1 00:00:01,280 --> 00:00:04,320 Speaker 1: Welcome to Stuff you missed in History Class, a production 2 00:00:04,360 --> 00:00:13,440 Speaker 1: of I Heart Radio. Hello, and welcome to the podcast. 3 00:00:13,480 --> 00:00:16,720 Speaker 1: I'm Holly Fry and I'm Tracy V. Wilson. And this 4 00:00:16,800 --> 00:00:20,880 Speaker 1: is a part two. Uh, you won't necessarily be lost 5 00:00:20,960 --> 00:00:23,560 Speaker 1: if you jump in here, because we're kind of talking 6 00:00:23,600 --> 00:00:28,520 Speaker 1: about episodic developments in emergency medicine. But that'll give you 7 00:00:28,600 --> 00:00:30,479 Speaker 1: some good background for how we get to the place 8 00:00:30,520 --> 00:00:33,800 Speaker 1: we start here. In our first episode, we talked about 9 00:00:33,880 --> 00:00:36,879 Speaker 1: some of the earliest emergency and first responder efforts in 10 00:00:36,920 --> 00:00:40,480 Speaker 1: the US, as well as resuscitation and then the rise 11 00:00:40,560 --> 00:00:44,000 Speaker 1: of emergency medicine as a medical specialty. Today, we're going 12 00:00:44,040 --> 00:00:47,040 Speaker 1: to jump right in and talk about a paper that 13 00:00:47,200 --> 00:00:50,239 Speaker 1: was very important. Yeah, So, as all of that was 14 00:00:50,280 --> 00:00:54,440 Speaker 1: playing out with with emergency medicine evolving as a specialty, 15 00:00:54,640 --> 00:00:58,040 Speaker 1: other strides and milestones and emergency medicine were also happening. 16 00:00:58,680 --> 00:01:02,360 Speaker 1: In nineteen sixties six, a white paper entitled Accidental Death 17 00:01:02,360 --> 00:01:06,520 Speaker 1: and Disability, the Neglected Disease of Modern Society was released. 18 00:01:07,120 --> 00:01:10,520 Speaker 1: This paper, published by the National Academy of Sciences National 19 00:01:10,640 --> 00:01:14,760 Speaker 1: Research Council Committees on Trauma and Shock, is often referenced 20 00:01:14,760 --> 00:01:17,959 Speaker 1: as a really pivotal point in the development of emergency 21 00:01:18,000 --> 00:01:21,120 Speaker 1: medicine in the United States. The paper opens with the 22 00:01:21,160 --> 00:01:25,840 Speaker 1: following statement, quote, in nineteen sixty five, fifty two million 23 00:01:25,959 --> 00:01:31,560 Speaker 1: accidental injuries killed one hundred seven thousand people, temporarily disabled 24 00:01:31,600 --> 00:01:36,119 Speaker 1: over ten million, and permanently impaired four hundred thousand American 25 00:01:36,200 --> 00:01:41,240 Speaker 1: citizens at the cost of approximately eighteen billion dollars. This 26 00:01:41,319 --> 00:01:44,840 Speaker 1: neglected epidemic of modern society is the nation's most important 27 00:01:44,959 --> 00:01:48,360 Speaker 1: environmental health problem. It is the leading cause of death 28 00:01:48,400 --> 00:01:51,560 Speaker 1: in the first half of life's span. And it then 29 00:01:51,560 --> 00:01:53,920 Speaker 1: went on to say that quote public apathy to the 30 00:01:53,960 --> 00:01:58,040 Speaker 1: mounting toll from accidents must be transformed into an action 31 00:01:58,120 --> 00:02:02,520 Speaker 1: program under strong leader ship. The paper discusses how other 32 00:02:02,720 --> 00:02:05,720 Speaker 1: problems that have arisen in terms of the health of 33 00:02:05,760 --> 00:02:08,440 Speaker 1: the public have been have seen action from both federal 34 00:02:08,480 --> 00:02:13,040 Speaker 1: agencies and various volunteer agencies, and those problems included things 35 00:02:13,080 --> 00:02:17,920 Speaker 1: like congenital disabilities, cancer, heart disease, things like that. They 36 00:02:17,919 --> 00:02:21,200 Speaker 1: said that similar efforts could make a significant impact on 37 00:02:21,400 --> 00:02:24,720 Speaker 1: accidental death and disability, and it called for better training 38 00:02:24,840 --> 00:02:29,400 Speaker 1: for emergency responders, research into trauma, and efforts to educate 39 00:02:29,440 --> 00:02:33,600 Speaker 1: the public about accident prevention and emergency medical services. In 40 00:02:33,720 --> 00:02:37,640 Speaker 1: breaking down the numbers of just how serious preventable accidents 41 00:02:37,680 --> 00:02:40,560 Speaker 1: were in terms of mortality and the resources needed to 42 00:02:40,600 --> 00:02:43,480 Speaker 1: treat them, the paper made a very clear case that 43 00:02:43,560 --> 00:02:47,160 Speaker 1: in not addressing these issues, many of which had compounded 44 00:02:47,160 --> 00:02:51,359 Speaker 1: over the years as technological and industrial advances became more commonplace, 45 00:02:51,880 --> 00:02:55,360 Speaker 1: the government, the public, and hospitals were all paying a 46 00:02:55,400 --> 00:02:58,400 Speaker 1: steep price, and one of the main issues was a 47 00:02:58,480 --> 00:03:01,880 Speaker 1: steep rise in automobile accidents as more and more people 48 00:03:01,960 --> 00:03:04,920 Speaker 1: got behind the wheel. This is also tied into the 49 00:03:04,960 --> 00:03:08,120 Speaker 1: development of the poison control system and accidental poisonings that 50 00:03:08,160 --> 00:03:11,840 Speaker 1: we talked about in our recent episode Yeah Too. Specific 51 00:03:11,880 --> 00:03:14,680 Speaker 1: areas of medicine that received a lot of attention in 52 00:03:14,680 --> 00:03:19,320 Speaker 1: this paper were ambulances and emergency departments. The paper noted 53 00:03:19,360 --> 00:03:22,880 Speaker 1: the lack of consistent standards and ambulance service and a 54 00:03:22,960 --> 00:03:27,040 Speaker 1: lack of funding for such services, the absence of certification 55 00:03:27,200 --> 00:03:30,600 Speaker 1: or licensing for ambulance personnel in most places, and the 56 00:03:30,600 --> 00:03:34,240 Speaker 1: fact that there was no such thing as a manufactured ambulance. 57 00:03:34,760 --> 00:03:38,760 Speaker 1: All existing ambulances were conversions of vehicles that had not 58 00:03:39,080 --> 00:03:41,680 Speaker 1: been built in order to do that job. Yeah For 59 00:03:41,840 --> 00:03:45,360 Speaker 1: most ambulances, what they were doing was just carrying a person. 