midst of a pandemic. There’s a lot happening in that regard. And yet the things that I’m writing about that took place in in the fifties and sixties are things that were taking place today. The fact that in my research, I come across, you know, this story of a cholera outbreak in London in 1832, in which for the first time there’s a medical transport service from a hospital to bring people to get some kind of care, even though it was really only quarantine. And the response to that was people saying there’s no such thing as cholera. This isn’t a pandemic. Um. You know, what’s happening is they’re trying to steal your loved ones so they can, you know, uh take their organs. It felt very much like where we were in 2020 um–

Dr. Abdul El-Sayed: Mmm. 

Kevin Hazzard: You know, so it in some ways it was frustrating to see what had not changed. Um. But the reason I wrote it, you know, as you said, I was a paramedic. I spent ten years on an ambulance. It was an incredibly important part of my life. And, you know, it was it kind of helped create the person I am today in this piece of of history, the people who are involved in this. You know, they are my forebears. I am the product of the work that they did in the 1960s. And so to me, this was a it was important on a larger scale, but it was important personally. And so once I heard about it, and started digging into it and realized that not only had I not heard of it, but that very few people had and no one had really sat down to lay the whole thing out and explain what happened and why it was so important. Um. I just kind of became transfixed. 

Dr. Abdul El-Sayed: I imagine that for most of the listeners, uh this is the first time they’re hearing about this story. Uh. I would love to ask you, how did you hear about it? And then why do you think so few of us have? 

Kevin Hazzard: I got an email. My first book had come out. It was a memoir about my time as a paramedic and one of the people who read it just dropped me a line, said, hey, read your book. Liked it. Have you um have you ever heard of this? Have you ever heard of Freedom House? Do you know how your profession began? And you know that’s a very intriguing question for anyone. Certainly, you know, for a writer. You you tease them with something they don’t know. Um and we’re going to dig into it. So that’s how I came upon the story. Um. Why does why do more people not know it? I mean, I think probably for the same reason that we have watched Tom Hanks go to the moon 50 times, but none of us had ever heard of Katherine Johnson before Hidden Figures. Um. 

Dr. Abdul El-Sayed: Yeah. 

Kevin Hazzard: You know, they’re just aspects of our history that we have not highlighted or emphasized or paid much attention to in the past. I think we are at a place where the world is ready to listen. We are ready to listen to ourselves. Um. And then, you know, that’s that’s happening. 

Dr. Abdul El-Sayed: One of the parts of the book that I really appreciated is that you uh do a great job developing so many of these characters, not just their place in history and the work that they did, but the interplay, the complexity of their own uh experiences as they went about this work, as they worked with each other, I think it really comes out. And I think that’s really important to understand both um the unlikelihood of what they did uh and also the frustration that we never heard about it before. Um. Can you can you tell us about some of the key characters in the book? Who were they? What brought them together? What brought them to this work? 

