Throughout history man has devised methods to transport the ill and injured.

Hammocks were readily available and used for centuries. During the time of

the Romans and Greeks, chariots served as ambulances. In 900 A.D. attendants

used a wagon with hammocks in it.

While this was a step forward, these wagons lacked effective brakes. Imagine

swinging back and forth or traveling downhill in one of these conveyances. In

1100 A.D. the Normans arrived in England with the

innovative horse litter. These units consisted of two

horses with special harnesses that suspended a bed

between them.

The most common definition for ambulance is a vehicle that transports

sick or wounded people. However, historians include Ferdinand and

Isabella's contribution when describing the word ambulance. In the late

1400s they introduced ambulancias or field hospitals. This was the first

time medical and surgical supplies were put in special

tents to treat the wounded. But it took another three

hundred years before troops wounded in battle were brought to the field hospitals

and aid came to those who could not be moved. 

Dominique Jean Larrey, a French surgeon, worked on the battlefields in the 1700s.

He saw first-hand the need for care as soon as possible. Prior to this time army

regulations required that the clumsy, heavy hospital wagons were stationed at the

rear of the armies. Larrey developed lightweight, two-wheeled wagons. Not only

did they take the wounded to the hospital but they

also brought the surgeons to the battlefield. These became

known as "flying ambulances" because they stayed with the "flying artillery"

on the battlefield.

Pack animals often served as ambulances. Horses,

mules and camels carried the injured for care. Attached to them

were litters or chairs, also known as cacolets. These held one

or two soldiers. Over time the apparatus grew more elaborate as

men sought to create safer and smoother rides.

The Civil War showed the glaring need to improve care for

the wounded. According to reports, none of casualties in the 1st Battle of Bull Run

traveled by ambulance to Washington but some walked the twenty-seven miles for

treatment. Those first assigned to remove the wounded were regimental musicians or

soldiers who were not good fighters. These soldiers were placed on ambulance duty

and served as medical assistants. During 1861, these men helped themselves to medicinal liquor or ignored the wounded to stay out of the line of fire. Surgeons treated only the soldiers who belonged to their regiment but the number of casualties became overwhelming.

Charles S. Tripler who served as Surgeon General of the Army of the Potomac Medical Department tried to improve the situation but when he was unsuccessful Dr. Jonathan Letterman was appointed to his position on July 4, 1862. Under Dr. Letterman's program, Medical Department officers selected soldiers who participated in the care and delivery of the wounded. Stretcher-bearers delivered the injured to primary centers. After rudimentary treatment ambulances carried the patients to field hospitals and then later moved them to the general hospitals by ambulances, rail cars or boats.

In 1864, Congress passed the Ambulance Corps Act. This was also called "An Act to Establish a Uniform System of Ambulances in the Armies of the United States." No longer were ambulances a part of the general transportation system. They now fell under the jurisdiction of the head of the medical department who was responsible for all aspects of the ambulance service:

Many hospitals that ministered to Civil War soldiers kept their ambulance service after the war. Records show that an Ohio hospital, Commercial Hospital (now known as Cincinnati General Hospital) had the first service for the general public in 1865. The ambulance driver's annual income was $360.

In New York, Dr. Edward B. Dalton, who had served as an army surgeon founded an ambulance service at Bellevue. Begun in 1869, it had 1401 calls in 1870 and by 1891 that number increased to 4392. While this increase is noteworthy five other hospitals in New York City also provided ambulance service by 1891. Bellevue's ambulances assigned doctors or surgeons to accompany them. The vehicles were well equipped with stretchers, handcuffs and strait jackets.

Located under the driver's seat were a box with brandy, two tourniquets,

six bandages, sponges, splint material and a small bottle of persulphate

of iron. The lightweight carriage weighed between six hundred and eight

hundred pounds and had a moveable floor that could be drawn out to take

and receive the patient. Drivers received an annual salary of $500 including

room and board. Horses were stabled close to the hospital and like the

fire service used special harnesses to attach the animals to the vehicle and get

them on the street as soon as possible. Other public ambulance services

connected to hospitals sprang up in Liverpool, Great Britain and in cities arou

nd the United States.

