Emergency Medical Services (EMS)

History

The concept of out-of-hospital care can be credited to Dominique Jean Larrey (1766–1842), who was Napoleon's chief army surgeon. Larrey recognized that it was imperative to treat wounded soldiers as [Page 346]quickly as possible. To accomplish this, he created the ambulance volante or “flying ambulance service” to rapidly transport the wounded. The concept behind the idea was to perform medical procedures as close to the battlefield and as quickly as possible. He believed that the quicker a procedure was done, the better are the chances the patient would survive. Larrey increased the mobility and improved the organization of field hospitals, establishing the first Mobile Army Surgical Hospital or MASH units. Larrey also created the concept of “triage,” which in French means “to sort.” He established rules for the triage of the wounded; treating them according to the seriousness of their injuries and the urgency of their need for medical care.

In 1865, during the American Civil War, the first civilian ambulance service was created. Four years later in New York City, ambulances were created that consisted of horse-drawn carriages staffed by physician interns to assist at the scene of the trauma and treat the patient as quickly as possible. However, it was not until the 20th century that ambulance services began to be used widely.

During World War I, the average evacuation time for combat personnel was 18 hours, resulting in a high mortality rate. Because of this, during World War II, focus was placed on the expeditious transportation of injured personnel from the frontlines to areas where physicians were available. Although many medical advancements were made during World War I and II, advancements in training EMTs and prehospital care did not occur at home in America.

It was not until the mid-1960s that prehospital care received the attention of government and the public. Many people before this time thought that all care for the sick and injured occurred in the hospital and therefore saw no reason for paramedics to be well versed in life-saving techniques, believing that hospital physicians would be able to save the patients. In addition, most EMTs were poorly trained and did not have adequate equipment. However, in 1966, all this changed with the publication of Accidental Death and Disability: The Neglected Disease of Modern Society, which was written by the National Academy of Sciences, National Research Council. This report was extremely influential and represented a turning point in EMTs' responsibilities.

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