60 00:03:45,520 --> 00:03:48,520 Speaker 1: They weren't really providing any kind of care, and a 61 00:03:48,560 --> 00:03:50,840 Speaker 1: lot of the ambulances you would see in the street 62 00:03:51,320 --> 00:03:56,120 Speaker 1: were converted horses or sometimes horses that worked both for 63 00:03:56,320 --> 00:04:00,560 Speaker 1: morticians offices and carrying bodies to the hospital. The other 64 00:04:00,640 --> 00:04:03,800 Speaker 1: major issue in ambulance service that was pointed out in 65 00:04:03,840 --> 00:04:07,640 Speaker 1: the paper was the ongoing problem of communication, and this 66 00:04:07,680 --> 00:04:10,440 Speaker 1: point was actually made by comparing it to the space 67 00:04:10,480 --> 00:04:14,360 Speaker 1: program quote. Although it is possible to converse with the 68 00:04:14,400 --> 00:04:18,840 Speaker 1: astronauts in outer space, communication is seldom possible between an 69 00:04:18,839 --> 00:04:23,560 Speaker 1: ambulance and the emergency department. It is approaching. Even though 70 00:04:23,560 --> 00:04:27,560 Speaker 1: there were already radio frequency channels dedicated to emergency use 71 00:04:27,600 --> 00:04:31,279 Speaker 1: by the Federal Communications Commission, they were not consistently being 72 00:04:31,400 --> 00:04:35,160 Speaker 1: used for dispatch and tracking, or ambulances or hospitals having 73 00:04:35,200 --> 00:04:39,440 Speaker 1: access to information about the developments of possible medical emergencies 74 00:04:39,720 --> 00:04:42,719 Speaker 1: such as train or traffic accidents. When it came to 75 00:04:42,800 --> 00:04:46,800 Speaker 1: emergency departments, the paper's assessment of the situation was similarly 76 00:04:46,839 --> 00:04:50,119 Speaker 1: really grim. It mentioned the same issue that we talked 77 00:04:50,120 --> 00:04:54,120 Speaker 1: about regarding the development of Alexandria, Virginia's emergency department, that 78 00:04:54,200 --> 00:04:57,560 Speaker 1: people were using it for outpatient care more than for 79 00:04:57,640 --> 00:05:01,400 Speaker 1: actual emergencies. Quote. More than two thirds of the forty 80 00:05:01,520 --> 00:05:05,240 Speaker 1: million emergency room visits in nineteen sixty six cannot be 81 00:05:05,320 --> 00:05:10,400 Speaker 1: classified as emergencies. But at the same time, emergency departments 82 00:05:10,400 --> 00:05:13,920 Speaker 1: were still having all kinds of problems. While it was 83 00:05:13,960 --> 00:05:17,039 Speaker 1: recognized that full time physicians needed to be contracted for 84 00:05:17,120 --> 00:05:21,560 Speaker 1: work in emergency departments, that cost often meant that hospitals 85 00:05:21,560 --> 00:05:24,440 Speaker 1: were actually losing money on emergency care because they had 86 00:05:24,480 --> 00:05:26,919 Speaker 1: to pay the staff, but they weren't always taking money 87 00:05:26,960 --> 00:05:30,000 Speaker 1: in for their work. There also weren't that many doctors 88 00:05:30,000 --> 00:05:33,240 Speaker 1: who were trained in emergency medicine, so many hospitals were 89 00:05:33,279 --> 00:05:37,080 Speaker 1: still making all the members of their medical staff, regardless 90 00:05:37,120 --> 00:05:39,200 Speaker 1: of whether they were just, you know, like a specialist 91 00:05:39,200 --> 00:05:44,360 Speaker 1: in some particular field, take emergency department shifts. The Accidental 92 00:05:44,400 --> 00:05:49,000 Speaker 1: Death and Disability paper recommended that medical undergraduate and residency 93 00:05:49,000 --> 00:05:52,719 Speaker 1: programs be improved to offer adequate training and trauma and 94 00:05:52,760 --> 00:05:57,400 Speaker 1: emergency care, that more research be done into trauma and shock, 95 00:05:57,760 --> 00:06:01,360 Speaker 1: and the hospital's plan ahead for population growth when developing 96 00:06:01,440 --> 00:06:06,039 Speaker 1: or implementing their emergency unit procedures, and budgets. There were additional, 97 00:06:06,279 --> 00:06:10,480 Speaker 1: much more specific recommendations for the emergency services in general. 98 00:06:11,040 --> 00:06:14,159 Speaker 1: For one, it stated that municipalities needed to make clear 99 00:06:14,240 --> 00:06:17,919 Speaker 1: where their hospitals were, writing quote, it is essential that 100 00:06:18,080 --> 00:06:22,040 Speaker 1: road maps and road signs and appropriate locations designate routes 101 00:06:22,080 --> 00:06:25,839 Speaker 1: to hospitals and emergency departments. And there was also a 102 00:06:25,880 --> 00:06:28,000 Speaker 1: call to ensure that in cities where there might be 103 00:06:28,080 --> 00:06:32,240 Speaker 1: multiple hospitals, patients and ambulances were routed to the facility 104 00:06:32,400 --> 00:06:36,000 Speaker 1: best equipped to treat their specific injury or illness. To 105 00:06:36,360 --> 00:06:40,520 Speaker 1: properly be able to determine which facilities offered specific levels 106 00:06:40,560 --> 00:06:44,520 Speaker 1: of care, it was recommended that emergency departments be sorted 107 00:06:44,520 --> 00:06:48,760 Speaker 1: into four classifications. The first of these, Type one was 108 00:06:48,839 --> 00:06:51,800 Speaker 1: called an advanced first Aid facility. This would mean there 109 00:06:51,839 --> 00:06:54,320 Speaker 1: was not a full time physician on staff and that 110 00:06:54,400 --> 00:06:58,480 Speaker 1: it would be best for minor issues and possibly emergency resuscitation. 111 00:06:58,839 --> 00:07:03,200 Speaker 1: Type two was limited emergency facility, and this classification would 112 00:07:03,240 --> 00:07:06,040 Speaker 1: mean that there was a nurse available at all times, 113 00:07:06,279 --> 00:07:09,840 Speaker 1: maybe a physician. The unit operated twenty four hours a 114 00:07:09,920 --> 00:07:12,760 Speaker 1: day and could address more serious injuries than a Type 115 00:07:12,760 --> 00:07:15,920 Speaker 1: one facility, but still would not likely be able to 116 00:07:15,960 --> 00:07:20,160 Speaker 1: manage a critical injury scenario. Type three was categorized as 117 00:07:20,200 --> 00:07:24,800 Speaker 1: a major emergency facility. This is a department classification that 118 00:07:24,840 --> 00:07:28,160 Speaker 1: would mean that that department was able to quote render 119 00:07:28,240 --> 00:07:31,600 Speaker 1: complete care to the severely injured or the seriously ill. 120 00:07:32,360 --> 00:07:35,520 Speaker 1: And this classification would mean that that department was staffed 121 00:07:35,520 --> 00:07:38,960 Speaker 1: with both nurses and doctors at all hours, and it 122 00:07:39,000 --> 00:07:42,200 Speaker 1: would have a unit director with experience and knowledge in 123 00:07:42,320 --> 00:07:46,440 Speaker 1: triag ing and treating patients with severe trauma. Type four 124 00:07:46,640 --> 00:07:50,600 Speaker 1: was an emergency facility combined with trauma research unit, and 125 00:07:50,600 --> 00:07:53,360 Speaker 1: this was intended to designate an emergency department at the 126 00:07:53,360 --> 00:07:56,640 Speaker 1: type three level that worked in correlation with staff that 127 00:07:56,680 --> 00:08:00,480 Speaker 1: could help establish and manage trauma registries and a trauma 128 00:08:00,480 --> 00:08:04,440 Speaker 1: committee that could tract patient care and identify areas for improvement, 129 00:08:04,520 --> 00:08:07,600 Speaker 1: among other duties. And this report was one of the 130 00:08:07,600 --> 00:08:11,200 Speaker 1: first times that information about the gaps in emergency care 131 00:08:11,200 --> 00:08:14,600 Speaker 1: in the US was really pulled together and widely shared, 132 00:08:15,000 --> 00:08:17,960 Speaker 1: and it made a big impact as the medical community 133 00:08:18,000 --> 00:08:20,600 Speaker 1: assessed how they could fill those gaps and provide that 134 00:08:20,640 --> 00:08:23,480 Speaker 1: better care that was needed. One of the authors of 135 00:08:23,480 --> 00:08:26,680 Speaker 1: the paper, John M. Howard, m D, wrote in two 136 00:08:26,720 --> 00:08:29,400 Speaker 1: thousand nine about having been a part of this project, 137 00:08:29,720 --> 00:08:32,920 Speaker 1: He wrote, quote, in many ways, the challenges facing e 138 00:08:33,080 --> 00:08:36,120 Speaker 1: MS now are similar to those we faced thirty odd 139 00:08:36,200 --> 00:08:39,520 Speaker 1: years ago. We can see the potential for better patient 140 00:08:39,600 --> 00:08:42,480 Speaker 1: care just beyond the horizon, and we need a plan 141 00:08:42,600 --> 00:08:46,040 Speaker 1: for getting there. Changes of this magnitude do not come 142 00:08:46,120 --> 00:08:49,840 Speaker 1: quickly or easily, but the rewards far outweighed the effort. 