Ambulance History: A Journey Between England and America

The concept of ambulance history has evolved over centuries of evolution and transformation. From the earliest rudimentary forms of transporting the wounded during the Crusades to the modernization of vehicles and equipment we know today, the history of ambulances is a testament to medical innovation and dedication to saving lives. In this article, we will explore how the ambulance service has developed over time, both in England and America, through key milestones that have defined its structure and organization.

The First Steps: The Knights of St. John and the Crusades

Origins of ambulance history date back to the 11th century Crusades. The Knights of St. John, a medieval religious order, were the first to be responsible for treating wounded soldiers, caring for both allied and enemy troops. Knights acted as the first emergency responders, providing aid to anyone in need, whether soldiers or sick pilgrims. Assistance they offered, often in war situations, marked the beginning of a tradition that would develop over the following centuries.

Rise of civilian Ambulances

In 1832, London saw the introduction of a carriage specifically designed to transport cholera patients. This marked a turning point in the ambulance history, as it highlighted the importance of fast and efficient patient transport.

The newspaper The Times reported: “The treatment of the patient begins as soon as they are placed in the carriage; precious time is saved, which can then be used for care. Additionally, rapid transport to the hospital reduces the number of healthcare facilities, allowing them to be positioned at greater distances from each other.”

In the United States, as reported by Indiana Health Care, significant innovations took place during the American Civil War. Military doctors Joseph Barnes and Jonathan Letterman developed new methodologies and transportation systems, ensuring that each regiment had at least one ambulance cart. This two-wheeled model could carry two or three patients but was found to be too light to be effective and was gradually replaced by the “Rucker” ambulance, named in honor of Major General Rucker.

First American Hospital Ambulance

The first known hospital ambulance service was established in 1865 at the Commercial Hospital in Cincinnati, Ohio. Soon after, other institutions followed this example, including Bellevue Hospital in New York. In 1869, Edward Dalton, a former Union Army surgeon, was tasked with organizing a hospital in New York and introduced an ambulance service to ensure faster and more comfortable transport for patients.

Convinced that speed was crucial, Dalton initially ensured that horses were harnessed while waiting for a call. After a few months, this method was replaced with a more efficient system: a drop harness, which, with a pulley, was lowered directly onto the horses from the ceiling. In both solutions, the ambulances were operational and ready to leave within 30 seconds.

The service quickly gained success and continued to expand. In 1870, 1,401 emergency calls were recorded, a number that became more than triple within twenty-one year.

British Ambulance Services in the 19th Century

While, by the second half of the 1800s, the United States already had a well-established ambulance service, in England, the system was still in development. A pivotal moment in ambulance history came  in 1882 when the St. John Ambulance Association founded the “Invalid Transport Corps.” Initially designed to transport the poor free of charge, the service quickly evolved into the St. John Ambulance Brigade in 1887. This event marked the beginning of a systematic and organized ambulance service, with the establishment of local bodies and the introduction of a network of assistance. As noted by Emergency Services, “St. John Ambulance became one of the most influential organizations in the history of emergency transport in England.”

On September 14, 1887, the Northampton Ambulance Corps was established, and a wheeled stretcher was purchased. It was a carriage with iron-edged wheels designed to carry a canvas stretcher, and it was stored at the Northampton Infirmary.
At that time, many patients were brought to the Infirmary by train and welcomed directly at the station, but transport to and from the hospital was still cumbersome and impractical. For this reason, in 1888, a horse-drawn carriage was purchased, making transport more efficient.

The Transition of the 20th Century: Automobiles Replacing Horses

In 1909, the first mass-produced automobile ambulance was created in the United States. The project was carried out by James Cunningham, Son & Company of Rochester, New York, a manufacturer of carriages and funeral carts. The ambulance, called the Model 774 Automobile Ambulance, was powered by a 32-horsepower (24 kW) 4-cylinder engine. A few years later, in 1912, England also took an important step in the evolution of ambulance services, replacing horse-drawn ambulances with the first motor vehicles.

Further development came in 1918 when ambulances used during the war were made available for civilian use. Meanwhile, the English government began planning a national ambulance service, which would have a fundamental impact on the future of healthcare. As highlighted by Northampton General, “Motorized ambulances marked a crucial step in the expansion of emergency services, allowing for a faster response and greater efficiency.”

World War II and the National Service

In 1937, Britain introduced the emergency phone number 999, marking a key moment in ambulance history by improving the efficiency of the British ambulance system and allowing citizens to call for an ambulance directly in emergencies. Many parts of the world experienced a drastic decline in the quality of ambulances during World War II, as doctors, assigned to the armed forces, were removed from emergency services.

In the United Kingdom, during the Battle of Britain, the demand for ambulances increased to such an extent that numerous vans were requisitioned and put into service, often used to transport multiple injured people at once. Due to the shortage of dedicated vehicles, other vehicles, such as civilian and police cars, were also used to transport patients.

World War II thus posed new challenges for the system but also new opportunities. During the conflict, new rapid-response systems and techniques for treating victims were developed. In 1946, the National Health Service (NHS) Act required English authorities to provide ambulances “where necessary,” making the service public and accessible to all citizens. The Ambulance Service, as we know it today, evolved from 1948 when the government decided that a free service should be provided for all needy patients.

American Ambulances During the Korean War (1950)

While in England the government of the time established a free ambulance service for all patients in need, in the United States, the military air force was preparing for the Korean War by developing air ambulance units. These units, integrated into advanced medical facilities, used helicopters to ensure rapid and effective evacuation of patients. The H-13 Sioux helicopter, made famous by the cinematic and television versions of MASH*, transported 18,000 wounded soldiers during the conflict. The work of the Medical Air Evacuation Squadrons was a success and was repeated by U.S. forces in Vietnam.

Modernization and Innovation: 1960s and 1970s in England

The 1964 Millar Report marked a revolution in ambulance history by suggesting that ambulances should serve a greater role beyond mere transportation. Ambulances became equipped to provide medical treatments, not just to transport patients. This change was accompanied by an improvement in the skills of rescuers, who began receiving advanced training in first aid and the use of equipment such as oxygen and Entonox. The first ambulances were equipped very simply.

In the following years, another fundamental change was the introduction of helicopters for rapid transport and the use of motorcycles for urgent rescues.

In the 1970s, ambulance designs underwent significant transformations. Initially, models based on cars with a high roof were developed, but the car frames proved unsuitable for supporting weight and meeting the new requirements of emerging standards. As a result, van chassis, more durable and fit for the purpose, were adopted.

The first ambulances based on vans were very similar to civilian models, equipped only with the essentials for emergencies. In addition to sirens and lights, they had internal accessories for carrying medical equipment, particularly a stretcher.

The 1990s and the Role of Paramedics

The major change in the 1990s was the introduction of the title “Paramedic,” which indicated a professional with advanced training in pre-hospital care. This marked the beginning of a new era, in which ambulance personnel not only transported patients but were also capable of providing a range of advanced treatments at the scene of the incident. This development paved the way for an increasingly professionalized system capable of handling complex emergencies.

A History of Innovation and Dedication

Today, ambulance services in England and America represent highly specialized systems, with staff trained to handle the most critical medical emergencies. From the early days of transporting the wounded during the Crusades to modern paramedics and advanced ambulances, the ambulance service has undergone an extraordinary transformation. Each step in its evolution has contributed to making the system ever more effective and human-centered.

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