History of the ambulance
Ambulances were first used for emergency transport in 1487 by the Spanish forces during the siege of Málaga by the Catholic monarchs against the Emirate of Granada,[1] and civilian variants were put into operation in the 1830s.
The Spanish army of the time was well treated and attracted volunteers from across the continent; and among their benefits were the first military hospitals (ambulancias), although injured soldiers were not picked up for treatment until after the cessation of the battle, resulting in many dying on the field.
[2][3] Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons to transport fallen soldiers from the (active) battlefield after they had received early treatment in the field.
Union military physicians Joseph Barnes and Jonathan Letterman built upon Larrey’s work and designed a prehospital care system for soldiers, which used new techniques and methods of transport.
Other vehicles were pressed into service during the civil war, including a number of steamboats, which served as mobile hospitals for the troops.
These ambulances carried medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine.
[7] This scheme foundered immediately, however, when graduates balked at the schedule and the salary offered: $50 a month, twelve-hour shifts, and one day off every four weeks.
[7] In 1867, the city of London's Metropolitan Asylums Board, in the United Kingdom, received six horse-drawn ambulances for the purpose of conveying smallpox and fever patients from their homes to a hospital.
[14] A fallen rider, suffering a broken leg was walked off the field by well-meaning but misguided bystanders, worsening his injury.
[14] In the late 19th century St Louis, Missouri, United States started using a trolley car on their tram network designed to act as an ambulance, transporting the sick and injured.
[2] In the late 19th century, the automobile was being developed, and started to be introduced alongside horse-drawn models; early 20th-century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence.
[2] This was followed in 1900, by New York City, which extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride.
[2] On October 6, 1909, Vancouver’s first auto ambulance went for a test drive and promptly killed a pedestrian, a wealthy visitor from Austin, Texas, USA.
The Vancouver World wrote that “hundreds of men and women saw the dreadful affair, and turned pale and sick as the man was rolled along under the wheels and done to death, the spouting blood adding to the ghastliness of the accident.”[16] The British Army followed quickly behind the Canadians in introducing a limited number of automobile ambulances.
[2] The first mass-production automobile-based ambulance (rather than one-off models) was produced in the United States in 1909 by the James Cunningham, Son & Company of Rochester, New York, a manufacturer of carriages and hearses.
The chassis rode on pneumatic tires, while the body featured electric lights, a suspended cot with two attendant seats, and a side-mounted gong.
Traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and mortality of patients with leg fractures.
Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio.
In the United Kingdom, during the Battle of Britain, the need for ambulances was so great that vans were commandeered and pressed into service, often carrying several victims at once.
Other vehicles, including civilian and police cars were pressed into service to transport patients due to a lack of a dedicated resource.
The use of helicopters for emergency medical evacuations extended to civilian practice by groups such as the Shock Trauma Air Rescue Society.
CPR was developed and accepted as the standard of care for out-of-hospital cardiac arrest; defibrillation, based in part on an increased understanding of heart arrhythmias, was introduced, as were new pharmaceuticals to be used in cardiac arrest situations; in Belfast, Northern Ireland, a mobile coronary care ambulance successfully resuscitated patients using these technologies;[2] and well-developed studies demonstrated the need for overhauling ambulance services.
Ambulance design also evolved to reflect the ergonomics and other human factors of emergency medical care (for instance, raising the roof higher than typical for a van).
Other factors driving improvement include the need to help protect ambulance crews from common accidents, such as traffic collisions and rarer, but potentially catastrophic incidents such as terrorist activities.