143 00:08:50,480 --> 00:08:53,040 Speaker 1: One of the outcomes of this paper was the introduction 144 00:08:53,080 --> 00:08:57,080 Speaker 1: of the National Highway Safety Act of nine. That act 145 00:08:57,200 --> 00:09:01,120 Speaker 1: established the Department of Transportation, under which the National Highway 146 00:09:01,120 --> 00:09:05,160 Speaker 1: Traffic Safety Administration was formed in nineteen seventy. It is 147 00:09:05,160 --> 00:09:08,400 Speaker 1: not surprising that in the years immediately following its publication, 148 00:09:08,559 --> 00:09:11,280 Speaker 1: a number of significant events happened in the field of 149 00:09:11,320 --> 00:09:15,920 Speaker 1: emergency medicine. For one, a formalized system of ambulance personnel 150 00:09:16,000 --> 00:09:18,600 Speaker 1: training came out of a conference that started in nineteen 151 00:09:18,640 --> 00:09:22,480 Speaker 1: sixty seven, the National Conference of Emergency Medical Services that 152 00:09:22,559 --> 00:09:25,319 Speaker 1: was hosted by the American Medical Association. We're going to 153 00:09:25,440 --> 00:09:28,600 Speaker 1: talk some more about emergency training in just a bit, 154 00:09:29,080 --> 00:09:32,400 Speaker 1: but uh, yeah, this paper catalyzed a lot of movement. 155 00:09:32,679 --> 00:09:34,440 Speaker 1: Coming up, we're going to talk about the number that 156 00:09:34,480 --> 00:09:36,840 Speaker 1: folks in the US have been trained for years to 157 00:09:36,880 --> 00:09:39,160 Speaker 1: call in an emergency, but first we will take a 158 00:09:39,200 --> 00:09:49,600 Speaker 1: sponsor break. In nineteen sixty eight, a significant and now 159 00:09:49,800 --> 00:09:52,880 Speaker 1: very familiar phone number was established that has become part 160 00:09:52,920 --> 00:09:56,840 Speaker 1: of emergency services in the US and other places ever since, 161 00:09:57,000 --> 00:09:59,800 Speaker 1: and that is nine one one. There had been re 162 00:10:00,040 --> 00:10:02,640 Speaker 1: quests for a service like this for more than a decade. 163 00:10:03,080 --> 00:10:06,320 Speaker 1: In the nineteen fifties, the National Association of Fire Chiefs 164 00:10:06,320 --> 00:10:09,160 Speaker 1: had asked for a dedicated number that people could use 165 00:10:09,200 --> 00:10:13,800 Speaker 1: to report fires. Before nine one one was established, and 166 00:10:13,880 --> 00:10:16,680 Speaker 1: before it was implemented, everywhere, dialing for help an emergency 167 00:10:16,720 --> 00:10:20,440 Speaker 1: could be tricky. For one, every municipality had their own 168 00:10:20,520 --> 00:10:23,520 Speaker 1: service or service number. They were not uniform from one 169 00:10:23,520 --> 00:10:26,840 Speaker 1: place to another. Where I grew up, if I was 170 00:10:26,880 --> 00:10:29,200 Speaker 1: at home, there was one number. If I was at 171 00:10:29,280 --> 00:10:31,320 Speaker 1: my dad's office in the city, there was a different one. 172 00:10:32,200 --> 00:10:34,880 Speaker 1: Um if you were traveling, the odds of knowing the 173 00:10:34,960 --> 00:10:37,680 Speaker 1: number in a place that wasn't your hometown were pretty low. 174 00:10:38,320 --> 00:10:41,079 Speaker 1: Many people in these situations would dial zero to get 175 00:10:41,120 --> 00:10:44,120 Speaker 1: the operator, but if they were in a busy metro area, 176 00:10:44,200 --> 00:10:46,880 Speaker 1: that meant that their call, which could be life or death, 177 00:10:47,120 --> 00:10:50,199 Speaker 1: was in a queue with non emergency calls like people 178 00:10:50,240 --> 00:10:53,040 Speaker 1: just trying to get phone numbers or be connected to 179 00:10:53,080 --> 00:10:57,679 Speaker 1: some municipal department. Those moments lost waiting on a switchboard 180 00:10:57,720 --> 00:11:00,200 Speaker 1: could mean that helped did not arrive in time time, 181 00:11:00,280 --> 00:11:02,559 Speaker 1: and if you live in a really busy city, there 182 00:11:02,600 --> 00:11:05,520 Speaker 1: could have been multiple possible numbers to call. Is there 183 00:11:05,559 --> 00:11:08,079 Speaker 1: was a lot of coverage overlap among different fire and 184 00:11:08,160 --> 00:11:12,080 Speaker 1: police departments. Finally, in nineteen sixty seven, there was some 185 00:11:12,200 --> 00:11:16,360 Speaker 1: movement on this issue. The President's Commission on Law Enforcement 186 00:11:16,400 --> 00:11:20,240 Speaker 1: and Administration of Justice initiated action on the need for 187 00:11:20,280 --> 00:11:24,720 Speaker 1: a universal emergency number. Eventually, after a number of other 188 00:11:24,800 --> 00:11:28,959 Speaker 1: government agencies got involved, the FCC was tasked with figuring 189 00:11:28,960 --> 00:11:32,079 Speaker 1: out the best solution. This number needed to be easy 190 00:11:32,080 --> 00:11:35,400 Speaker 1: to remember, easy to dial, and hardest of all, it 191 00:11:35,480 --> 00:11:38,359 Speaker 1: had to be a program that could be implemented countrywide. 192 00:11:38,880 --> 00:11:41,679 Speaker 1: That last part turned out to be tricky. The FCC 193 00:11:41,840 --> 00:11:45,520 Speaker 1: reached out to the American Telephone and Telegraph Company to 194 00:11:45,640 --> 00:11:48,959 Speaker 1: help brainstorm a solution. If you're wondering why the government 195 00:11:48,960 --> 00:11:51,600 Speaker 1: reached out to a private company, at this point, a 196 00:11:51,679 --> 00:11:53,520 Speaker 1: T and T, which had been found in the late 197 00:11:53,559 --> 00:11:57,000 Speaker 1: eighteen hundreds, still had a monopoly on phone service in 198 00:11:57,040 --> 00:12:00,640 Speaker 1: the United States, so to make an emergency number work, 199 00:12:00,800 --> 00:12:02,800 Speaker 1: they would have to be on board and just in 200 00:12:02,800 --> 00:12:05,160 Speaker 1: case anyone does not know the A T and T 201 00:12:05,320 --> 00:12:08,320 Speaker 1: monopoly wasn't broken until the nineteen eighties, when it was 202 00:12:08,320 --> 00:12:11,920 Speaker 1: split into eight pieces to end an antitrust suit. That's 203 00:12:11,960 --> 00:12:13,920 Speaker 1: a whole long story on its own and a whole 204 00:12:14,000 --> 00:12:17,079 Speaker 1: different podcast. Uh. It was ultimately a T and T 205 00:12:17,360 --> 00:12:20,880 Speaker 1: that came up with the nine number, which was relatively 206 00:12:20,920 --> 00:12:23,439 Speaker 1: easy to dial, even on a rotary phone, which were 207 00:12:23,480 --> 00:12:25,839 Speaker 1: still in wide use throughout the US at this time. 208 00:12:26,800 --> 00:12:29,520 Speaker 1: The number had never been assigned as an area code 209 00:12:29,559 --> 00:12:32,200 Speaker 1: or for any other purpose, so the number could be 210 00:12:32,240 --> 00:12:36,360 Speaker 1: easily recognized throughout the phone company's various systems and thus 211 00:12:36,520 --> 00:12:40,479 Speaker 1: routed appropriately. The first nine one one call was ceremonial. 