Early patient transport

A horse drawn ambulance from the American Civil War (1861-1865)

The transportation of the sick and injured has been going on since before recorded history, and there is evidence of forced transport of those with psychiatric problems or leprosy in to ancient times.^[19] The first record of an ambulance, in terms of a wagon for transporting invalids, was probably a hammock based cart constructed around 900AD by the Anglo-Saxons .

During the Crusades of the 11th Century, the Knights of St John set up hospitals to treated 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.

In Norman times, a litter suspended between horses on two poles was used.^[19] Variations on the horse litter and horse drawn wagons were used from then right in to the 20th century.

Early battlefield treatment

The first record of ambulances being used for emergency purposes was the use by Queen Isabella of Spain , in 1487. The Spanish army of the time was treated extremely well and attracted volunteers from across the continent, and part of this was the first military hospitals or '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 ambulance volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte ’s chief physician. Larrey was present at the battle of Spires, between the French and Prussians , and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities has ceased, and set about developing a new ambulance system.^[19] Having decided against using the Norman system of horse litters, he settled on two or four-wheeled horse drawn wagons were used to transport fallen soldiers from the (active) battlefield after they had received early treatment in the field. These 'flying ambulances' were first used by Napoleons Army of the Rhine is 1793. Larrey subsequently developed similar services for Napoleon's other armies, and adapted his ambulances to the conditions, including developing a litter which could be carried by a camel for a campaign in Egypt .

Development of civilian services

In civilian ambulances, a major advance was made (which in future years would come to shape policy on hospitals and ambulances), with the introduction of a transport carriage for cholera patients in London during 1832. The statement on the carriage, as printed in The Times , said that "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".^[19] This tenets of ambulances providing instant care, allowing hospitals to spaced further apart displays itself in modern emergency medical planning.

Advances during the American Civil War

More advances in medical care for the military were made during the United States ’ Civil 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 wheel design that accommodated two or three patients. These ambulances unfortunately proved to be too lightweight for the task, and were phased out to be replaced by the "Rucker" ambulance, named for Major General Rucker ,^[19] which was a four wheeled design, and was a common sight on battlefield of that war. Other vehicles were pressed in to service during the civil war, including a number of Steamboats , which served as mobile hospitals for the troops. It was in this period that the practice of transporting wounded soldiers to treatment facilities by railroad was introduced.^[20]

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