History of the ambulance
History of the ambulance
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History of the ambulance

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History of the ambulance

The history of the ambulance begins in ancient times, with the use of carts to transport patients. 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, and civilian variants were put into operation in the 1830s. Advances in technology throughout the 19th and 20th centuries led to the modern self-powered ambulance.

There is evidence of forced transport of those with psychiatric problems or leprosy in ancient times. The earliest record of such an ambulance was probably a hammock-based cart constructed around 900 AD by the Anglo-Saxons.

During the Crusades of the 11th century, the Knights Hospitaller set up hospitals to treat pilgrims wounded in their battles in the 'holy land', although there is no clear evidence to suggest how the wounded made their way to these hospitals.

The Normans used a litter suspended between horses on two poles. Variations on the horse litter and horse-drawn wagons were used until the 20th century.

The first record of ambulances being used for emergency purposes relates to the troops of Isabella I of Castile in 1487. 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.

A major change in usage of ambulances in battle came about with the ambulances volantes designed by Dominique Jean Larrey (1766–1842), who later became Napoleon Bonaparte’s chief physician. Larrey was present at the battle of Spires, between the French and Prussians, and was distressed that wounded soldiers were not picked up by the numerous ambulances (which regulations required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, so he set about developing a new ambulance system. 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. Larrey adapted the axle assembly from the French army's horse-drawn artillery ("flying artillery" – artillerie volante [fr]) that made their gun carriages especially maneuverable on uneven terrain, and so christened his ambulances "flying ambulances" (ambulances volantes). The flying ambulances were first used by the Army of the Rhine in 1793. Larrey subsequently developed similar services for Napoleon's armies, and adapted his ambulances to the conditions; including developing a litter which could be carried by a camel for the 1798–1801 French campaign in Egypt.

In civilian ambulances, a major advance was made with the introduction of a transport carriage for cholera patients in London in 1832. The Times newspaper said, "The curative process commences the instant the patient is put in to the carriage; time is saved which can be given to the care of the patient; the patient may be driven to the hospital so speedily that the hospitals may be less numerous and located at greater distances from each other".

More advances in medical care for the military were made during the United StatesCivil War. 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. They ensured that every regiment possessed at least one ambulance cart, with a two-wheeled design that accommodated two or three patients. These ambulances proved to be too lightweight for the task, and were phased out to be replaced by the "Rucker" ambulance, named for Major General Rucker, which was a four-wheeled design, and was a common sight on the battlefield. Other vehicles were pressed into service during the civil war, including a number of steamboats, which served as mobile hospitals for the troops. It was during this period that the practice of transporting wounded soldiers to treatment facilities by railroad was introduced.

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