212 00:12:40,720 --> 00:12:43,600 Speaker 1: It was made by Senator Rankin Fight in the town 213 00:12:43,640 --> 00:12:48,120 Speaker 1: of Haileyville, Alabama, on February nine, sixty eight. The call 214 00:12:48,240 --> 00:12:51,560 Speaker 1: was answered by another Alabama politician who was standing by 215 00:12:51,920 --> 00:12:56,120 Speaker 1: US Representative Tom Belville. But while this system could work 216 00:12:56,200 --> 00:12:59,120 Speaker 1: almost anywhere in the US, that didn't mean that every 217 00:12:59,160 --> 00:13:03,480 Speaker 1: municipality instantly implemented the use of nine one one plus. 218 00:13:03,520 --> 00:13:06,000 Speaker 1: There were still plenty of rural areas where a T 219 00:13:06,120 --> 00:13:08,600 Speaker 1: and T just did not offer service of any kind, 220 00:13:09,360 --> 00:13:12,959 Speaker 1: and even in cities there were some unforeseen problems. In 221 00:13:13,080 --> 00:13:16,400 Speaker 1: nineteen seventy article in The New York Times mentioned the 222 00:13:16,480 --> 00:13:19,920 Speaker 1: issues that were slowing adoption of the system, down stating quote, 223 00:13:20,240 --> 00:13:23,640 Speaker 1: the delays are due to rivalries between police and fire 224 00:13:23,679 --> 00:13:28,040 Speaker 1: departments unwilling to yield control of incoming calls, to the 225 00:13:28,080 --> 00:13:33,680 Speaker 1: difficulty in obtaining cooperation among political subdivisions within a metropolitan area, 226 00:13:33,920 --> 00:13:37,040 Speaker 1: and to the reluctance of politicians to add another expense 227 00:13:37,120 --> 00:13:40,040 Speaker 1: to the cost of government. One of the cases made 228 00:13:40,040 --> 00:13:42,640 Speaker 1: in support of nine one in the article was the 229 00:13:42,720 --> 00:13:45,520 Speaker 1: success with which similar numbers had been rolled out in 230 00:13:45,600 --> 00:13:49,440 Speaker 1: other countries, specifically the UK, which started using nine nine 231 00:13:49,600 --> 00:13:53,720 Speaker 1: as an emergency number in nineteen thirty seven, thirty years 232 00:13:53,760 --> 00:13:56,760 Speaker 1: before the US got around doing something similar. Yeah, it's 233 00:13:56,760 --> 00:13:58,559 Speaker 1: one of those things, kind of like we were talking 234 00:13:58,559 --> 00:14:01,600 Speaker 1: about when we discussed poison control. When I was doing 235 00:14:01,600 --> 00:14:05,360 Speaker 1: research for this, I really had not realized that, um 236 00:14:05,480 --> 00:14:08,200 Speaker 1: well into my lifetime, not even like just when I 237 00:14:08,240 --> 00:14:10,480 Speaker 1: was a kid and not aware there were lots of 238 00:14:10,520 --> 00:14:12,520 Speaker 1: places and still could not call nine one one. I 239 00:14:12,600 --> 00:14:14,640 Speaker 1: did not know that for the longest time. As this 240 00:14:14,720 --> 00:14:20,760 Speaker 1: implementation process dragged out, California Legislator Charles Hugh Warren championed 241 00:14:20,760 --> 00:14:23,040 Speaker 1: a bill in that state called the Warren nine one 242 00:14:23,120 --> 00:14:27,360 Speaker 1: one Emergency Assistants Act, and this act made implementation of 243 00:14:27,480 --> 00:14:30,080 Speaker 1: nine one one for emergency calls a law in the 244 00:14:30,120 --> 00:14:34,000 Speaker 1: state of California and to help municipalities pay for getting 245 00:14:34,000 --> 00:14:37,200 Speaker 1: the service up and running and then maintaining it. Warren's 246 00:14:37,240 --> 00:14:41,080 Speaker 1: bill included provisions for creating funding by adding a surcharge 247 00:14:41,080 --> 00:14:45,160 Speaker 1: on phone bills. But while this established a law for California, 248 00:14:45,280 --> 00:14:47,480 Speaker 1: that was not a law in other states, and the 249 00:14:47,520 --> 00:14:50,360 Speaker 1: costs of such systems continued to be a sticking point 250 00:14:50,400 --> 00:14:53,320 Speaker 1: for a lot of politicians. One of the primary events 251 00:14:53,360 --> 00:14:55,160 Speaker 1: that got a lot of the country over that hump 252 00:14:55,240 --> 00:14:57,880 Speaker 1: was the founding of the Robert Wood Johnson Foundation in 253 00:14:57,960 --> 00:15:02,320 Speaker 1: ninety two. The foundation, which is a philanthropy that funds 254 00:15:02,360 --> 00:15:05,480 Speaker 1: health initiatives, focused a lot of its early grant efforts 255 00:15:05,520 --> 00:15:09,640 Speaker 1: on improving emergency care in rural areas that included funding 256 00:15:09,680 --> 00:15:12,480 Speaker 1: for the implementation of the nine one one system. In 257 00:15:12,600 --> 00:15:16,400 Speaker 1: nineteen seventy three, the White House established a Federal Information 258 00:15:16,440 --> 00:15:19,600 Speaker 1: Center to work with state and local governments to assist 259 00:15:19,640 --> 00:15:22,680 Speaker 1: in a more total rollout of the nine one one system, 260 00:15:22,720 --> 00:15:26,240 Speaker 1: and over the next thirty years the service expanded slowly 261 00:15:26,360 --> 00:15:29,360 Speaker 1: to cover almost all of the country. There are today 262 00:15:29,480 --> 00:15:32,680 Speaker 1: even still small pockets without it UH, and the Americans 263 00:15:32,680 --> 00:15:36,000 Speaker 1: with Disabilities Act included a provision that people with disabilities 264 00:15:36,040 --> 00:15:39,720 Speaker 1: who use teletypewriters had to be accommodated by this system 265 00:15:39,760 --> 00:15:43,760 Speaker 1: as well. Today, all US states have a search arge 266 00:15:43,920 --> 00:15:47,600 Speaker 1: on phone landline service to fund nine one one, and 267 00:15:47,640 --> 00:15:51,200 Speaker 1: most have a similar searcharge on wireless and void connections 268 00:15:51,200 --> 00:15:54,760 Speaker 1: as well. Nine one one is also international, although it's 269 00:15:54,800 --> 00:15:58,320 Speaker 1: not the standard emergency number in every country. Our last 270 00:15:58,320 --> 00:16:01,680 Speaker 1: segment in this two parter is a out ambulance services. 