Kevin Hazzard: So one of the main characters is sort of the person who created this entire thing, his name is Peter Safar. He’s an Austrian born anesthesiologist who, you know, quite literally escaped, you know, many aspects of the Second World War by the skin of his teeth. And he arrives in the United States in the late 1940s um to finish his his medical training. He wants to be a surgeon. He sees this brand new field of anesthesiology. He is one, an incredibly smart guy, two, the kind of person who wants to change the world. And three, you know, he had survivor’s guilt. Why did millions die when I lived? So he feels this compulsion to help humanity and to repay his survival. And anesthesiology is the way he can do that. And as he’s studying it, he comes across this paper that said expired air contains as much uh or enough oxygen to keep you alive. And he uses that piece of information to create CPR. At the time, what was being done is essentially like, you know, you’d press on somebody’s back and move their arms around with the hoping that if you moved their body enough, you would open and close their lungs and they would breathe, which, of course, did not work. And he knew it didn’t work. And so he sets up the series of tests in which he sedates and then paralyzes volunteers and uses first this terrible method, which he knows to be totally ineffective. And when their oxygen levels reach dangerously low points, he then brings in laypeople. Um. It could be a businessman, a housewife. In many cases, it was Boy Scouts, 11 year old kids who have never heard of rescue breathing. Nobody has. He’s created this. Um. He gives them this 15 or 20 second crash course and says, okay, go keep that human being alive, which they do. He does this for 8 hours over a series of 40 different tests. He takes all of his data, which again proves that not only does the old way not work, but that rescue breathing does. He publishes that data at a forum in Los Angeles and [snaps] instantly CPR is born. He pairs rescue breathing with chest compressions, and there you have it. He forever changed how lives are saved around the world. So he’s the father of CPR. This is the sort of person that you have. You know, he’s living in Baltimore at the time that it does that but in early 1960s, he moves to Pittsburgh and it’s there that he begins to turn this very restless, creative, uh ingenious mind on the problem of prehospital care. You also have, you know, this other doctor by the name of Nancy Caroline, who is a very young, new physician, um incredibly bright, graduated high school, early, attended Radcliffe. This was before Harvard was allowing women, um did her medical residency in Cleveland and then moved to Pittsburgh. And, you know, she’s she just wants to go to Israel. She’s a young Jewish doctor whose goal is to go to Israel. And Safar sees in this brand new physician um somebody that he can sort of coop and he knows how smart she is. He sees how energetic she is and he needs someone to help him be a day to day medical director for this ambulance service that he has created. Um. And that’s what she eventually becomes. And then the third uh main character of of the story is John Moon. And, you know, John, you know, he’s he’s such a wonderful, wonderful guy, um but he’s had a crazy um a very difficult life. And it doesn’t he wears it very lightly. He he was born in Atlanta uh in a neighborhood in the middle of the town that in the 1950s did not have running water or electricity. His mother died when he was very young. He wound up in an orphanage and eventually he was adopted by family he did not know existed who brought him to Pittsburgh. And it was there that he grew up throughout the civil rights movement, was seeing freedom riders and marchers and sit ins. And and he he bought into the rhetoric of the 1960s that we are going to change the world, that things are going to be different. And he gets he graduates from high school and he gets out into the workforce and he sees that things aren’t different and nobody’s changed the world. And so he’s looking for an opportunity to make his mark on the world. And so, you know, through the unlikely uh body of an ambulance, these three incredible people come to mind, come together and, you know, wind up creating the world’s first paramedics. 

Dr. Abdul El-Sayed: Can you tell us a little bit about the, the state of emergency medical care uh and ambulance services before Freedom House was created? 

Kevin Hazzard: Yeah. So if you go back to 1965, depending on where you live in the city, your emergency call will summon one of three things. It might get a volunteer firefighter or a pair of volunteer firefighters. It might get two police officers or it might get two undertakers in a hearse, um which is you know I mean, if you think about the conflict of interest there alone. You know, I mean, they’re going to make a lot– 

Dr. Abdul El-Sayed: Pretty bleak. 

Kevin Hazzard: –More money on your funeral than they are on your drive to the hospital. But that’s what you had. So this paper is published in 1965 called The White Paper. And what it says is uh emergency, you know, there’s the word paramedic does not exist, but ambulance attendants um are too few to be there when you need them and too unskilled to be of much use when they arrive. So this problem is laid bare uh. In 1965 alone, more Americans are killed in highway accidents than in the entirety of the Korean War. So we know there’s a big problem, but nobody knows how to fix it. It’s just it’s sort of a recognition of the problem. And Peter Safar, uh again, Father of CPR, this incredibly restless guy picks up the problem and he says, okay, I know how to fix this. So he creates a brand new kind of profession. He he imagines what you do in an emergency room and in an emergency room, you’re prepared for everything. Someone in labor, someone who’s been shot, asthma attack, a seizure, a stroke, a heart attack. Anything that can come through the door, an allergic reaction, an ER doctor has to be prepared for that. And so he says, what if we took a professional and we we geared this broad spectrum of education to this these people, and we redesigned the hearse, so it’s no longer a hearse, but an actual ambulance like the one we have today. And we give them this incredible training program, much like you would do with a doctor. So it’s shorter, of course, but it’s a long um it’s an eight month long uh classroom course. And then when they’re done with that, we’re going to put them in the E.R., the O.R., the ICU. We’re going to put them in the O.B. wing. We’re going to put them in the morgue so they can watch autopsies. We’re going to do all the things on a smaller scale for this professional that we would do for a doctor, and then we’re going to unleash them upon the world and allow them to save lives right at the point of injury or illness. And it’s a revolutionary idea because nobody had done that before. But he that’s that’s a program that he created. So that’s what is born in Pittsburgh in 1966. 

