The History of the Ambulance

Transporting the wounded

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From earliest times, people have required a means of transporting their wounded and sick.  The first wounded were probably carried in a hammock strung between two poles.  Other unique conveyances included human dhooleys which were used in India; wicker cradles called mule panniers; and Egyptian camel litters.   The Mojave Indians devised a litter comprised of a sheet of canvas between two poles carried on the shoulders of two men.

A more formalized ambulance surfaced in the late 15th century, when Ferdinand and Isabella of Spain took an unprecedented interest in the welfare of their troops during their crusade against the Moors.  Surgical and medical supplies were brought together in special tents for the wounded called ambulancias.

The concept of the ambulance was developed further by a man named Dominique-Jean Larrey who had been appalled by the neglected wounded and poor medical conditions he had witnessed during France’s war with the Austrians and Prussians in 1792.  Larrey came up with the idea of mobile ambulances – light-weight, two wheeled vehicles which stayed with the troops and allowed surgeons to work on the battlefield, an idea he later refined for Napoleon during the General’s Italian campaign.

The evolution of the ambulance took yet another turn during the American Civil War when ambulances were too few, often late, and driven by civilian drunkards and thieves.  A physician named Jonathan Letterman reorganized the field medical service to provide an effective ambulance service for the evacuation of battle casualties.  In 1864, an act was passed in Congress entitled “An Act to Establish a Uniform System of Ambulances in the Armies of the United States,” which spelled out who was responsible for each phase of the ambulance system.

 

The Geneva Convention, 1864

During the 1864 Convention in Geneva, an agreement was made by several European countries to recognize the neutrality of hospitals, of the sick and wounded, of all persons connected with relief service, and the adoption of a protective sign or badge.

In America, a similar organization had been functioning during the Civil War – The Sanitary Commission, which 20 years later became the American Red Cross, brought into being in large part due to the efforts of Clara Barton.

 

Precursors of modern ambulances

Most ambulance innovations took place during wartime, which were then adapted to civilian life.  American hospitals initiated their own ambulance services during the late 1860s.  Horsedrawn, these ambulances had a moveable floor that could be drawn out to receive the patient.  Beneath the driver’s seat was a container with:  a quart of brandy, two tourniquets, six bandages, six small sponges, splint material, blankets and a two-ounce vial of persulphate of iron.

With the arrival of the automobile came a different type of ambulance, the first appearing in 1899.  During World War I, many ambulances were adapted from buses and taxis.

The world’s oldest builder of ambulances is the Hess and Eisenhardt company in Cincinnati, Ohio.  In 1937, they sold the first air-conditioned ambulance built in America.  Developed with the idea that the ambulance should be a prehospital emergency room, these precursors of the modern ambulance were filled with medicine cabinets, roof lights, and two-way radios.

 

Post World War II

Ambulance service has not been confined to ground units.  During the Civil War, train ambulances and steam boat hospitals were used, and street car/trolley ambulances were popular in some cities in the late 1800s.   More recently, the Star of Life, a water cruiser, began to operate under the direction of the Coast Guard and Marine Police in 1976.  And the “medicopter” is commonplace now, first coming into service as a means of evacuating combat patients in Korea and Vietnam, and now invaluable during natural disasters, such as the Johnstown Flood, when medical supplies required refrigeration and patients needed to be airlifted to hospitals.

Today’s ambulances come equipped with some amazing new technology, from defibrillators and monitors that can transmit a complete 12-lead ECG directly to the emergency department to the latest in handheld computers.

 

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Material taken from the American College of Emergency Physicians.