271 00:16:01,720 --> 00:16:04,120 Speaker 1: But before we dig into that, let's pause and take 272 00:16:04,160 --> 00:16:14,480 Speaker 1: a quick sponsor break. Before we get into talking about 273 00:16:14,480 --> 00:16:16,840 Speaker 1: early paramedics and e m t s in the US, 274 00:16:16,960 --> 00:16:19,680 Speaker 1: we should note that those are two different things. UH. 275 00:16:19,760 --> 00:16:22,440 Speaker 1: You may not always know that if you watch television 276 00:16:22,440 --> 00:16:25,440 Speaker 1: medical shows because they're not always careful about it, and 277 00:16:25,480 --> 00:16:28,400 Speaker 1: I think in casual conversation people intermingle them without knowing 278 00:16:28,440 --> 00:16:31,240 Speaker 1: there's a difference. So in broad strokes, e m T 279 00:16:31,480 --> 00:16:35,040 Speaker 1: S Emergency medical technicians are first care providers. They can 280 00:16:35,080 --> 00:16:38,080 Speaker 1: assess and monitor a patient. They can care for them 281 00:16:38,160 --> 00:16:41,560 Speaker 1: during transport to a medical facility, and then provide clear 282 00:16:41,640 --> 00:16:44,760 Speaker 1: details of their status and health during handoff to the 283 00:16:44,800 --> 00:16:48,320 Speaker 1: next level of care. Paramedics are trained to perform a 284 00:16:48,360 --> 00:16:51,160 Speaker 1: more advanced level of emergency care, and they are able 285 00:16:51,200 --> 00:16:55,680 Speaker 1: to handle sudden illness, injury, and emergencies like childbirth before 286 00:16:55,800 --> 00:16:59,080 Speaker 1: a patient arrives at a medical facility. The first fire 287 00:16:59,120 --> 00:17:03,080 Speaker 1: department paramedic training in the US started in nineteen sixty nine. 288 00:17:03,840 --> 00:17:07,320 Speaker 1: That year, the Miami Fire Department started training firefighters for 289 00:17:07,400 --> 00:17:12,480 Speaker 1: paramedic skills, creating the first paramedic training program. In nineteen seventy, 290 00:17:12,520 --> 00:17:15,399 Speaker 1: the Seattle Fire Department teamed up with the University of 291 00:17:15,480 --> 00:17:19,040 Speaker 1: Washington and the Harvard View Medical Center to offer paramedic 292 00:17:19,119 --> 00:17:23,200 Speaker 1: training to its firefighters. The Medic one program that started 293 00:17:23,240 --> 00:17:26,680 Speaker 1: that year continues to this day. The early nineteen seventies 294 00:17:26,720 --> 00:17:30,000 Speaker 1: saw a huge push for government funding for emergency care. 295 00:17:30,640 --> 00:17:34,280 Speaker 1: The first curriculum for the Advanced Emergency Medical Technician that's 296 00:17:34,400 --> 00:17:36,960 Speaker 1: e m t S was published, and the first exam 297 00:17:37,040 --> 00:17:39,800 Speaker 1: for certification in the program was developed. In the first 298 00:17:39,840 --> 00:17:43,520 Speaker 1: two years of the decade. In nineteen seventy two, sixteen 299 00:17:43,560 --> 00:17:47,200 Speaker 1: million dollars was allocated by the Department of Public Health, Education, 300 00:17:47,240 --> 00:17:52,680 Speaker 1: and Welfare to establish emergency medical services demonstrations in several states. 301 00:17:53,119 --> 00:17:56,800 Speaker 1: In nineteen seventy three, the development of emergency services in 302 00:17:56,840 --> 00:17:59,679 Speaker 1: the US got another federal push from the e m 303 00:17:59,720 --> 00:18:03,199 Speaker 1: S This STEMS Act. That congressional act established funding for 304 00:18:03,320 --> 00:18:07,720 Speaker 1: three hundred regional emergency medical services systems. Also in the 305 00:18:07,720 --> 00:18:11,000 Speaker 1: early nineteen seventies, the Star of Life symbol was adopted 306 00:18:11,040 --> 00:18:14,800 Speaker 1: by the National Highway Traffic Safety Administration as the symbol 307 00:18:14,840 --> 00:18:18,760 Speaker 1: for emergency medical services. You have probably seen this symbol. 308 00:18:18,840 --> 00:18:21,359 Speaker 1: It sort of looks like a thick blue asterist with 309 00:18:21,440 --> 00:18:24,080 Speaker 1: a staff in the center with a snake wrapped around it. 310 00:18:24,160 --> 00:18:27,520 Speaker 1: That is the rod of Asclepius from Greek mythology. Each 311 00:18:27,680 --> 00:18:31,120 Speaker 1: arm of that asterisk stands for an element of emergency care. 312 00:18:31,520 --> 00:18:33,800 Speaker 1: So if you start at the top and you work clockwise, 313 00:18:34,359 --> 00:18:40,040 Speaker 1: those are detection, reporting, response on seene care, care, and 314 00:18:40,119 --> 00:18:45,199 Speaker 1: transit and transfer to definitive care. The first nationwide course 315 00:18:45,280 --> 00:18:48,159 Speaker 1: to train paramedics started in nineteen seventy five at the 316 00:18:48,240 --> 00:18:52,040 Speaker 1: University of Pittsburgh. It was led by doctor Nancy Caroline. 317 00:18:52,560 --> 00:18:55,280 Speaker 1: Doctor Caroline wrote the book Emergency Care in the Streets 318 00:18:55,320 --> 00:18:58,159 Speaker 1: as part of her work in developing paramedics training. That 319 00:18:58,280 --> 00:19:01,600 Speaker 1: text continues to be published in used for emergency services 320 00:19:01,640 --> 00:19:05,200 Speaker 1: training today, and she developed the national training program through 321 00:19:05,200 --> 00:19:07,520 Speaker 1: her work on a project in Pittsburgh in the nineteen 322 00:19:07,600 --> 00:19:10,720 Speaker 1: seventies that has been requested a number of times by listeners, 323 00:19:11,160 --> 00:19:14,760 Speaker 1: and that is the Freedom House Ambulance Service. And to 324 00:19:14,800 --> 00:19:17,639 Speaker 1: talk about the Freedom House and Dr Caroline, we will, 325 00:19:17,680 --> 00:19:21,560 Speaker 1: as promised in Part one, circle back to Dr Peter Safar. Yes, 326 00:19:21,640 --> 00:19:24,240 Speaker 1: so just as a reminder, he was one of the 327 00:19:24,240 --> 00:19:28,760 Speaker 1: people who developed CPR as we knew it today. But 328 00:19:28,840 --> 00:19:31,280 Speaker 1: even before we talk about him, we have to jump 329 00:19:31,280 --> 00:19:34,320 Speaker 1: back a few years and talk about Pittsburgh's Hill District 330 00:19:34,600 --> 00:19:39,080 Speaker 1: in the nineteen sixties. The Hill District, a predominantly black community, 331 00:19:39,240 --> 00:19:42,200 Speaker 1: had a high rate of unemployment. There were no social 332 00:19:42,200 --> 00:19:45,359 Speaker 1: services to speak of there. It was a place where 333 00:19:45,440 --> 00:19:48,600 Speaker 1: in an emergency during this time period, people might call 334 00:19:48,720 --> 00:19:51,560 Speaker 1: for medical assistance, but that did not mean they were 335 00:19:51,600 --> 00:19:54,399 Speaker 1: going to get it. If your call was answered, it 336 00:19:54,480 --> 00:19:56,879 Speaker 1: was in the form usually of a police car, and 337 00:19:56,960 --> 00:20:00,920 Speaker 1: anyone needing transport to a medical facility, got rough treatment 338 00:20:01,000 --> 00:20:03,119 Speaker 1: at best. There are lots of reports of people kind 339 00:20:03,160 --> 00:20:04,520 Speaker 1: of just being thrown in the back of the car 340 00:20:04,560 --> 00:20:08,040 Speaker 1: and driven to the hospital. Enter Philip Holland. Hollen was 341 00:20:08,080 --> 00:20:11,080 Speaker 1: a former ambulance driver who in the sixties had moved 342 00:20:11,119 --> 00:20:13,879 Speaker 1: on to activist work as the chair of the Office 343 00:20:13,920 --> 00:20:17,560 Speaker 1: of Economic Opportunity Health Committee and the president of the 344 00:20:17,640 --> 00:20:21,160 Speaker 1: Maurice Falk Medical Fund, which helped to provide medical services 345 00:20:21,240 --> 00:20:25,520 Speaker 1: to disadvantaged communities. And