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Obituary: Dr. Nancy Caroline / A leader in preparing nonphysicians 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 nonphysicians 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 anethesiology 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.

Anita Srikameswaran can be reached at anitas@post-gazette.com or 412-263-3858.

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