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First Ambulance Service

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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,[1] 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 ambulances.

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.[2]

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.

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".[2]

The first known hospital-based ambulance service was based out of Commercial Hospital, Cincinnati, Ohio, (now the University of Cincinnati Medical Center) by 1865.[2] This was soon followed by other services, notably the New York service provided out of Bellevue Hospital. Edward Dalton, a former surgeon in the Union Army, was charged with creating a hospital in lower New York; he started an ambulance service to bring the patients to the hospital faster and in more comfort, a service which started in 1869. These ambulances carried medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine. Dalton believed that speed was of the essence, and at first the horses were kept in harness while awaiting a call: within a few months this practice had been replaced with a 'drop,' or 'snap,' harness arrangement, whereby the tack was lowered by pulley from the ceiling straight onto the horse: under either scheme, ambulances were ready to go within 30 seconds of being called.[7] The service was very popular and grew rapidly, with the year 1870 seeing the ambulances attend 1401 emergency calls, but twenty-one years later, this had more than tripled to 4392.[2] For the first week of their operation, the ambulances were crewed by the hospital's house-staff, after which the hospital hired Drs. Duncan Lee and Robert Taylor as full-time ambulance surgeons; going forward, the plan was to crew the ambulances with fresh graduates of Bellevue's surgical training program, who would serve for six-month terms and be replaced by new hires from successive graduating classes.[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. Instead, by the end of 1869, the system of staffing the ambulance with residents in training (who could simply be assigned, rather than having to be recruited) was firmly established. As late as 1935, these interns were earning the same $50 a month their grandfathers had received.[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. These ambulances were designed to resemble private carriages, but were equipped with rollers in their floors and large rear doors to allow for a patient, lying on a specially designed bed, to be easily loaded. Space was provided for an attendant to ride with the patient, and the entire patient compartment was designed to be easily cleaned and decontaminated. Anyone willing to pay the cost of horse hire could summon the ambulance by telegram or in person.[8]

In 1880, the President of the Liverpool Medical Institution, Reginald Harrison, suggested a horse-drawn ambulance for the city.[9][10] In 1884, this ambulance service was created based at the Liverpool Northern Hospital: it was the first in Britain.[11]

In June 1887 the St John Ambulance Brigade was established to provide first aid and ambulance services at public events in London.[12] It was modelled on a military-style command and discipline structure. The St John Ambulance Association had already been teaching first aid to the public for 10 years prior to that.[12] National or state based branches of St John Ambulance now provides ambulance and first aid services in many countries around the world.[13]

In Ireland the St John Ambulance was set up in 1903 in the Guinness Brewery in St. James Gate in Dublin by Doctor, later Sir, John Lumsden for workers. In 1910 the Brigade began its first public duty at the Royal Dublin Society. During the 1916 rising and (after becoming the independent St. John Ambulance Brigade of Ireland) the 'Emergency' (World War II) the brigade acted as an ambulance service and remained so until the set up of Regional Ambulance Services.

In 1938 the Order of Malta Ambulance Corps was set up in Galway. In the years since this voluntary service has gone from strength to strength and is now Ireland's largest voluntary ambulance service and one of Ireland's largest charities.

In Queensland, Australia, military medic Seymour Warrian called a public meeting in Brisbane and established an ambulance service after witnessing an event at the Brisbane showgrounds during Show Week in 1892.[14] A fallen rider, suffering a broken leg was walked off the field by well-meaning but misguided bystanders, worsening his injury. As a result of the meeting, the Queensland Ambulance Transport Brigade was formed on the 12 September.[14] The first ambulance station in Queensland operated out of the Brisbane Newspaper Company and officers on night duty slept on rolls of newspaper on the floor. They had a stretcher, but no vehicle and transported patients on foot, although in time, they gained horse-drawn stretchers and eventually vehicles. A year after the establishment of the Brisbane centre, another was established in Charters Towers in north Queensland, growing to over 90 community controlled ambulance centres. In 1991 the independent QATB centres amalgamated to form the Queensland Ambulance Service which is now the fourth largest ambulance service in the world.[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.[15] The design of the tram network in St Louis was such that the ambulance streetcar, introduced in 1894 was able to reach all 16 infirmaries in the city.[2] Introduced in 1913, trolley cars in Bahia, Brazil, included a fumigating compartment and a two-bed nurses work area.

In Germany, in 1902, a civilian ambulance train was introduced (building on the use of trains during military conflict) for use during railway accidents. It housed a mobile operating room and eight stretchers. Railroad employed surgeons lived near the railway station where the ambulance train was stationed, and were summoned to urgently attend in the event of an emergency. This train had priority over the tracks, with all other trains obliged to give way.[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. However, the first motor-powered ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated in February 1899 by 500 prominent local businessmen.[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. These first two automobile ambulances were electrically powered with 2 horsepower (1.5 kW) motors on the rear axle.[2]

The first gasoline-powered ambulance was the Palliser Ambulance, introduced in 1905, and named for Capt. John Palliser of the Canadian Militia. This three-wheeled vehicle (one at the front, two at the rear) was designed for use on the battlefield, under enemy fire. It was a heavy tractor unit, cased in bulletproof steel sheets. These steel shields opened outwards to provide a small area of cover from fire (nine feet wide by 7 feet (2.1 m) high) for the ambulance staff when the vehicle was stationary.[2]

The British Army followed quickly behind the Canadians in introducing a limited number of automobile ambulances. In 1905, the Royal Army Medical Corps commissioned a number of Straker-Squire motor ambulance vans. They were based on a double-decker bus manufactured by the same company, although on a shorter wheelbase.[16] A number of them were based in Oxfordshire, serving several major encampments in the area.[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. This ambulance, named the Model 774 Automobile Ambulance, featured a proprietary 32 horsepower (24 kW), 4-cylinder internal combustion engine. The chassis rode on pneumatic tires, while the body featured electric lights, a suspended cot with two attendant seats, and a side-mounted gong.[17]

Throughout World War One, the Red Cross brought in the first widespread battlefield motor ambulances to replace horse-drawn vehicles, a change which was such a success, the horse-drawn variants were quickly phased out. In civilian emergency care, dedicated ambulance services were frequently managed or dispatched by individual hospitals, though in some areas, telegraph and telephone services enabled police departments to handle dispatch duties.[6] 59ce067264


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