Dr. Abdul El-Sayed: Now, one of the original stipulations uh was that the paramedics who were hired by Freedom House had to be Black. Can you walk us through both the significance of that decision and what it meant for the culture of uh EMT paramedic work? Um. And you know, how that now, what the implications of that now are for the way we think about this work moving forward? 

Kevin Hazzard: Sure. So. Again, Safar has this great idea. He’s created a training program in an ambulance. He doesn’t yet have a professional to do it, and he’s not sure where to get this professional and across town, there’s an organization, as you mentioned, called Freedom House, and it’s a nonprofit that was started by a guy named Jim McCoy. And the goal was uh to create. Basically it was supposed to be a job training organization where they would take people from the Hill district, which is, you know, to say Harlem or Watts. You know, it’s just, you know, economically depressed area and and they’re looking for opportunities for the people from this neighborhood, and they’re just not finding any. And someone had the idea, someone involved with Freedom House had the idea of, well, what if we drove people to doctors appointments? And so this concept of like, well, we could take some of the guys that we have and do this very lo fi sort of ambulance system. And they bring that to to Peter Safar, who immediately shakes his head. He has no interest in sort of this modest proposal. He doesn’t want to do that. He says, however, I’ve got this incredible idea and it’s going to be this massive thing. And here’s what we’re going to do and it’s of course, revolutionary and exciting, and they’re excited, but they’re kind of looking at him going, pal, we don’t have professionals. These are people we’re trying to get trained for jobs. And Safar says no no, that’s the whole point. I need to prove that this is something that can be replicated in every city across the country and throughout the world. So I just need ordinary people that I can turn myself into professionals. And so they said, well, we’re happy to do this, but you have to hire people from the Hill district. This has to be people, our Freedom House constituents, which of course, means that they’re going to be Black. So because Safar is approached by Freedom House, um the world’s first paramedics wind up being 24 Black men from the Hill District of Pittsburgh. 

Dr. Abdul El-Sayed: Hmm. That’s incredible. And what did that mean for um the way that they were uh accepted, both in communities like The Hill, but then also in other communities in a segregated Pittsburgh? 

Kevin Hazzard: It’s a blessing and a curse. At home, they’re a tremendous source of pride. Um. People around the city see these guys who look like them, who come from the same neighborhoods that they come from, in some cases, who know each other. And they’re watching them walk around and they’re watching them save lives. They’ve become medical professionals. They are paramedics. They are, you know, leading this new branch of medicine. And it’s an incredibly inspiring thing for a neighborhood that is still sweeping up the ashes of the unrest following the assassination of Martin Luther King Jr. So this is a tremendous thing for the community, a tremendous sense of pride that to this day, the people, both the paramedics and people who live in the Hill point to and say that was a high point. Um. From a larger standpoint, however, it becomes incredibly problematic. For one, Pittsburgh’s ambulances up to that point were staffed by police officers. So they are quite literally stealing jobs from the cops, which does not endear them to the police force, as you can imagine. On top of that, they come from a neighborhood that has a long history of acrimony with the police department. You know, Pittsburgh police was the first um that was the first department in the country that was placed under a consent decree. This was this was a city with, you know, with a lot of problems. And, you know, those two, the police force and people living in the Hill, they did not get along. It was not an easy marriage. So these are two institutions, you know, uh Freedom House and the police department, who simply aren’t going to get along. And it is a fight from start to finish. Um. You know, they’re at one point the police are not giving them emergency calls. So Freedom House medics actually steal a police scanner, listen in on calls and then race the cops to the call, which if you can think about like imagine the optics for a moment of, you know, two young Black men in an ambulance racing a pair of police officers to the scene of a crime. It seems to upend everything we know about America. But, you know, that relationship is very complicated and then their relationship with the city government is complicated. Both the city and the county have a lot of reservations about uh whether, you know, about EMS in general, but very specifically about who’s providing that EMS. And though it is never explicitly said, uh the the justifications they give for their resistance are so specious and so easily batted aside that it becomes clear there are very few legitimate reasons to resist this program, other than the fact that the people who are doing it are Black. 