Holland had had an idea about 346 00:20:25,520 --> 00:20:28,520 Speaker 1: how to address both the lack of emergency medical response 347 00:20:28,760 --> 00:20:33,520 Speaker 1: and the unemployment issues in Hill District. Freedom House Enterprises, 348 00:20:33,600 --> 00:20:36,719 Speaker 1: Incorporated was a group that had formed to address issues 349 00:20:36,760 --> 00:20:39,440 Speaker 1: in the community and offer a place to gather and 350 00:20:39,520 --> 00:20:42,560 Speaker 1: kind of do community outreach. It was an offshoot of 351 00:20:42,600 --> 00:20:47,880 Speaker 1: Pittsburgh's United Negro Protest Committee, and Hallen approached Freedom House 352 00:20:47,920 --> 00:20:51,040 Speaker 1: about his idea, which was to start an ambulance service 353 00:20:51,359 --> 00:20:53,840 Speaker 1: that would be staffed by people from the community and 354 00:20:53,880 --> 00:20:57,199 Speaker 1: would serve the community. To help develop the program from 355 00:20:57,240 --> 00:21:00,800 Speaker 1: the medical side, Hollen brought in Dr Peters Far and 356 00:21:00,840 --> 00:21:03,840 Speaker 1: the training started at Freedom House. There were people who 357 00:21:03,920 --> 00:21:06,280 Speaker 1: showed up for training classes that didn't even know what 358 00:21:06,359 --> 00:21:08,320 Speaker 1: they were there for. They just knew that it was 359 00:21:08,359 --> 00:21:12,359 Speaker 1: a job opportunity. Some of the men had issues with addictions, 360 00:21:12,640 --> 00:21:15,639 Speaker 1: some had been convicted of crimes, but so Far taught 361 00:21:15,760 --> 00:21:18,840 Speaker 1: anybody who was willing to follow this program. Yeah, there 362 00:21:18,840 --> 00:21:20,800 Speaker 1: were a number of the men that got involved that 363 00:21:20,880 --> 00:21:23,200 Speaker 1: had come back from Vietnam and had never really found 364 00:21:23,200 --> 00:21:26,320 Speaker 1: their footing. Like it was a really open door policy 365 00:21:26,359 --> 00:21:27,800 Speaker 1: if you were willing to do the work he was 366 00:21:27,840 --> 00:21:30,760 Speaker 1: willing to teach. So far As training program was a 367 00:21:30,840 --> 00:21:34,280 Speaker 1: year long curriculum, and because some of the trainees that 368 00:21:34,359 --> 00:21:37,040 Speaker 1: were there were not high school graduates, so Far saw 369 00:21:37,080 --> 00:21:40,200 Speaker 1: to it that they took classes like algebra and English 370 00:21:40,240 --> 00:21:42,919 Speaker 1: in a series of courses that started before their medical 371 00:21:42,960 --> 00:21:45,760 Speaker 1: training that enabled them to get a diploma, and then 372 00:21:45,760 --> 00:21:48,560 Speaker 1: they could move on to medical classes. And then they 373 00:21:48,560 --> 00:21:52,480 Speaker 1: took medical foundational courses like anatomy and physiology, and they 374 00:21:52,560 --> 00:21:56,200 Speaker 1: also trained in CPR. There were a hundred and sixty 375 00:21:56,240 --> 00:21:59,600 Speaker 1: hours of class work in so far As instructional program 376 00:21:59,600 --> 00:22:02,680 Speaker 1: and after that six weeks of training in a hospital 377 00:22:02,720 --> 00:22:07,080 Speaker 1: emergency department. The men in the program observed in operating 378 00:22:07,160 --> 00:22:11,200 Speaker 1: rooms and intensive care units, and they watched autopsies being performed. 379 00:22:11,560 --> 00:22:15,560 Speaker 1: They watched childbirths. Doctor Safar wanted the Freedom House trainees 380 00:22:15,640 --> 00:22:18,760 Speaker 1: to know about every stage of care that a patient 381 00:22:18,880 --> 00:22:22,000 Speaker 1: might receive, because he wanted them to basically take all 382 00:22:22,040 --> 00:22:24,439 Speaker 1: of that knowledge and care and reproduce it in a 383 00:22:24,520 --> 00:22:28,720 Speaker 1: mobile package. Then his programm did exactly that. After completing 384 00:22:28,760 --> 00:22:33,920 Speaker 1: the program, Freedom House Ambulance staffords could intubate, assess vital signs, 385 00:22:34,200 --> 00:22:38,000 Speaker 1: administer life saving care, and more. Their first call came 386 00:22:38,000 --> 00:22:41,040 Speaker 1: in on July fifteenth, ninety eight, when a woman had 387 00:22:41,080 --> 00:22:43,399 Speaker 1: a seizure on a bus. It was the first of 388 00:22:43,520 --> 00:22:46,480 Speaker 1: five thousand, eight hundred calls that they would answer in 389 00:22:46,520 --> 00:22:49,439 Speaker 1: that first year under a contract with the city that 390 00:22:49,560 --> 00:22:53,600 Speaker 1: Safar and Holland had arranged. The Freedom House Ambulance program 391 00:22:53,800 --> 00:22:56,800 Speaker 1: was not really expected to succeed. People didn't think you 392 00:22:56,840 --> 00:23:00,440 Speaker 1: could just take people from a disadvantaged community, aid them 393 00:23:00,440 --> 00:23:02,840 Speaker 1: to be medics and that that would function, But in 394 00:23:02,880 --> 00:23:06,480 Speaker 1: fact it did. The paramedics that finished this training described 395 00:23:06,520 --> 00:23:09,840 Speaker 1: feeling empowered by having jobs where they can actually help people, 396 00:23:10,400 --> 00:23:12,439 Speaker 1: and the level of care provided by the men that 397 00:23:12,480 --> 00:23:16,520 Speaker 1: were trained by so far was really high. But this 398 00:23:16,560 --> 00:23:19,040 Speaker 1: was still the late sixties in early seventies, and these 399 00:23:19,040 --> 00:23:22,360 Speaker 1: men encountered racism in scenarios that they had never even 400 00:23:22,440 --> 00:23:25,919 Speaker 1: been in before. So when they were bringing patients into hospitals, 401 00:23:26,040 --> 00:23:29,560 Speaker 1: white doctors would often ignore or dismiss them, even as 402 00:23:29,600 --> 00:23:32,399 Speaker 1: they were giving vital information about the patients that they 403 00:23:32,400 --> 00:23:35,120 Speaker 1: had been caring for, and if they answered a call 404 00:23:35,280 --> 00:23:39,280 Speaker 1: involving a white person needing care, they were not always welcomed. 