Nancy Caroline, Paramedic Textbook Pioneer Dies at age 58

By: Tom Long, Boston Globe Staff

Date: December 13, 2002

Dr. Nancy Caroline, 58, a Newton native who wrote the book on emergency medical services died of cancer yesterday in Metulla, Israel.

Dr. Caroline was the author of “Emergency Care in the Streets,” a primer on prehospital care that has been an integral part of the training of thousands of emergency medical care technicians. First published in 1979, it is currently in its fifth printing. “Without Caroline’s work and support, EMS would not have evolved into the profession it has become,” said Dr. Bryan Bledsoe, author of “Paramedic Medical Care” and several other texts.

“She was a pioneer who went to bat for paramedics when paramedic wasn’t a household word,” A.J. Heightman, editor of the Journal of Emergency Medical Services, said yesterday. “She believed that prehospital care could be rendered efficiently by lay people, like firefighters and others who took on the task.” Her book is a model of concision and simplicity. “She managed to explain extremely complicated medical concepts in words and images that people can understand,” said Heightman.

In order to get a better handle on emergency care, Dr. Caroline often rode with EMTs. In her book, Dr. Caroline tells of treating a gunshot wound victim in an ambulance when his gun-toting assailant entered the vehicle, intent on finishing the job. He was not successful. “She wasn’t just an academic – she was comfortable on the street,” said Heightman. “You’d always see her riding with the crews.”

Dr. Caroline was a member of the faculty at the University of Pittsburgh in 1974, when the school received a grant from the US Department of Transportation to create a curriculum for emergency medical services. Dr. Peter Safar oversaw the project, but most of the work was delegated to Dr. Caroline. Dr. Safar also persuaded her to assume direction of the Freedom House Ambulance Service in Pittsburgh, a nonprofit group founded by Safar to serve the minority community. It was with the Freedom House Ambulance Service that she got her first hands-on experience.

A graduate of Newton High School and Radcliffe College, she earned her medical degree at Case Western Reserve University. “Nobody could tell her she couldn’t do something,” her brother, Peter, of Green Valley, Ariz., said yesterday. “They told her she couldn’t apply to Radcliffe when she was in her junior year at Newton High; she did and was accepted. They told her she couldn’t take a year off between high school and college, and she did. They told her she couldn’t take a year off between college and medical school and she did that, too. She took a year off to study linguistics or something.”

In 1977, Dr. Caroline immigrated to Israel to become medical director of Magen David Adom, the Israeli equivalent of the Red Cross. “She liked to be where the action was,” said her brother. From 1982 to 1983, she worked with the Flying Doctors, providing medical care to the needy in East Africa. Upon her return to Israel, she got additional training in oncology and established the Hospice of Upper Galilee, a nonprofit that provides comprehensive palliative care. That was before she was diagnosed with cancer. The organization she founded would ultimately treat her in her final illness.

“When she was working at the hospice, the area was getting shelled by the Palestinians every other day,” said her brother. “I told her, `Why don’t you come home and set up a medical practice where it’s safe.’ ” Dr. Caroline replied, “At least the streets are safe. I know I can go out for walk after midnight if I feel like it.”

“She was the most opinionated and obstinate person I ever met,” said her brother. “Unfortunately, she was always right.”

Besides her brother, she leaves her husband, Dr. Lazarus Astrachan of Cleveland; and her mother, Zelda Caroline of Chestnut Hill.

Submitted to NEMSM May 2008 by Cygnus Business Publications

Dr. Nancy Caroline

Nancy Caroline, MD (1944-2002)

Dr. Caroline was one of the first physicians to understand that non-physicians could perform emergency skills traditionally relegated solely to docs. She was mentored by early EMS pioneer, Dr. Peter Safar, and became involved in one of the first paramedic education projects in the United States: training members of the pioneering Freedom House Enterprises Ambulance Service in the Pittsburgh area.

During the late 1970s, spurred by the fact that paramedics had to utilize nursing or medical textbooks that did not take into account EMS’ unique working environments, she authored the now-revered original paramedic textbook, Emergency Care in the Streets. For a decade her book was the only resource available for paramedic care.

Dr. Caroline followed her efforts in the U.S. with work overseas in Israel as the first medical director of Magen David Adom, Israel’s Red Cross equivalent. There she developed a training program that enabled emergency workers to respond to terrorist attacks within minutes. Until the end of her life, Dr. Caroline continued to write books for EMS education, and her first textbook, now in its sixth revision, remains well-known by EMS educators and is venerated by the many paramedics who began their careers through her words.

Obituary: Dr. Nancy Caroline / A leader in preparing non-physicians to provide emergency medical care

Saturday, December 21, 2002

By Anita Srikameswaran, Post-Gazette Staff Writer

A doctor who trained Pittsburgh paramedics in the mid-1970s, and who colleagues later would call “Israel’s Mother Teresa” for her pioneering work with paramedics and in resuscitation and palliative medicine, died of cancer Dec. 12.

Dr. Nancy Caroline was 58. She was buried in Boston, where she grew up.

Dr. Caroline attended Radcliffe College and got her medical degree from Case Western Reserve University in Ohio. In 1973, she came to the University of Pittsburgh for training in critical care medicine under the mentorship of Dr. Peter Safar, renowned for his work in emergency medicine and cardiopulmonary resuscitation.

Safar initiated the Freedom House project, in which people from the Hill District were trained to be ambulance attendants. He delegated much of the work to Dr. Caroline, asking her to teach them to become paramedics. The program was very successful. Among other books, she wrote “Emergency Care in the Streets,” a textbook that was the first and, for a decade, only resource for paramedic care. It is currently in its fifth printing.

“One reason for her great impact was the fact that she is a caring, dynamic, compassionate ‘super doctor,’ a Renaissance woman and an eloquent writer,” said 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.”

After leaving Pittsburgh in 1976, she became an Israeli citizen and medical director of its organization Magen David Adom, which was responsible for ambulance services throughout the country. Her former assistant, Yehudit Avior, told the Jerusalem Post that at that time, the organization had only basic equipment and ambulances.

“She insisted that mobile intensive care units were needed for serious cases and that every ambulance had to reach the patient within three minutes,” he recalled. “MDA medics thought she was crazy.”

Dr. Caroline then spent five years in East Africa, flying around as a “bush doctor” and again teaching non-physicians to provide medical services. When she returned to Israel, she set up the nonprofit Hospice of Upper Galilee, which delivered end-of-life care to cancer patients. The hospice was taking care of her when she died of multiple myeloma at home in Metulla.

She had maintained her status as a visiting professor in Pitt’s anesthesiology and critical care department. In February, a two-year research fellowship was named in her honor.

Dr. Caroline is survived by her husband, Dr. Lazarus Astrachan, formerly of Cleveland; her mother, Zelda Caroline of Boston; and her brother, Peter Caroline of Green Valley, Ariz.


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