Nancy Caroline
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Nancy Lee Caroline (; June 27, 1944 – December 12, 2002) was an American physician and writer who worked in
emergency medical services Emergency medical services (EMS), also known as ambulance services, pre-hospital care or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to d ...
(EMS). She was medical director of
Freedom House Freedom House is a nonprofit organization based in Washington, D.C. It is best known for political advocacy surrounding issues of democracy, Freedom (political), political freedom, and human rights. Freedom House was founded in October 1941, wi ...
, an emergency ambulance service that assisted underserved populations in
Pittsburgh Pittsburgh ( ) is a city in Allegheny County, Pennsylvania, United States, and its county seat. It is the List of municipalities in Pennsylvania#Municipalities, second-most populous city in Pennsylvania (after Philadelphia) and the List of Un ...
in the 1960s and 1970s. She was also the first medical director of
Magen David Adom The Magen David Adom (, abbr. MDA, pronounced ''MAH-dah'' per its Hebrew acronym, ) is Israel's national emergency medicine, emergency medical, Emergency management, disaster, ambulance and blood bank service. The literal meaning of the name is ...
,
Israel Israel, officially the State of Israel, is a country in West Asia. It Borders of Israel, shares borders with Lebanon to the north, Syria to the north-east, Jordan to the east, Egypt to the south-west, and the Mediterranean Sea to the west. Isr ...
's
Red Cross Society The International Red Cross and Red Crescent Movement, the world's largest group of non-governmental organizations working on humanitarian aid, is composed of the following bodies: *The International Committee of the Red Cross (ICRC), is an indep ...
, and was later called "Israel's Mother Teresa" by colleagues.


Early life

Nancy Lee Caroline was born on June 27, 1944, in
Newton, Massachusetts Newton is a city in Middlesex County, Massachusetts, United States. It is located roughly west of Downtown Boston, and comprises a patchwork of thirteen villages. The city borders Boston to the northeast and southeast (via the neighborhoods of ...
, to Leo and Zelda Caroline. From a young age, Nancy had a strong social conscience and a strong sense of her identity as a Jewish person. She began her medical career while still a teenager, working as a photographer and lab worker at
Massachusetts General Hospital Massachusetts General Hospital (Mass General or MGH) is a teaching hospital located in the West End neighborhood of Boston, Massachusetts. It is the original and largest clinical education and research facility of Harvard Medical School/Harvar ...
. In 1966 she received a B.A. in linguistics from
Radcliffe College Radcliffe College was a Women's colleges in the United States, women's Liberal arts colleges in the United States, liberal arts college in Cambridge, Massachusetts, that was founded in 1879. In 1999, it was fully incorporated into Harvard Colle ...
and her M.D. from
Case Western Reserve University Case Western Reserve University (CWRU) is a Private university, private research university in Cleveland, Ohio, United States. It was established in 1967 by a merger between Western Reserve University and the Case Institute of Technology. Case ...
in 1971. She stayed in Cleveland to complete her residencies, and then began a fellowship in critical care medicine at the University of Pittsburgh in 1973.


Freedom House project

Her mentor in the fellowship was Peter Safar known for his work in emergency medicine and cardiopulmonary resuscitation. In 1974, the university received grant funding from the U.S. Department of Transportation to create a "curriculum for nation wide emergency medical services". Safar oversaw this project, but recruited Caroline as the medical director for
Freedom House Freedom House is a nonprofit organization based in Washington, D.C. It is best known for political advocacy surrounding issues of democracy, Freedom (political), political freedom, and human rights. Freedom House was founded in October 1941, wi ...
in 1974, one of the first EMS medical directors in the United States. The service had encountered police oppression and opposition as well as financial and administrative issues. By the time Caroline first became involved, the service was on the brink of collapse. However, she staged a successful comeback during her time as medical director. This service was the first to train and use EMT paramedics in America as well as
EKG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of t ...
in the ambulances. Despite this, funding was cut in 1975 when the city launched its own ambulance service and Freedom House quickly folded. In 1976, she took over as deputy director for the emergency department of Shadyside Hospital in Pittsburgh. The Freedom House project – not to be confused with the organization created by Eleanor Roosevelt – was created to train ambulance attendants and teach paramedics in the
Hill District The Hill District is a grouping of historically African American neighborhoods in the City of Pittsburgh, Pennsylvania. Beginning in the years leading up to World War I, "the Hill" was the cultural center of black life in the city and a major ce ...
. In segregated Pittsburgh, ambulance service was privatized and rarely answered calls in black neighborhoods. Police were the only emergency responders in most of these neighborhoods. The service was very successful and became the national model for cities' ambulances. Caroline wrote ''Emergency Care in the Streets'', a textbook which was the first of its kind for paramedic training.


