On a sunlit highway in Israel in 1978, an ambulance races toward a burning bus under live gunfire. Inside is a young physician who helped write the rules that will decide who lives and who dies in the next few minutes. Her name is Nancy Caroline, and this moment captures the idea that would define her life’s work: survival is decided long before the hospital doors ever open.

In this episode, PMHX traces the extraordinary story of the woman who helped invent modern paramedicine. Nancy Caroline helped prove that advanced medical care belongs wherever people collapse, bleed, and stop breathing... not just inside hospitals. You’ll follow her as she transforms struggling street crews into true clinicians, writing the protocols, building the training, and standing beside her medics under real danger. You’ll see how that vision spread beyond the U.S. to Israel’s national EMS system, where her training was tested during mass-casualty attacks and later to remote regions of Africa, where she carried emergency medicine to places that had never known it.

This is a story about beating the clock, about collapsing the deadly gap between injury and care, and about a physician who believed that if you know how to help, you have a responsibility to step forward. Because sometimes the difference between death and survival is nothing more than what happens in the next few minutes and who is willing to stand there and act.

In 1967, in Pittsburgh’s Hill District, calling an ambulance was often a gamble and too often, a losing one. In this episode of PMHX: The Story of EMS, we tell the powerful story of Freedom House Ambulance Service, a group of Black men and women who changed emergency medicine forever.

Before paramedics existed, before emergency care reached the streets, patients were scooped up and left alone in the back of police wagons, or hearses with little hope of survival. With guidance from pioneers like Peter Safar and Nancy Caroline, Freedom House trained local residents of Pittsburgh's Hill District to deliver advanced medical care in the space between the incident and the hospital. This episode traces the birth, success, and heartbreaking dismantling of Freedom House, and shows how they proved that life-saving medicine could happen on sidewalks and in living rooms, how they invented the paramedic before the word even existed, and how politics and prejudice nearly erased their legacy.

This is the story of how modern EMS was born on the streets of the Hill District, through necessity, courage, and a refusal to accept that nothing could be done.

In June of 1966, an eleven-year-old girl struggles to breathe in a Pittsburgh living room. Help is called. Transport arrives. Care does not.

Her death exposes something medicine had not yet learned how to see... the most dangerous moments are often not the ones inside the hospital, but the minutes before anyone is trained or permitted to act. In this episode, we follow Dr. Peter Safar as he confronts the limits of resuscitation, the silence between collapse and intervention, and the realization that saving lives would require more than new techniques. It would require moving care into places it had never existed before.

From the development of airway management and CPR to the emergence of intensive care units and the first true experiments in prehospital medicine, this is the story of how emergency care began to claim the space between injury and hospital doors, and why waiting was no longer an option.