In 1899, the first motorized ambulance came on the

scene. Made in Chicago and donated by five

businessmen to Michael Reese Hospital; it weighed

sixteen hundred pounds and traveled at sixteen miles an hour. In 1900, New

York's St. Vincent Hospital obtained its first horseless vehicle. Katherine

Barkley includes this quote from The New York Herald in The Ambulance:

"An ambulance of this kind [motorized] possesses many advantages over its

horse-drawn prototype. A greater speed is attainable; and there is more

ease and safety for the patient; it may be stopped within its own length

when running at full speed, and on account of its weight it runs with greater

smoothness." The first motorized ambulances had two horsepower electrical

engines and had the capability of traveling as far as twenty to thirty miles. The doctor in the back of the vehicle could communicate with the driver via a speaking tube. These came equipped with electric lights, both inside and outside.

When World War I began some ambulances were still horse-driven. But as war continued buses were put into service and Parisian taxis were adapted to serve as ambulances. When the United States entered the war they brought Model-T Fords with them for many purposes. The framing on those used as ambulances was increased to provide adequate space for the litters.

These vehicles could travel as fast as 45 miles an hour and served well on

the rough terrain. The 1915 ambulances had painted canvas stretched across

a frame but the following year light wooden slats were added to the frame

and then canvas placed over it. .

Gradually, especially during and after World War II,

hospitals and physicians faded from prehospital practice,

yielding in urban areas to centrally coordinated programs.

Nationwide, the hearse often served as an ambulance.

Or the local ambulance was a converted hearse, designed

to deliver a patient as quick as possible. The ambulances had

space for the patient to lie down but lacked room for an

attendant to ride in the back with them. Texas passed

legislation in 1947 to regulate their ambulance operators. They were required to carry a traction splint, oxygen and minimal first aid equipment and their workers needed to have first aid training. The philosophy at this time was that emergency care began when the victim or injured person arrived at the hospital.

In the late 1950s and the 1960s, two key advancements mouth-to-mouth resuscitation and closed cardiac massage (CPR) caused medical professionals to recognize the impact of having trained community members in the field who could respond quickly to medical emergencies. The physicians came to the realization that treatment at the scene, especially for heart attacks, could make the difference between life and death. At the same time, statistics recorded 50,000 fatalities from automobile accidents.

In 1965 The Accidental Death & Disability Paper stated that the style of ambulance in current use (station wagon or limousine chassis) was inadequate. More space was needed for the patient, attendant and equipment. Four years later a report titled "Medical Requirements for Ambulance Design and Equipment" was submitted to the Department of Transportation-National Highway Traffic Safety Administration. The EMS Systems Act, passed in 1974, required that communities receiving federal funds for their programs had ambulances the met new federal specifications. Three chassis styles meet the criteria and are still in use today: Type I uses a small truck body with a modular compartment, Type II has a van body with a raised roof and Type III has van chassis with a modular compartment.

As we enter the twenty-first century, experts continue to discuss changes for ambulances. With the possibility of bioterrorism and naturally occurring communicable diseases, the air quality in the ambulance is receiving attention. Air circulation and filtration need improvement to protect both the patient and those who render care. Occupant safety and equipment access are also items to be addressed. Emergency Service workers are beginning to voice their needs as new vehicles are purchased. They are influencing the design of the unit in such areas as vehicle visibility, sliding side-entry doors and the needs of specialized units (i.e. cardiac or neonatal).

EVOLUTION OF THE AMBULANCE

Type I Ambulance

Type II Ambulance

Type III Ambulance

Minimum Required Basic Life Support (EMT) Ambulance Equipment

A. Ventilation and Airway Equipment:

1. Electric suction apparatus and accessories

▪ Portable suction

▪ Installed suction

▪ Wide bore tubing (2)

▪ Tonsilar suction tips (4)

▪ Flexible suction catheters 5F-14F (1 ea)

2. Portable oxygen equipment

▪ Portable min 300 L capacity/'D' tank (2)

▪ Constant flow regulator with adjustable flow rates from at least 2 - 15 lpm (2)

3. Installed fixed oxygen equipment able to simultaneously deliver to at least two patients

▪ Fixed min 3000 L capacity/ 'M'tank (1)

▪ Remaining tank-pressure gauge (1)

▪ Liter flowmeter with adjustable flow rate and quick disconnect (2)

▪ Wall mounted standard oxygen port with quick disconnect (2)

4. Oxygen administration equipment

▪ Nasal cannula

Adult (4)

Pediatric (2)

Infant (2)

▪ Transparent non -rebreather mask

Adult (4)