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Dr. Abdul El-Sayed: What about the citizens, white citizens of Pittsburgh? You know, you have this well-trained EMS force that is uh the first of its kind to actually bring evidence based um real medical training to the field. And surely the outcomes are speaking for themselves. Um. And at the same time, you’re talking about 1960s Pittsburgh. You’re talking about a um a context of a civil rights era that is that is contentious uh in terms of you know, we talked about the the aftermath of the of the assassination of Dr. Martin Luther King. How do white Pittsburgh residents react to the uh Freedom House EMS, and what’s their perspective? 

Kevin Hazzard: They have two very conflicting and enlightening responses. One is why is that happening over there? During their time, early seventies, there’s a heroin epidemic that breaks out in Pittsburgh. Heroin had made its way from New York west to Pittsburgh. Deaths for overdoses begin going down in Black neighborhoods even as they’re going up in white neighborhoods. And the reason for that is because of Safar’s experience as an anesthesiologist. He knows how to reverse the effects of an opioid. He you know, he just says, well, we’ve got this drug called Narcan. I’m going to train these guys to use it, and that’ll be that. So so the the birth of what we see today in terms of, you know, Narcan being this thing that everybody knows about and it is widely used, happens right there that’s used for the first time by by Freedom House paramedics. And it’s because the guy who created the program knew very specifically uh you know which drugs would be used to reverse anesthesia in an operating room. So people see this tremendous care that is being given to poor neighborhoods and they say, well, wait a minute, why are we getting crappy care when these people are getting wonderful care? The flip side to that is, even though they’re acknowledging, hey, this is incredible care, they don’t necessarily want it delivered by the People of Freedom House. This was a city that had filled in its swimming pool um when it was forced to desegregate it. There are suburbs where they have outlawed covenants, so you can now sell your home to anyone you wish. But you know, white families begin spite selling their homes to Black families in order to, you know, uh take revenge on neighbors that they don’t like. So that is a, you know, a very uh a tricky environment. You know, when you have people who are coming from these suburbs and they’re coming into the city and they have a medical emergency, and the people who are walking to the door are clearly people that they in their normal life that they would not want to interact with. And there are instances, a number of them, where the medics are told um, I don’t want you to touch me. You know, can’t you just drive me to the hospital? Why do you have to do this? There’s one point where John Moon and his his partner, George McCarry, are treating a woman with chest pain. And they say, look, we need to put these electrodes on you because we need to see what your heart’s doing so we can give you morphine and aspirin and these other drugs to help you. And she says, well, no, I don’t want you to do that. And so they explain we can either if we do this, um you know, we can treat you. But if we don’t, there’s a chance that you could die. And there’s a hesitation there. And in that hesitation between dying and allowing Black men to touch me is kind of all you need to know about how complicated the situation was. And, you know, that’s the environment in which they were trying to practice medicine. 

Dr. Abdul El-Sayed: Man, what an illustration of the obscenity of racism. Um.

Kevin Hazzard: That’s such a good way to put it. That’s such a good way to put it. 

Dr. Abdul El-Sayed: You can you can also just imagine being this these folks riding around in the ambulance, not knowing what you’re going to see next, which is of course, the nature of being an EMT or paramedic and and also not knowing what manifestation of the civil strife around you is going to show up next. Right. Are you going to have to do battle with the cops to be able to save someone’s life? Are you going to have to deal with someone’s racism to save their life despite themselves? Uh. Are you going to be able to answer a call um that may be saving the life of someone with whom you grew up? I mean, this this particular moment in history, particular moment in time, and and particular group of people um really uh exemplifies so much of that particular moment. I want to shift to the question of being an EMT, a paramedic. I went to medical school. Um. I have been around many, many EMTs and paramedics. And they always um strike me as being folks who truly, deeply care, but also uh have a unique um interest in the adrenaline side of health care. Um. [laugh] And uh I’d love to ask, you know, as someone who sort of is a professional descendant from um from John Moon and the other uh EMS folks um from Freedom House, how do you see the profession having shifted since then? Is it still the same sort of um personality thumbprint that that you tend to see uh or um or has it has it changed quite a bit? 

