On a summer night in 1981 in Kansas City, a crowded hotel atrium feels safe. Ordinary. Predictable. Then something truly disastrous happens. What follows is not just a collapse of steel and concrete, but a test of an entire city’s ability to respond when everything moves at once. Ambulances flood toward a single address. Dispatch boards fill. And across town, emergencies continue to happen with no one left to answer them.

This episode explores what happens when disaster doesn’t just injure people... it consumes capacity. When speed alone isn’t enough, and when emergency medicine is forced to confront a question it had never fully answered before: How do you design a system that can survive the unimaginable?

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.