405 00:23:40,080 --> 00:23:42,960 Speaker 1: The success of the Freedom House Ambulance enabled it to 406 00:23:42,960 --> 00:23:47,000 Speaker 1: continue for a while, though in ninety four and Anti Caroline, 407 00:23:47,080 --> 00:23:51,000 Speaker 1: a resident at Presbyterian Hospital, was brought on as medical 408 00:23:51,040 --> 00:23:54,560 Speaker 1: director by Dr Safar. During her time with Freedom House, 409 00:23:54,600 --> 00:23:57,280 Speaker 1: Caroline wrote along on the calls and ensured that the 410 00:23:57,320 --> 00:24:00,359 Speaker 1: people on their team had the best training as well 411 00:24:00,400 --> 00:24:03,960 Speaker 1: as support. She's been nicknamed the mother of paramedics as 412 00:24:03,960 --> 00:24:08,639 Speaker 1: a consequence she throughout her life when she was asked 413 00:24:08,640 --> 00:24:11,080 Speaker 1: to talk about this, like, she really liked to talk 414 00:24:11,080 --> 00:24:16,320 Speaker 1: about how people in emergency departments tried to dismiss these men, 415 00:24:16,440 --> 00:24:19,280 Speaker 1: and how they would then just like rattle off medical 416 00:24:19,400 --> 00:24:23,159 Speaker 1: terminology with like complete knowledge and confidence, and how she 417 00:24:23,280 --> 00:24:25,399 Speaker 1: kind of loved like writing back to the hospital giggling 418 00:24:25,400 --> 00:24:28,679 Speaker 1: about it afterwards. Um she was really their champion in 419 00:24:28,720 --> 00:24:31,120 Speaker 1: a lot of ways. But she did more than train 420 00:24:31,200 --> 00:24:34,359 Speaker 1: these men. She took the medical services offered by Freedom 421 00:24:34,400 --> 00:24:37,920 Speaker 1: House to entirely new levels. She would push a little 422 00:24:37,960 --> 00:24:41,040 Speaker 1: farther past where anyone thought mobile medicine could go in 423 00:24:41,119 --> 00:24:44,160 Speaker 1: terms of treatment that they could perform. And she refined 424 00:24:44,200 --> 00:24:47,920 Speaker 1: and solidified the team's protocols, and she documented everything as 425 00:24:47,920 --> 00:24:51,880 Speaker 1: she went. It was from that documentation that Nancy wrote 426 00:24:51,880 --> 00:24:55,320 Speaker 1: her book on emergency care. The men she trained continued 427 00:24:55,359 --> 00:24:58,160 Speaker 1: to perform at an incredibly high level, earning the respect 428 00:24:58,160 --> 00:25:02,000 Speaker 1: and praise of the nation's medical community. Allen's idea, the 429 00:25:02,080 --> 00:25:05,800 Speaker 1: training programs of SAFAR in Caroline, and the ambulances designed 430 00:25:05,880 --> 00:25:08,880 Speaker 1: by Safar to actually be like many hospitals on wheels 431 00:25:09,320 --> 00:25:13,040 Speaker 1: all combined to create the first civilian emergency medical service, 432 00:25:13,560 --> 00:25:16,639 Speaker 1: and they had got the bar extremely high. In the process, 433 00:25:17,040 --> 00:25:20,240 Speaker 1: they created the model that all similar services would be 434 00:25:20,240 --> 00:25:25,600 Speaker 1: built on in As neighborhoods outside of Hill District started 435 00:25:25,600 --> 00:25:29,080 Speaker 1: pressuring their city officials to ensure that they had similar 436 00:25:29,119 --> 00:25:33,440 Speaker 1: services in their neighborhoods, the Freedom House program abruptly ended 437 00:25:34,600 --> 00:25:37,359 Speaker 1: all of the complaints that the black community was somehow 438 00:25:37,400 --> 00:25:40,800 Speaker 1: getting special treatment in having this service led to Freedom 439 00:25:40,840 --> 00:25:45,000 Speaker 1: Houses contract being canceled. While the paramedics of Freedom House 440 00:25:45,040 --> 00:25:47,240 Speaker 1: were told that they would be hired by the city 441 00:25:47,280 --> 00:25:50,080 Speaker 1: as it set up its own emergency service, only a 442 00:25:50,080 --> 00:25:52,600 Speaker 1: few of them actually were, and the claim that was 443 00:25:52,640 --> 00:25:54,919 Speaker 1: often made when they were denied employment was that they 444 00:25:54,960 --> 00:25:57,680 Speaker 1: were not qualified, despite the fact that they had been 445 00:25:57,680 --> 00:26:00,800 Speaker 1: instrumental in developing the very stand Dirge that they were 446 00:26:00,800 --> 00:26:04,439 Speaker 1: being judged by. Dr Nancy Caroline commented on the end 447 00:26:04,480 --> 00:26:07,320 Speaker 1: of the program, quote, it should have been the success 448 00:26:07,320 --> 00:26:10,600 Speaker 1: story of the century. In a way, it was, but 449 00:26:10,760 --> 00:26:13,760 Speaker 1: it is a sad success story because Freedom Houses no more, 450 00:26:14,119 --> 00:26:16,800 Speaker 1: because so many of those who gave so much of 451 00:26:16,840 --> 00:26:20,320 Speaker 1: themselves during eight years, who cleared the path for the 452 00:26:20,400 --> 00:26:24,240 Speaker 1: kind of paramedic services now glorified on national television, have 453 00:26:24,359 --> 00:26:28,880 Speaker 1: been shunted aside, forgotten, left to return to the street corners, 454 00:26:28,960 --> 00:26:32,400 Speaker 1: and watched the parade pass them by. Despite the closure 455 00:26:32,480 --> 00:26:35,640 Speaker 1: of the Freedom House Ambulance service, it's certainly left a legacy. 456 00:26:36,240 --> 00:26:40,240 Speaker 1: The American Ambulance Association formed in nineteen seventy nine. The 457 00:26:40,359 --> 00:26:43,040 Speaker 1: National Registry of E m t S followed in nineteen 458 00:26:43,119 --> 00:26:47,560 Speaker 1: eighty five the National Association of e M S. Physicians 459 00:26:47,640 --> 00:26:50,240 Speaker 1: was formed so that we don't end on a bummer. 460 00:26:50,600 --> 00:26:54,159 Speaker 1: Freedom House was eventually reborn, although in a different place. 461 00:26:54,600 --> 00:26:57,600 Speaker 1: In twent twelve, a new Freedom House ambulance service was 462 00:26:57,680 --> 00:27:00,960 Speaker 1: launched in St. Paul, Minnesota, and, like namesake, the Saint 463 00:27:01,000 --> 00:27:04,399 Speaker 1: Paul Program formed to offer job opportunities and healthcare to 464 00:27:04,520 --> 00:27:08,880 Speaker 1: underserved communities, as well as to diversify the city's medical workforce. 465 00:27:09,520 --> 00:27:12,880 Speaker 1: Thank you to everyone who may be listening who works 466 00:27:12,960 --> 00:27:16,359 Speaker 1: in medical care, who lives with someone who works in 467 00:27:16,400 --> 00:27:20,200 Speaker 1: medical care, isn't any way connected to medical care, because 468 00:27:21,000 --> 00:27:23,639 Speaker 1: you guys, it's it is not enough to say that 469 00:27:23,680 --> 00:27:27,080 Speaker 1: you are heroes. We recognize that there are issues in 470 00:27:27,160 --> 00:27:29,440 Speaker 1: terms of equity of payment in a lot of these jobs. 471 00:27:30,080 --> 00:27:32,920 Speaker 1: Sure I want to fix that, But thank you. I'm 472 00:27:32,920 --> 00:27:35,679 Speaker 1: gonna move on to slightly peppier listener mail because I'm 473 00:27:35,680 --> 00:27:40,479 Speaker 1: getting all choked up listener mail about first cats. This 474 00:27:40,520 --> 00:27:43,040 Speaker 1: one is very very short. Uh. It is from our 475 00:27:43,080 --> 00:27:45,800 Speaker 1: listener Connie, and she just wrote it with the subject 476 00:27:45,840 --> 00:27:49,280 Speaker 1: line example of social distancing. Uh. And it is a 477 00:27:49,320 --> 00:27:52,600 Speaker 1: picture of her cat and her cat's friend from next 478 00:27:52,600 --> 00:27:55,480 Speaker 1: door and they are just looking at each other through 479 00:27:55,520 --> 00:27:58,640 Speaker 1: a door. And it is adorable. The cat from next 480 00:27:58,640 --> 00:28:01,119 Speaker 1: door has a fabulous grumpy ace and it is a giant, 481 00:28:01,440 --> 00:28:04,560 Speaker 1: fluffy thing. And like her cat is a beautiful, little, 482 00:28:04,600 --> 00:28:06,840 Speaker 1: sleek black cat, which is one of my favorite things 483 00:28:06,880 --> 00:28:09,240 Speaker 1: on earth, and it's adorable. She just wrote, my cat 484 00:28:09,280 --> 00:28:11,000 Speaker 1: and her friend from next door. She and I are 485 00:28:11,000 --> 00:28:14,720 Speaker 1: long term listeners, Connie, thank you so much. That was precious. Um. 486 00:28:14,760 --> 00:28:16,879 Speaker 1: I love a kiddie picture. And then I have another 487 00:28:16,920 --> 00:28:20,439 Speaker 1: email from our listener Liz, who started her her email 488 00:28:20,480 --> 00:28:23,640 Speaker 1: by writing this subject line, want to see my bathroom, um, 489 00:28:24,280 --> 00:28:26,320 Speaker 1: which the answer is always yes for me. I want 490 00:28:26,320 --> 00:28:28,879 Speaker 1: to see anything people do creatively in their house, and 491 00:28:28,920 --> 00:28:31,280 Speaker 1: she writes, I was hoping that title would get your attention. 