Kevin Hazzard: I mean, [laugh] these guys were getting into it for different reasons. So I, I, but what I find intriguing is that in many ways they come, they came from all sorts of, of, of backgrounds or at least approaches. You know, these were guys of varying degrees of education. There were some who who didn’t finish high school. Um. There were some that were college graduates. They were there were war veterans. Um. They were kind of guys who were just chillin on the street and didn’t know what to do, and this opportunity came along and they said yeah okay, I’ll give this a try. Today, people understand the field, but it still draws this weird, you know, stew of people who come in, who are very interested in in some version, they’re interested in medicine. They are interested in chaos. You have to you know, anyone who’s ever been on an emergency call knows that more than anything, it is the process of trying to control chaos. All hell is breaking loose and you’re all you’re really trying to do is like wrangle every all the pieces together and get them all sort of moving chaotically in the same direction. And so you have to kind of enjoy all that stuff. But, you know, you don’t you’re not going to work in a hospital. There’s not going to be, there’s no air conditioning, there’s no heat. There’s there’s not a security guard, there’s not a cafeteria. There is nobody um waiting. You know, registration is not waiting to take the patient’s information down. There’s not a phlebotomist waiting to draw blood. There’s not a nurse waiting to do vitals and give the meds. You know, you’re trying to do all these things here. And there’s not an attending physician who’s standing in the back, you know, looking at the resident saying, okay, you tried that, it didn’t work and maybe once you guys try this all that you’re sort of all those things wrapped into one and, you know, in a lot of ways it’s it’s not the world’s most enviable um career because it’s really difficult. And I don’t know that people recognize it as as important as it is. So while it’s so you know, it’s so crucial and so rewarding, it is not always rewarded. And you have to you have to know all that and just say, ah screw it, I’m doing it anyway. And that is a very specific personality. And I think the guys who did it then and were you know showing up and, you know, doing all this, you know, middle of the night, you know, in abandoned buildings, running around, you know, trying to wrangle patients and trying to, you know, even on a very controlled call, trying to convince patients that, you know, hey, we’re medical professionals and we’re here to keep you alive. Um. You know, there’s still that element of chaos and it still draws you know, I think it’s the sort of maverick element. 

Dr. Abdul El-Sayed: Mmn. I um you know, I’m I’m struck by uh your description of the kind of experience that um one faces and the kind of personality that’s drawn to that kind of experience in the context of the pandemic, um when uh for a long time, our society paid a lot of lip service. And I think still do to frontline workers, people who are out there every single day doing battle with a pandemic or battle with uh traffic accidents or battle with you name the thing um that so many of us, you know, have the privilege of running away from. But it’s their job to run toward. And at the same time. Right. We talk about these things, but but we don’t necessarily put our, literally our money where our mouth is. You know, you look at the the pay rates for folks who are EMTs or paramedics, and they’re not close to what other frontline professionals are getting. Um. Why do you think that exists? Do you think that um, you know, the the origin story of uh of of this line of work has something to do with it and how do we fix that? 

Kevin Hazzard: I mean, I think it I think part of it, quite frankly, is that it is this strange part of public safety that is very easy to overlook. You know, when an emergency happens, there’s a big wreck on the highway. They talk about on the news, they talk about cops, firefighters, and other emergency personnel. That other emergency personnel. Those are the paramedics that were doing the work of actually, you know, treating the patient. Um, you know I, it is a very easy thing to overlook. I think it is very commonly overlooked. It requires public funds to get it done. When I first started, I could have made significantly more money had I quit my job and walked to Starbucks, um that would have made me more money. I don’t know. I don’t really know how to change that. You know, that is an ongoing conversation. One of the biggest problems that EMS faces is what do you do once you’re an experienced paramedic? Where do you go? 

Dr. Abdul El-Sayed: Yeah. 

Kevin Hazzard: Because you can you can be a nurse. Um. I guess you could go to med school. If, you know, if you’re so inclined and talented, uh you could go I don’t know, maybe a flight job. But those are incredibly uh few and far between and and they often are so competitive that they pay less because they can. So not a lot of people are willing to take a pay cut. It’s a it’s a tricky thing. So so what happens to an experienced paramedic when they leave the field? You know, they do end up in a hospital. They do end up you know, they become a nurse. They do something else because they’re a PA, because they’re like there is nowhere for it to go. There there’s not a good ladder right now for you to climb. And, you know, I think a lot of that comes back to its history. And its history is is this thing that, you know, was part of the fire department, but only because the fire department had to have it. And or, you know, it’s a private company and, you know, private companies come and go. And so it’s very it feels very transient. You know, I didn’t didn’t know any paramedics who off of being a paramedic who had a pension and then expected to be there for 35 years. It was it was a job uh more so than a career. And I think until those kind of things are addressed, you’re going to face the immediate, you know, problems of retention and payment and, you know, getting people to take pride in what is not only a very critical job, but a really difficult one. It’s not easy. 

