Ambulances were first used by Catholic Monarchs during the Siege of Málaga in 1487. EMS progressed slowly during this time and it wasn’t until 300 years later that Baron Dominique Jean Larrey, a surgeon in Napoleon’s army, revolutionized battlefield medicine. He recognized the need for improvement of transport and treatment in the battlefield.
Larrey implemented early treatment for fallen soldiers in the field and transport by horse-drawn wagons, called ambulances volantes or “flying ambulances.” Further advances in the field were made during the United States Civil War. Union military physicians expanded on Larrey’s work and innovated the prehospital care system for soldiers.
Infrastructure and technological developments greatly influenced the EMS system, and soldiers were soon transported by railroad to hospitals. Civilian ambulances were first put into service in 1865 in Cincinnati and shortly after in New York city. Contemporary medical equipment on the ambulance included splints, stomach pumps, morphine, and brandy.
The first motorized ambulance was introduced later in the 19th century, which had two horsepower, weighed 1,600 pounds and traveled 16 miles per hour. A ‘speaking tube’ allowed communication between the driver and the physician in the back. During World War II, physicians were drafted, and as a result, ambulance services declined. Funeral homes stepped in to fill shortages and began transporting patients to hospitals. The prehospital scene was then in the hands of untrained funeral home employees.
As the highway system expanded and vehicle travel increased, car accidents began to skyrocket. In 1966, the Highway Safety Act led to the formation of the National Highway Safety Bureau, of which EMS is a part. In 1967, “911” was established as the emergency number in the United States by the Federal Communications Commission and AT&T. The medical community began recognizing the importance of on-scene treatment to improve patient outcomes. In the 1950s and 1960s, medical advancements included mouth-to-mouth resuscitation and CPR. Interestingly, demonstrations of mouth-to-mouth resuscitation were performed on volunteers who were sedated to mimic patients in respiratory arrest.
EMS mentality began to shift, and the federal government provided funding for improvements in prehospital care and transportation. Today, EMT services are not funded in 39 states because they are not considered “an essential service” like police or fire. Communities heavily rely on volunteer agencies like Essex Rescue all across the country. Changes in technology and medicine will continue to shape EMS, and I’m excited to see how these advancements improve prehospital care.
Sources: West Virginia Department of Education and EMRA.org