Imagine this: You feel a sudden, sharp pain in your chest. You call 911 and tell the dispatcher you think you may be having a heart attack. Within minutes, an ambulance arrives at your door. Paramedics put you on a stretcher, attach EKG leads to your chest, start an IV and put an oxygen mask on your face.

The paramedics call the nearest hospital to tell emergency room staff they’re on the way, and transmit your EKG to a doctor, who reads it and confirms that you’re having a heart attack.

The paramedics administer cardiac drugs to stabilize you for transport to the hospital and load you into the ambulance. Within minutes, you arrive at the hospital and are prepped for a cardiac catheterization to clear the blockage.

Thanks to the quickness, skill and technology of the EMS team, you not only survive the heart attack, but the damage to your heart is minimal.

In honor of National EMS Week in the third week of May, we’re taking a look at how emergency medical services have evolved over the years. In this first part, I’ll talk about the early roots of EMS on the fields of combat throughout history, as well as how advances in treating wounded military personnel led to advances in treating civilian medical emergencies.

The Battle-Hardened Roots of Emergency Medical Services

Even though EMS as we know it has been around for only the last 40 years or so, the concept of first aid goes back thousands of years. Perhaps the first recorded case of what we know as first aid was the story of the Good Samaritan who bandaged the injured traveler and transported him to an inn to recover.

First aid really took off on the battlefields of war. Ancient Greek and Roman armies employed military and civilian personnel on the battlefield to treat wounded soldiers and transport them away from the combat zone for care. During the Middle Ages, the Knights Hospitaller, or the Knights of St. John, set up hospitals to treat battle casualties.

Illustration of 19th-century ambulanceBut it was during Napoleon’s European wars in 1792 when what we know as ambulance transport came about. Napoleon’s physician, Dominique-Jean Larrey, developed the ambulance volante — or “flying ambulance” system of horse-drawn carriages designed to transport battle casualties to field hospitals away from the front lines. Dr. Jonathan Letterman, a medical officer in the Union Army, introduced this system to the U.S. during the Civil War.

World War I brought the motorized ambulance, along with changes in how medical units were organized. Combat medics began to treat the wounded on the battlefield, as well as evacuate them to aid stations. Also, advances in treating bleeding and broken bones helped save limbs and lives. These practices continued in World War II. Also during World War II, antibiotics were first used to prevent and treat infections.

During the Korean War, helicopters were first used to evacuate wounded personnel to field hospitals, particularly if they were wounded in places where other vehicles couldn’t reach them. The U.S. Army refined helicopter rescue during the Vietnam War.

Bringing Emergency Care to the Home Front

Lessons learned at war also made their way to treating ill and injured civilians. Around the time of the Civil War, civilian hospitals took notice and developed their own ambulance squads. The first known civilian ambulance service was based out of Cincinnati’s Commercial Hospital, now known as Cincinnati General Hospital, in 1865. Others, such as New York City’s Bellevue Hospital, soon developed their own ambulance services. The St. John Ambulance Brigade, established in 1877 in London, was the first dedicated ambulance service.

In 1899, the Michael Reese Hospital in Chicago used the first motorized ambulance. The first purpose-built, mass-produced ambulances were produced in 1909 by James Cunningham, Son & Company in Rochester, New York. By 1928, the Royal Flying Doctor Service of Australia was using airplanes to transport ill and injured patients in Australia’s outback to care in major cities.

Along with advances in transportation methods, ambulance services also benefitted from advances in treatment methods and organizational structures. In 1907, the Dräger Company of Lubeck, Germany introduced the Pulmotor, the first resuscitation device. It was used to resuscitate victims of mining and industrial accidents, smoke, carbon monoxide and gas inhalation, drowning and electric shock. Fire and police departments, as well as gas companies, mines and hospitals, created “Pulmotor squads.” With technologies like the Pulmotor, ambulance crews began to focus on not only transporting patients, but also delivering basic care at the scene.

In 1928, the city of Roanoke, Virginia organized the Roanoke Life Saving and First Aid Crew, the first volunteer rescue squad. The New York City Police Department followed suit with its Emergency Services Unit in 1930.

Between World Wars I and II, ambulances gained two-way radios, traction splints to immobilize leg fractures, oxygen tanks and larger and better selections of first aid gear.

During World War II, President Franklin D. Roosevelt created the Office of Civilian Defense to mobilize and train civilians to fight fires, provide first aid and create air raid shelters.

Postage stamp of military medics

A Need Arises for a New Model of Emergency Care

As nurses, doctors, and others who staffed ambulance crews were enlisted into military service, ambulance services found themselves shorthanded. As a result, many funeral homes provided ambulance service, because the funeral director’s hearse was often the only vehicle capable of transporting a person lying down.

Ambulance care was fragmented and sporadic. Some ambulances were well-supplied with the most modern equipment … others were not. Some ambulance staff were well-trained in caring for patients … others were not.

Every U.S. state had different regulations for how ambulances needed to be equipped and staffed, and what training and knowledge ambulance staff needed. Many states did not require ambulance staff to have even basic first aid training, and most ambulances typically carried little more than a first aid kit and oxygen tank. A need for new approaches to medical emergencies beyond the “load and go” of ambulance attendants of the time was needed.

In Part II, I’ll look at how this need, along with important advances in emergency medicine techniques and technology, shaped modern EMS. I’ll also examine the social and political changes that made EMS as we know it today possible.