Dr. Abdul El-Sayed: Yeah. Yeah. The the other part of this is that you talked a little bit about the bureaucratic housing of this profession. And in some communities, there are private EMS companies. Uh. In some they’re run by the the the fire department. Um. And it’s always somewhat precarious. Now, one of the the the things that I found is that in lower income communities, particularly urban communities uh like The Hill, where this entire practice was founded, you tend to have uh less efficient paramedic services, which, you know, is a function of of the same types of what we call social determinants or um the the patterns that pattern access to all kinds of things, uh including health and health care services. Um. Why do you think that is? And um you know it just seems to me so, so tragically ironic um that this entire uh phenomena of paramedic services would have been founded in a low income, predominantly Black part of a uh midwestern city. And yet so many low income, predominantly Black parts of Midwestern cities are so underserved. 

Kevin Hazzard: Why are the sidewalks more cracked in certain neighborhoods than they are in others? 

Dr. Abdul El-Sayed: Yeah. 

Kevin Hazzard: You know, I mean, it is a function of where we prioritize our resources and it simply isn’t um you know always in the right places. I know in Atlanta we spent the vast majority of our time in neighborhoods very similar to the Hill District and very little time in wealthier neighborhoods, because that was where the calls were most likely to go out. And what you had in that in those neighborhoods were people who used both the 911 system and the E.R. as a sort of a, you know, a family doctor. And people would grumble about that and say, you know, none of these calls are emergencies. And [?] but so so what’s the reason? Why is it that people in these neighborhoods are calling 911 and riding an ambulance to the hospital because their child has a fever? Well, it is a lack of access to those sort of, you know, health care components. The you know, the pediatrician, the family doctor’s office, someone being involved in their health care and making sure that they’re taking their blood pressure meds. I mean, if you go to a poor side of town, you’re probably more likely to see a lot of uh dialysis clinics. And, you know, that’s a product of people not taking blood pressure medications and causing kidney failure. Well, that, to get someone to take the blood pressure medicine they need to be a part of you know, that they need to be underneath a health care umbrella. And if that thing is not, you know, if they’re if that is not sheltering them, then then, you know, everything kind of goes awry. And I think that’s so much of that, access to health care is so critical, so many things begin you know, we you hear these talks about like food deserts, grocery stores not being in in poor neighborhoods, I think it’s, you know, community medical centers are as critical as anything else. And and it it’s a tiny piece that just very quickly snowballs. 

Dr. Abdul El-Sayed: You’re making a really important point here. And there’s a notion that when people don’t have the health care access that they need and deserve in full, that they’re just not going to get health care. That’s actually not the case. It’s that they’re going to get health care when it’s least effective and least efficient. And often times that ends up um showing up in the emergency room or before the emergency room, which is uh in EMS. And so what happens is EMS resources, emergency resources get drawn away from, quote unquote, “true emergencies”, although they are truly emergencies for these folks, except for they just don’t have other institutions that they can go to to get access to the care that would best meet their needs in that moment. And so as a system, we have, in effect, chosen to um not to invest in the most effective and efficient forms of health care for the lowest income people. And instead, we’ve saddled our entire health care system with that burden. More importantly, though, we have forced people to forego access to health care when it’s the most effective for them uh and um and then to access it when it’s uh the least effective and then least efficient for everyone else. And, you know, this is the this is the choice we are actively making, simply so that health care corporations can make as much money as humanly possible by charging rates that make sure that they profit and um and thereby excluding folks um from the obvious means of health care like a primary care clinic. And you’re right, there are bureaucratic fixes. You have federally qualified health centers that do amazing work. Um. But even then, I’ve never met an FQHC uh director, and I’ve met many FQHC directors, who says that um, you know, we are able to meet all of the demand that exists for our services. And so, you know, it is this is the health care system we’ve wed ourselves to. 

Kevin Hazzard: Yeah. 