492 00:28:31,320 --> 00:28:34,199 Speaker 1: I bet that's an original subject line, Holly. I know 493 00:28:34,240 --> 00:28:36,439 Speaker 1: how much you love Haunted Mansion, which happens to be 494 00:28:36,520 --> 00:28:39,440 Speaker 1: my favorite Disney attraction. I thought you would enjoy seeing 495 00:28:39,440 --> 00:28:42,959 Speaker 1: my disney bound version of a Haunted Mansion bathroom streights. 496 00:28:42,960 --> 00:28:44,960 Speaker 1: If you don't know, a disney bound is a non 497 00:28:45,000 --> 00:28:49,080 Speaker 1: literal interpretation of something Disney you for listeners. You may 498 00:28:49,080 --> 00:28:52,200 Speaker 1: have heard that term applied to outfits, but it does 499 00:28:52,240 --> 00:28:54,920 Speaker 1: apply to other things. She writes, our paint choice is 500 00:28:55,000 --> 00:28:58,560 Speaker 1: what we've dubbed hitchhiking ghost green. The damnask pattern took 501 00:28:58,600 --> 00:29:01,520 Speaker 1: me another entire day to stencil on the one wall. 502 00:29:01,960 --> 00:29:03,960 Speaker 1: Does that mirror remind you of the entrance sign? It 503 00:29:04,040 --> 00:29:06,640 Speaker 1: did for me. The shower curtain rings are also in 504 00:29:06,640 --> 00:29:09,720 Speaker 1: that same oval shape. The small greenhouse reminded me of 505 00:29:09,720 --> 00:29:12,840 Speaker 1: the glass architecture at the Walt Disney World Mansion. See 506 00:29:12,880 --> 00:29:15,520 Speaker 1: the ghost in the mini mansion Inside. Not pictured is 507 00:29:15,560 --> 00:29:18,720 Speaker 1: the marble pattern Linolium, which relates to the marble bus 508 00:29:18,800 --> 00:29:21,640 Speaker 1: the ghostwriters in the library. I seem to recall you 509 00:29:21,720 --> 00:29:24,320 Speaker 1: having a halloween or haunted mansion ish living room. Is 510 00:29:24,360 --> 00:29:26,800 Speaker 1: that right? I'd love to see it. Okay, now I'm 511 00:29:26,840 --> 00:29:29,520 Speaker 1: sure I'm sounding creepy. Uh And then she says, now 512 00:29:29,560 --> 00:29:31,640 Speaker 1: onto a question I'd love to have answered. Do you 513 00:29:31,680 --> 00:29:34,120 Speaker 1: guys have any topics you've been putting off? But no, 514 00:29:34,280 --> 00:29:36,719 Speaker 1: you'll have to circle back around too to finally, do 515 00:29:37,280 --> 00:29:39,720 Speaker 1: you know the obligatory podcast that you've been avoiding? But 516 00:29:39,800 --> 00:29:42,160 Speaker 1: you know it's got to happen eventually. I tell everyone 517 00:29:42,200 --> 00:29:44,480 Speaker 1: how much I love the show. You've had a substantial 518 00:29:44,480 --> 00:29:46,760 Speaker 1: amount of free advertising out of me over the years. 519 00:29:46,800 --> 00:29:49,000 Speaker 1: As mist in history is my favorite. Much love and 520 00:29:49,040 --> 00:29:51,360 Speaker 1: many blessings, Liz, Liz, thank you so much. Your bathroom 521 00:29:51,400 --> 00:29:53,800 Speaker 1: is so pretty. I love when people do create a 522 00:29:53,840 --> 00:29:56,000 Speaker 1: stuff like that with their spaces. And I thought that 523 00:29:56,080 --> 00:29:58,840 Speaker 1: was an interesting question to pose. Uh. You and I 524 00:29:58,880 --> 00:30:01,080 Speaker 1: have both had a number of topics over the years 525 00:30:01,080 --> 00:30:03,120 Speaker 1: that we've like, we're going to get to this eventually 526 00:30:04,480 --> 00:30:06,840 Speaker 1: kind of back away from for various reasons. I'm trying 527 00:30:06,880 --> 00:30:08,480 Speaker 1: to think of one now off the top of my 528 00:30:08,520 --> 00:30:12,000 Speaker 1: head that I have as of at this moment in history, 529 00:30:12,120 --> 00:30:16,000 Speaker 1: anything that involves a fire or a massacre or an 530 00:30:16,040 --> 00:30:20,200 Speaker 1: expulsion of people from a place, all that's tabled because 531 00:30:20,240 --> 00:30:26,600 Speaker 1: I can't emotionally deal with this while also living in 532 00:30:26,600 --> 00:30:29,720 Speaker 1: the time that we are living in. I'm in kind 533 00:30:29,760 --> 00:30:33,120 Speaker 1: of an opposite situation. For some reason. I keep stumbling 534 00:30:33,200 --> 00:30:39,400 Speaker 1: upon fairly grizzly murder stories. Uh, and I'm like, oh, 535 00:30:39,480 --> 00:30:42,480 Speaker 1: I probably shouldn't do that. So they're going on the 536 00:30:42,520 --> 00:30:47,160 Speaker 1: Halloween list and we'll see October is only so long. Um. 537 00:30:47,200 --> 00:30:49,080 Speaker 1: But yeah, and there are always ones that just it's 538 00:30:49,400 --> 00:30:52,240 Speaker 1: I always say, because we do get asked this question 539 00:30:52,240 --> 00:30:55,400 Speaker 1: when we do live events pretty frequently, and I usually say, 540 00:30:55,400 --> 00:30:57,720 Speaker 1: like Queen Victoria, I can I can only talk about 541 00:30:57,760 --> 00:30:59,800 Speaker 1: little pieces of her life, or I can talk about 542 00:30:59,840 --> 00:31:02,640 Speaker 1: things related to her, but I love her despite her 543 00:31:02,640 --> 00:31:05,840 Speaker 1: many faults, And like, it's also a long rain, so 544 00:31:05,880 --> 00:31:09,240 Speaker 1: you kind of got to break that one down. Um, 545 00:31:09,280 --> 00:31:13,360 Speaker 1: there's just so much history. Yeah, thank you so much 546 00:31:14,000 --> 00:31:16,080 Speaker 1: to both Kanye and Liz for sharing a little bit 547 00:31:16,080 --> 00:31:19,480 Speaker 1: of your lives with us, especially now when we're inside 548 00:31:19,480 --> 00:31:21,760 Speaker 1: all the time. It's extra nice. If you'd like to 549 00:31:21,760 --> 00:31:24,040 Speaker 1: write to us, you can do so at History Podcast 550 00:31:24,160 --> 00:31:26,400 Speaker 1: at i heart radio dot com. You can also find 551 00:31:26,480 --> 00:31:29,800 Speaker 1: us on social media as missed in History. Uh, you 552 00:31:29,840 --> 00:31:32,720 Speaker 1: can subscribe to our show. That sounds fabulous, so you 553 00:31:32,760 --> 00:31:34,680 Speaker 1: can do that on the I heart Radio app, at 554 00:31:34,720 --> 00:31:42,760 Speaker 1: Apple podcasts, or wherever it is that you listen. Stuff 555 00:31:42,800 --> 00:31:44,760 Speaker 1: you Missed in History Class is a production of I 556 00:31:44,920 --> 00:31:48,320 Speaker 1: heart Radio. For more podcasts from I Heart Radio, visit 557 00:31:48,360 --> 00:31:51,600 Speaker 1: the iHeart Radio app, Apple Podcasts, or wherever you listen 558 00:31:51,680 --> 00:31:52,640 Speaker 1: to your favorite shows.