Nancy Caroline (June 27, 1944 — December 12, 2002)

Born in Newton, MA, Nancy Lee Caroline, (June 27, 1944 — December 12, 2002), graduated with a MD in 1971. She went on to do residency and fellowship in Critical Care, where she met Dr. Peter Safar. Safar was a pioneer in emergency medicine and CPR, having not only developed the first (and still used) algorithm for CPR in unresponsive patients, he also helped co-develop the resuscitation doll “Anne” with Åsmund S. Lærdal. Dr. Caroline worked with him on all that.

Nancy Caroline
Nancy Caroline

Safar’s work on CPR resulted in a sizeable grant from the USDOT to develop a nation wide pre-clinical emergency medicine system. He appointed Nancy Caroline to become the first director of Freedom Hose in 1974, a Pittsburg-based EMS service. Freedom House, other than its predecessors, did not just “scoop and drop” patients and did not segregate along racial lines, but provided medical care by trained EMS to anyone in need.

She was the first to train EMS in ECG interpretation, something originally thought to be the domain of physicians, intubation, and pre-medical diagnostics. Under her leadership, EMS expanded into the Paramedic system, highly trained providers on par with EM physicians of the time.

Only a year later, with Freedom House having been extremely successful, Pittsburg started a competing EMS service, prompting Caroline to become deputy director of Shayside Hospital. Nevertheless, Freedom House became the national model for EMS services and still is. She also wrote “Emergency Care in the Streets,” the first paramedic training manual, which is still used (albeit much updated) today.

In 1977, she relocated to Israel where she founded and became the first medical director of Magen David Adom, the Israeli Red Star (our Red Cross) society. He goal was to cover all of Israel in successively better trained “waves” of first responders, with the first response at any given point in less than five minutes.

In 1982, she moved to Kenya and founded the Flying Doctors service. She also co-founded the African Medical and Research Foundation (AMREF), which brought medical expertise into remote and rural areas. She returned to Israel five years later and continued to work in all the roles above. She also became an ardent proponent of Hospice Care, founding multiple hospices in the US, Africa, and Israel.

Only in 2002 did she allow herself a brief break from work when she married her medical school boyfriend Lazarus. Unfortunately only days after returning from her honeymoon, she was diagnosed with multiple myeloma and died on December 12, 2002 at one of the Hospices she founded. Her husband died of cancer only months after her, also in one of her hospices.

I was fortunate enough to meet her in 2001. She was an emergency medic through and through, responding in short sentences to anything non-medical but seemingly able to fill days of anecdotes and stories about medical and emergency medical events. Her eyes glazed over whenever the topic strayed, but she was a rapt listener as soon as the conversation moved back into medicine. My kind of person.

Few people know her name. Or that of Peter Safar. Or Åsmund Lærdal. It’s the fate of medicine, that we’ll always remember the names of those who do little and talk much, with those who made medicine what it is today and make it what it’ll be tomorrow, too busy to talk and thus forgotten.

I have not. Dr. Nancy Lee Caroline, with Peter Safar and Peter Rosen, will always be my idols and the people who defined modern Emergency Medicine. Tonight, I’ll drink to you, Nancy Caroline, and celebrate your life.