Dr. Abdul El-Sayed: Going going back to um to Freedom House, EMS, um they uh ended up working alongside um the city for some time. Uh. Can you walk us through what ultimately ended up happening? How did they get there? And then what happened next? 

Kevin Hazzard: So as the seventies progressed, the city of Pittsburgh is kind of finds itself in a funny position because they have for years resisted Freedom House and they’ve also resisted the idea of paramedics. But the rest of the country has embraced this idea in not only as a television show Emergency all over TV. And, you know, millions of people are watching it. But cities, large and small, have paramedics. And [laughing], you know, the originals are sitting right there in Pittsburgh. And the city was doing everything they could to try to shut [?] down. They cut their budget. Um. They had instituted a bunch of rules to make it more difficult for them to operate. You know, it was just it was a it was an ongoing battle. So finally, the city can no longer fight this battle. And they are forced to acknowledge that paramedics are a viable form of medicine. And so they said, okay, fine, we’re going to we’re going to start a paramedic corps. And they do. And they start one completely independent of not only the people who designed Freedom House, Peter Safar and the other doctors involved, but it was independent of the people who’d been working on the Freedom House ambulances. And so it is essentially an all white paramedic group that’s completely, you know, inexperienced and brand new in the city, launches it and almost immediately things start to go haywire. And so they reach out to Nancy Caroline, and they say, hey, uh we need to um we need some help. And would you come over here as our medical director. And she says, yeah, sure. The only stipulation I have is that you have to hire all of my people. Anyone who from Freedom House wants a job, you have to hire them. And so the city says yes but you know, what we find out very quickly is they were forced to hire the people of Freedom House. They were not forced to keep them. So in October of ’75, the city cuts off funding from Freedom House. It shuts down, it ceases to operate, and the people who want are swallowed by uh Pittsburgh EMS. And over the course of the next 12 months, the city works very systematically to get rid of them, though they said they would not. They test everyone from Freedom House on a weekly basis, a pass fail test, and if you fail, you’re fired. 

Dr. Abdul El-Sayed: Wow. 

Kevin Hazzard: These are people who had just been named the National Standard in paramedic training and this brand new program with no experience is testing them? Um. They’re moved on different shifts. They’re moved with different partners. They’re not allowed to practice up to their standard of care. So they’re usually sitting in the back of the ambulance holding the bag while these brand new paramedics who don’t have experience are up front calling the shots. 

Dr. Abdul El-Sayed: Wow. 

Kevin Hazzard: And people get very frustrated. They some of them, you know, eventually fail one or two of these tests and they’re gone. Um. Others just say, I’ve had enough and I’m out. But a handful hold on. And the ones that do, you know, go on to have long and distinguished careers. But, you know, there was a, a very concerted effort to sort of wipe this part of the history from the books. 

Dr. Abdul El-Sayed: Wow. What what is the legacy uh of Freedom House, EMS as you think about this work in this time um what is what is the legacy and how should we be thinking about that vis a vis how the program ended and was ended um as a function of the same exact system of racism we’ve been talking about all along? 

Kevin Hazzard: There. There’s some very tangible things. The design of the ambulance, the color scheme of the ambulance, um the equipment that paramedics carry. The introduction of the medical director. Introduction of Narcan. Uh. The drugs that are used. There are many things that Freedom House pioneers. And so technically you could look at that and say, well, well there you go. That’s that is the Freedom House legacy. These things that they passed on to the field of of EMS. But I think the larger story is one of resilience and perseverance. You know, so many times in our history, somebody has been marginalized and they fought to make their mark in the face of that and have succeeded. And, you know, that is really the story. You know, if you ask these guys, um they didn’t, you know, go crying into a hole in 1975 when this thing shut down, as angry as they were and as frustrated as they were, they held on and they continued to climb and they continued to grow. And they went on to live, you know, big lives. There were people who wound up the assistant chief of, you know, a guy, John Moon, wound up the assistant chief of Pittsburgh EMS. There were PhDs, masters, MDs that came out of this. Um. One of the guys left and went to Ohio, where he served as public safety director for Cleveland and in Columbus and then became a politician there. So, you know, Nancy Caroline left and and started the EMS the national EMS program in Israel. Then started their hospice program, spent years in East Africa as an AMREF flying doctor. Peter Safar was nominated three times for the Nobel Prize in Medicine. So the people who were involved in Freedom House, they continued to grow. And not just the physicians, but the people who were involved, the people on the ambulances. And you know, that more than anything is the story of, you know, people demanding to be uh reckoned with based on their character and their accomplishments and their abilities as opposed to where they were born or how they looked and forcing their way through the door and saying, we’re here and this is what we’re going to do. And I think that’s something to hold on to. You know, that is, you know, things might not change, certainly not as quickly as we’d like them to. But one thing that will always be there is, you know, the the uh the success of perseverance, of somebody refusing to quit and refusing to go away, regardless of how many times are told no thanks, not wanted. Um. They keep knocking on the door. And, you know, that really to me is the legacy of Freedom House. 