Pediatric (3)

▪ Oxygen tubing (6)

▪ Pocket mask

Adult (1)

Pediatric (1)

5. Bag-valve mask resuscitators

▪ Adult minimum 800 ml tidal volume (2)

▪ Child maximum 400 ml tidal volume (2)

▪ Clear masks for use with resuscitators

Adult (2)

Child (2)

Infant (2)

6. Airways

▪ Oropharyngeal sizes 55 mm - 115 mm (2 ea)

▪ Nasopharyngeal sizes 20F - 34F (1 ea)

B. Immobilization Devices:

1. Rigid cervical collars

Pediatric and adult assorted sizes (1 ea, total 5)

2. Head immobilization device (2)

3. Lower extremity traction device (1)

4. Extremity immobilization devices in appropriate sizes (1 set)

5. Long backboards (2)

6. Short spine immobilization device (2)

7. Immobilization straps or cravats (1 set per board)

C. Dressings and Bandages:

1. Sterile burn sheets (2)

2. Triangular bandages (1)

3. Sterile dressings

▪ 10x30" or larger (4)

▪ ABD 5x9" or larger (6)

▪ 4x4" (50)

4. Clean rolled bandages 4" or larger (10)

5. Sterile occlusive dressing, 3x8" or larger (4)

6. Adhesive tape

▪ 2" or 3" hypoallergenic (6)

D. Radio Communication:

1. Installed mobile radio transceiver utilizing State EMS frequencies 155.340 MHZ and 155.280 MHZ

E. Obstetrical:

1. Individual sterile kits containing at least a bulb syringe, surgical gloves, sterile disposable scalpel, cord clamps, and plastic bag for placenta disposal (2)

2. Heat reflective or insulating blanket for infant

F. Miscellaneous:

1. Sphygmomanometer

▪ Adult (2)

▪ Child (1)

▪ Infant (1)

2. Stethoscope (2)

3. Heavy bandage shears (2)

4. Flashlights (2)

5. Blankets (4)

6. Sheets (4 sets) pillowcases (4)

7. Pillows (2)

8. Fire extinguisher min. Rating 2A10BC (1)

9. Triage tags (50)

10. Ambulance cot with mounted cot fastening system (1)

11. Luminescent traffic warning devices (2)

12. Scoop stretcher (1)

13. Stair chair or equivalent seated transport device

14. Current US DOT Emergency Response Guidebook (1)

G. Infection Control:

1. Body substance isolation

▪ Eye protection, gloves, gowns, masks, shoe covers (sufficient number for crew)

▪ Antimicrobial hand wash

▪ Standard sharps container (1)

▪ Disposable trash bags (2)

▪ Biohazard bags

H. Medications:

1. Oral Glucose (1 tube)

2. Defibrillator (AED)

▪ Automatic external defibrillator (1)

▪ Defibrillator pads (2 sets)

Minimum Required Advanced Life Support (Paramedic) Ambulance Equpiment

A. Vascular Access:

1. Minimum 6000 ml of intravenous fluids

▪ Normal Saline and/or

▪ Lactated Ringers

2. Intravenous administration sets (6)

3. Intravenous Catheters sized 14g to 24g (6 ea)

4. Tourniquet (2)

5. Antiseptic wipes (6)

6. IV pole or roof hook (1)

7. Intraosseous needles (4)

8. Syringes of various sizes including tuberculin

9. Needles size 14g - 24g

B. Advanced Airway Control:

1. Laryngoscope handle with extra batteries and bulbs

2. Laryngoscope blades

▪ Straight size 0, 1, 2

▪ Curved and/or straight 3, 4

3. Endotracheal tubes

▪ Uncuffed size 3.0 mm - 5.0 mm (2 ea)

▪ Cuffed size 5.5 mm - 8.0 mm (2 ea)

4. 10 ml non-Luerlock syringes (6)

5. Stylettes

▪ Adult (2)

▪ Pediatric size 6 Fr(1)

6. Water soluble lubricating jelly (6 pkg or 1 tube)

7. Magill forceps, adult and pediatric sizes (1 ea)

C. Cardiac:

1. Manual monitor/defibrillator (1)

2. Monitoring patches (2 sets)

3. Pacing patches (2 sets)

D. Medications:

Paramedical personnel carry 30 different types of medications to treat various medical and traumatic emergencies. Full disclosure is not available for safety control purposes.