Public Awareness of Freedom House Ambulance Service After Viewing the Pitt

Abstract

Purpose

To conduct an exploratory, descriptive trends analysis related to The Pitt’s Freedom House Ambulance Service (FHAS) storyline.

Design

Multi-method examination of Google Trends and Reddit data.

Setting

Google Trends and the subreddit r/ThePittTVShow.

Sample

We extracted relative search volume (RSV) data from Google Trends 2 weeks before the episode aired on February 20, 2025 to 2 weeks after. We also searched r/ThePittTVShow for “Freedom House.” We retrieved posts published prior to September 15, 2025 using RedditExtractoR, which were coded by 2 trained research assistants (RAs).

Measures

RSV for Google Trends. RAs coded Reddit comments for the presence or absence of specific content.

Analysis

Calculation of percent change for Google Trends. For Reddit comments, calculation of descriptive statistics and cross-tabulations.

Results

RSV for “freedom house” increased 170% the day after the episode aired and remained elevated until 1 week later. Of the 196 relevant posts, 36.9% (n = 72) provided information about FHAS. Posts coded as emotional engagement (27.6%, n = 54) were often also coded as not knowing about FHAS (29.6%), n = 16) or reflection (24.1%, n = 13).

Conclusions

There is a temporal association between online searches about FHAS and The Pitt storyline as well as online information sharing about FHAS via social media.

Keywords

health history television emergency medical services health information health communication mass media health equity

Purpose

Few are aware that the modern system of pre-hospital emergency medical services (EMS) began in the 1960s with Freedom House Ambulance Service (FHAS), a group of Black men and women deemed “the unemployables” from the Pittsburgh Hill District neighborhood.¹ After the City of Pittsburgh created its own EMS service in 1975 that excluded most Black paramedics from FHAS, these pioneers were virtually forgotten. While knowledge has grown recently due to documentaries and the book American Sirens, it remains limited in comparison to the recognition of other early EMS services.

On February 20, 2025, the medical drama The Pitt featured an older Black male patient named Willie who discussed being a member of FHAS, their groundbreaking work, and later dissolution. A prior scoping review found that medical television programs can influence viewers’ health-related knowledge²; researchers have used social media data, including Google Trends and Reddit posts, to examine this.^3,4 However, there has yet to be a study examining the potential influence of The Pitt FHAS storyline. As a first step toward such a study, we used social media data to conduct an exploratory, descriptive trends analysis related to The Pitt FHAS storyline.

Methods

Design

We conducted a multi-method examination of Google Trends (https://trends.google.com/) relative search volume (RSV) and Reddit posts and comments from the largest subreddit dedicated to The Pitt, r/ThePittTVShow.

Sample

We extracted RSV data from Google Trends using the following settings—location: United States, time frame: February 6-March 6, 2024, search type: web search. We queried the terms “freedom house,” “freedom house ambulance,” and “emergency medical services,” with the latter serving as a counterfactual check. We also searched r/ThePittTVShow, for “Freedom House” and retrieved the resulting posts and comments—hereafter referred to as posts—using the RStudio package RedditExtractoR.⁵ We conducted the searches on September 22, 2025 and all posts prior to September 15, 2025 that were still available (ie, not deleted) were included to capture posts prior to the influx of new viewers following the Emmy Awards.⁶

Measures

The content analysis was informed by prior research examining television health content on Twitter (X)^7,8 and followed best practices for theory-based exploratory studies,⁹ with codebook development informed by the research question, initial examination of a subset of posts (n = 50), and narrative influence theories such as the eudaimonic entertainment overcoming resistance model (EEORM).¹⁰ Two trained research assistants (RAs) independently coded the retrieved posts (n = 2052) using the final codebook (Table 1). No distinction was made between posts and comments when coding, although RAs were instructed to refer to the initial post as needed for context. RAs completed 5 rounds of double-coding approximately 200 posts, calculating Cohen’s κ, and meeting with the first author to adjudicate differences and refine the codebook. Once Cohen’s κ was greater than 0.70 for all coding categories, we single-coded the remaining posts.

Table 1.

Frequencies and Percentages of Different Coding Categories (n = 196)

Code	Definition	Examples	N (%)
Information	Directs other readers to more information about freedom house, or where they can find more information. Can also mention increased interest in America Sirens or getting information offline.	• For those who like podcasts, 99% Invisible has an episode about freedom house ambulance	72 (36.9)
Self-transcendent emotional engagement (EEORM)^a	Displays emotions of elevation, awe, gratitude, or hope with respect to the storyline and/or characters specific to the freedom house storyline.	• I Read American Sirens and loved it, so I was really excited and was definitely pointing at my screen when freedom house got a mention…	54 (27.6)
Not knowing about freedom house	Mentions not knowing about freedom house before the episode, or learning about freedom house from the episode.	• Willie’s storyline made me angry…because it highlighted how cheated I was in my EMT and paramedic program for never learning about freedom house!	37 (18.9)
Reflection (EEORM)	Displays greater elaboration on the legacy of freedom house, for example, connecting it to broader structural racism or history.	• What’s crazy is that they were saving lives and were still shut down…some white people were so openly racist that they refused care from Black medics.	21 (10.7)
Healthcare provider	Author mentions that they are a healthcare provider, including an EMT.	• From Pittsburgh and work in the medical field and…i had NO idea about freedom house ambulance	16 (8.2)
Pittsburgh	Expresses being happy to see Pittsburgh representation or being proud to be from Pittsburgh.	• An incredible shout-out not just to the city of Pittsburgh, but to the amazing people who gave us the invaluable services we rely on today.	15 (7.7)
Searching for freedom house	Mentions googling or looking up freedom house from the episode.	• I Had to look it up to learn more. Before that, ambulance services were apparently run by funeral homes.	14 (7.1)
Disbelief	Expressing disbelief or being upset that this was not taught elsewhere or they had to learn about this from a television show instead of in school.	• I’m frustrated that as a Pittsburgh native and a historian, this is the first time I’m learning about this AMAZING piece of history!	12 (6.2)
Reactance (EEORM)	Expresses a negative reaction in the context of feeling lectured at or as if the show is a PSA.	• I Love the show but I cant fully agree. Usually it is great with the show-dont-tell, but occasionally it gets VERY heavy handed and PSA-like.	1 (0.5)