Dr. Abdul El-Sayed: I really appreciate you uh both bringing this story to life in the book um and telling it uh to us here. Folks, really recommend checking out the book. It’s extremely well written and um riveting, and it is a piece of history that uh I think we don’t have an excuse um to forget again. Our guest today was Kevin Hazzard. He is the author of the new book American Sirens. I hope you’ll check it out. Kevin, thank you so much for taking the time. 

Kevin Hazzard: Thank you. I appreciate it. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. I hate to remind you this, but this is what we all were hearing after our Thanksgiving dinners last year in 2021. 

[clip of unspecified news reporter] COVID 19 hospitalizations have jumped by 70% since the US Thanksgiving holiday just three weeks ago. 

Dr. Abdul El-Sayed: Omicron, a new COVID variant, was wreaking havoc in South Africa and would ultimately go on to cause more illness and death than every COVID variant that came before it. That was one year ago. This year, cases, hospitalizations, and deaths are starting to slowly tick upwards. The consequence of so many Omicron descendants all doing battle to infect us. Cases are up 7% over the last two weeks and hospitalizations are up 3% and deaths up 5%. And make no mistake, while I don’t think we’re going to see the same spike that we saw last year after Thanksgiving, cases are likely to go upward. Critically, as we discussed a few weeks ago, COVID won’t be the only virus pummeling our health care system. It’ll also be RSV, which is filling up hospitals with infants and toddlers and the flu. But don’t sleep on COVID. A new analysis of COVID deaths found that, unlike in the past, the majority of COVID deaths is now occurring among vaccinated people. You heard that right. Vaccinated people now make up 59% of all COVID deaths. That’s up from 42% in January and February last year. But there’s a catch. The vaccinated people who are dying are disproportionately likely to be elderly, and though they may be vaccinated, they’re not up to date on their vaccines. One thing I want you all to understand here, it’s not that vaccinated people aren’t protected from COVID. When you correct for the impact of age, vaccinated people at all ages are still less likely to die of COVID than unvaccinated people of similar age. It’s that so many older people are now partially vaccinated. They’re just not up to date. And the overall number of deaths among that group means that vaccinated people account for more deaths than unvaccinated people overall. This might be a good time to remind you, if you’re not up to date on your vaccines, yes, vaccines both flu and COVID. This would be a great time to take care of that. Finally, as we emerge from a holiday dedicated specifically to family and togetherness, it’s worth remembering that America is more alone than it’s ever been. Loneliness is a full blown American epidemic. 36% of Americans over 50 live alone. That’s 26 million Americans, nearly double the number of that age group living alone in the year 2000. There are lots of causes for this. More people who were never married or got separated or divorced, more people who never had children. And there are certainly some upsides to this, independence and opportunities that older folks, particularly women, never enjoyed in the past. And yet the scientific evidence is clear about the impact of living alone in older age, people who live alone have categorically worse mental and physical health. They’re more likely to experience depression, less likely to engage in key health behaviors like being up to date on vaccines or getting screening exams like colonoscopies and mammograms, and they ultimately die younger for it. All of this reminds us that health is about a lot more than what happens in our bodies. It’s about what happens in our society and about how we adjust to changing norms and mores to support folks in new ways as society changes. Creating togetherness and support for folks aging alone would be a critical place to focus. That’s it for today. On your way out, please do rate and review the show. It really does go a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some American Dissected merch. We’ve got our logo, mugs and T-shirts. Our science always wins sweatshirts and dad caps are available too. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez, and me. Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health.