EMS Hall of Fame: The Pioneers of Prehospital Care—Boyd, Caroline

The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This new series honors these trailblazers. 

David Boyd, MD

EMS trauma system development

EMS’ seminal 1966 white paper urged the establishment of major trauma units in hospital emergency departments that could provide complete care for those injured. Chicago’s Cook County Hospital launched one that same year and in 1968 named resident surgeon David Boyd, MD, its director. Boyd’s refinement and promotion of the concept caught the attention of Illinois Governor Richard Ogilvie, who tasked him to create a plan for a statewide trauma system. 

The resulting scheme categorized all hospitals and designated some 40 new trauma centers in a three-tiered system. It also featured the pooling and coordination of medical resources within geographic areas. The program, which Boyd ran from 1971–74, became America’s model for hospital trauma care. 

In 1974 President Gerald Ford named Boyd director of the federal Division of Emergency Medical Services Systems, then part of the Department of Health, Education, and Welfare. There Boyd spent almost a decade distributing grant funds and working to build emergency medical systems.

“The thing about being a…maverick bureaucrat is that if you have reasonably good enough argument and balls enough to stick with it, you can win a lot of battles,” Boyd told Washington Monthly for a profile in 1986. “The thing is, nobody ever tries.”¹ 

Later Boyd helped organize EMS systems in Canada, Europe, and the Middle and Far East. He has published more than 140 scientific articles and received honors including the Distinguished Career Award from the American Public Health Association and the Surgeons’ Award for Service to Safety from the National Safety Council. He served for several years on the editorial advisory board of EMS Magazine, the precursor to EMS World. 

Nancy Caroline, MD

Freedom House; Emergency Care in the Streets

After receiving her MD in 1971, Nancy Caroline began a fellowship in critical care medicine at the University of Pittsburgh in 1973. Her mentor there was resuscitation giant Dr. Peter Safar, and the next year they received a Department of Transportation grant to create a national EMS curriculum. 

While Safar led that effort, Caroline became the first medical director for the pioneering Pittsburgh service Freedom House, the country’s first paramedic-staffed civilian emergency medical service. Freedom House used a largely African-American workforce to bring new levels of care to underserved, mostly black citizens. Though successful, the program was disbanded in 1975.  

“One reason for [Caroline’s] great impact was the fact that she is a caring, dynamic, compassionate ‘super doctor,’ a Renaissance woman, and an eloquent writer,” wrote Safar in his 2000 memoir. “The [Freedom House] program gave Caroline the opportunity to demonstrate her exceptional skills in laying hands on victims in emergencies outside the hospital.”²

Caroline authored the landmark textbook Emergency Care in the Streets, the first resource of its kind for training paramedics. First published in 1979 and commonly known as the “orange book,” it’s now in its eighth edition. 

After Freedom House Caroline relocated to Israel, where she became medical director of its national EMS organization, Magen David Adom. Her work modernizing MDA’s equipment and improving its responses earned her the nickname “Israel’s Mother Teresa.” She later served as a flying “bush doctor” in East Africa, teaching medical skills there, and worked to improve nutrition and healthcare in orphanages. In her latter years she returned to Israel and established the nonprofit Hospice of Upper Galilee. 

Caroline’s last years were focused on cancer treatment and hospice care there, and she died of cancer in 2002 at the hospice she founded. 

References

1. Glastris P. An American Hero—Dr. David Boyd and Emergency Health Care. Washington Monthly, excerpted by Questia, www.questia.com/magazine/1G1-4118412/an-american-hero-dr-david-boyd-and-emergency-health.

2. Srikameswaran A. Obituary: Dr. Nancy Caroline / A leader in preparing nonphysicians to provide emergency medical care. Pittsburgh Post-Gazette, 2002 Dec 21; https://old.post-gazette.com/obituaries/20021221caroline2.asp.