^aEudaimonic Entertainment Overcoming Resistance Model.

Analysis

We calculated percent change for Google Trends data. For the Reddit posts, we calculated descriptive statistics and cross-tabulations to describe the data. This study was deemed exempt by the University of Pittsburgh Human Research Protection Office; all quotations have been slightly modified to preserve author anonymity.

Results

Google Trends

RSV for the term “freedom house” increased 170% on February 21, the day after the episode aired, and remained elevated compared to pre-episode levels until 1 week later. RSV for the term “freedom house ambulance” rose from 0 to 100 the day after the episode aired and remained elevated for 3 days. RSV for “emergency medical services” showed no discernible change (Figure 1).

Figure 1.

Relative Search Volume for Google Searches for Freedom House (top line), Freedom House Ambulance (bottom line), and Emergency Medical Services (middle line)

Reddit Posts

Approximately 9.5% (n = 196) of posts were relevant to the FHAS storyline. Complete frequencies, percentages, and examples are provided in Table 1. The most frequent category was providing information about FHAS (36.9%, n = 72), and 7.1% (n = 14) mentioned searching online for more information because of viewing the episode. Cross-tabulations found that posts coded as emotional engagement (27.6%, n = 54) were often also coded as not knowing about FHAS (29.6%, n = 16) or reflection (24.1%, n = 13).

Discussion

While previous studies have used Google Trends or Reddit posts to examine associations regarding health content on television programs,^3,4 this is the first study to combine these two methods. Our findings suggest a temporal association between online searches about FHAS and The Pitt storyline, and that the subreddit r/ThePittTVShow may have served as an additional conduit for sharing information about FHAS. Additionally, the overlap in subreddit posts expressing emotional engagement with those not knowing about FHAS or reflecting on the legacy of FHAS suggests that, consistent with the EEORM,¹⁰ emotional engagement with the storyline was associated with broader connections, such as the role of systemic racism in the story of FHAS, among Reddit users discussing the episode.¹ While previous research has found that graduating medical students can learn about systemic racism through medical television programs,¹¹ to the best of our knowledge this is the first study to describe online engagement related to a television storyline that addresses systemic racism. Particularly in light of current challenges with health promotion and education about systemic racism,¹² our findings highlight the potential value of collaboration between health promotion professionals and fictional medical content creators for such education.

Limitations

We only extracted data from one subreddit, which reflects a highly engaged community. Thus, our results cannot be generalized to a broader audience or conversations elsewhere on Reddit. We may have missed relevant posts that did not contain our keywords, although the number of posts retrieved that were deemed irrelevant suggests this was unlikely. Qualitative content coding includes a degree of subjectivity. We sought to mitigate this by using rigorous double-coding, calculating agreement statistics, and adjudication. Finally, this study design prevents us from directly inferring causality regarding the temporal association between the increase in Google Trends and the release of the episode.

So What?

What is Already Known on This Topic?

Medical content on television can influence viewers, and social media data can be used to assess viewer engagement with this content.

What Does This Article Add?

This is the first study to combine analysis of Google Trends and Reddit posts to explore a health storyline onscreen, and the first to conduct a descriptive trends analysis related to the airing of The Pitt FHAS storyline.

What are the Implications for Health Promotion Practice or Research?

These findings can be used for future research explicitly examining the influence of this storyline on viewers knowledge about FHAS, and to promote further collaboration between health professionals and medical drama content creators.

Footnotes

Acknowledgements

The authors would like to thank Tiffany Lee and Tommy Manning for their assistance with coding the Reddit data. The authors would also like to thank Hollywood, Health & Society for facilitating conversations about Freedom House Ambulance Service with the writers of The Pitt, and Dr Joe Sachs for writing the episode of The Pitt that discussed Freedom House Ambulance Service.

ORCID iD

Beth L. Hoffman

Ethical Considerations

The University of Pittsburgh Human Research Protection Office deemed all study procedures exempt.

Author Contributions

Authors BLH and SOA conceived of the work. Authors BLH, KL, and OF contributed to the acquisition, analysis, and interpretation of data for the work. Author BLH drafted the initial manuscript and authors KL, OF, and SOA contributed to subsequent drafts. All authors approved the version to be published and agree to be accountable for all aspects of the work.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project described was supported by The University of Pittsburgh Undergraduate Research Funds. The funder had no role in the design of the study; collection, analysis, and interpretation of data; or preparation, review, or approval of the manuscript.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Sylvia Owusu-Ansah served as a medical advisor to The Pitt, providing information about Freedom House Ambulance Service that informed the storyline.

Data Availability Statement

Data is available upon reasonable request.*

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