Israel and Magen David Adom

In 1977, Caroline immigrated to Israel, becoming the first medical director of
Magen David Adom The Magen David Adom (, abbr. MDA, pronounced ''MAH-dah'' per its Hebrew acronym, ) is Israel's national emergency medicine, emergency medical, Emergency management, disaster, ambulance and blood bank service. The literal meaning of the name is ...
, Israel's Red Cross Society. The program she created was focused on emergency medical responses to terrorist attacks, dedicated to enabling the providers to respond to emergencies within minutes. She also translated her EMS textbook into Hebrew.


East Africa

Nancy Caroline relocated to Kenya in 1982 to become Senior Medical Officer of the African Medical and Research Foundation (AMREF) in Nairobi. While working in the region, she managed the Flying Doctors emergency medical service, which covers Tanzania, Uganda, Kenya, and southern Sudan. She conducted medical classes for health workers throughout the region and wrote a weekly health column for the Kenyan newspaper ''
The Standard The Standard may refer to: Entertainment * The Standard (band), an indie rock band from Portland, Oregon * ''The Standard'' (novel), a 1934 novel by the Austrian writer Alexander Lernet-Holenia * ''The Standard'' (Tommy Flanagan album), 1980 * ...
'' entitled "Ask Dr. AMREF". During her five-year stay in East Africa, she wrote a handbook on basic life support while consulting for the League of Red Cross societies and running seminars on first aid. She worked extensively with the Ethiopian Orthodox Church to provide better health care and nutrition in over 600 orphanages. She set up a non-profit organization, Agro-Africa Limited, the purpose of which is to set up small scale agricultural projects to ameliorate Kenya's massive droughts and help its victims. Finally, she was the director of medical programs for the American Joint Distribution Committee in
Addis Ababa Addis Ababa (; ,) is the capital city of Ethiopia, as well as the regional state of Oromia. With an estimated population of 2,739,551 inhabitants as of the 2007 census, it is the largest city in the country and the List of cities in Africa b ...
. In 1987, she returned to Israel and continued to work for AMREF, writing correspondence courses for rural health workers in Africa and developing training materials in emergency medicine.


Final years

Caroline worked until her death in 2002. She remained an adjunct visiting professor at the
University of Pittsburgh The University of Pittsburgh (Pitt) is a Commonwealth System of Higher Education, state-related research university in Pittsburgh, Pennsylvania, United States. The university is composed of seventeen undergraduate and graduate schools and colle ...
's medical school and, on a volunteer basis, as a physician and medical adviser of Magen David Adom, the Oncology Department of
Sheba Medical Center Chaim Sheba Medical Center at Tel HaShomer (), also known as Tel HaShomer Hospital, is the largest hospital in Israel, located in the Tel Aviv District city of Ramat Gan in the Tel HaShomer neighborhood, Israel. In 2025, ''Newsweek'' ranked it as ...
, and the Tel Hashomer Hospice. For the last fifteen years of her life, she dedicated her work to cancer treatment and hospice care in Israel. In 1995, concerned about the limited options she saw in hospice care in Israel, she founded the Hospice of Upper Galilee (HUG). In 2002, she married geneticist and molecular biologist Lazarus Astrachan, whom she had first met in medical school. They were only married a few months before she died. She was diagnosed with
multiple myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibody, antibodies. Often, no symptoms are noticed initially. As it progresses, bone ...
and was cared for at the Hospice center she founded. She died of multiple myeloma on December 12, 2002, at home in
Metula Metula () is a town in the Northern District of Israel. It abuts the Israel-Lebanon border, and had a population of in . History Bronze and Iron Age Metula is located near the sites of the biblical cities of Dan, Abel Beth Maacah, and Ijon ...
, Israel, and was buried in her native Boston. Her husband died in 2003, also of cancer.


Published works

* ''National Training Course, Emergency Medical Technician, Paramedic: Course Guide'', 1977 * ''Workbook for Emergency Care in the Streets'' (with James C. McClintock), 3rd edition, 1987 * ''Ambulance Calls: Review Problems for the Paramedic'', 3rd edition, 1991 * ''CPR for All: An Illustrated Manual of Basic Cardiopulmonary Resuscitation (CPR) in Adults, Children, and Infants'' (with Ilan Yeshua), 1991 * ''Emergency Medical Treatment: A Textbook for EMT-As and EMT-Intermediates'', 1991 * ''A Manual for Instructors Adapted to Emergency Medical Treatment'', 3rd edition, 1991 * ''Workbook for Emergency Medical Treatment: Review Problems for EMTs: With Answers'', 1991 * ''Handbook of Prehospital Medications'', 1995 * ''Study Guide for Emergency Care in the Streets, 5th Edition'', 1995 * ''Handbook of Palliative Care'' (with Alexander Waller), 2nd edition, 2000


References


External links


Papers of Nancy L. Caroline.Schlesinger Library
Radcliffe Institute, Harvard University. {{DEFAULTSORT:Caroline, Nancy 1944 births 2002 deaths Deaths from multiple myeloma Deaths from cancer in Israel American emergency physicians Israeli emergency physicians American emigrants to Israel American hospital administrators Radcliffe College alumni Case Western Reserve University alumni 20th-century Israeli women physicians 20th-century Israeli physicians