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 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.
Advances in EMS were made during the United States' Civil War. Union military physicians Joseph Barnes and Jonathan Letterman built new techniques and methods of transport. They ensured that every regiment possessed at least one ambulance cart, with a two-wheeled 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, which was a four-wheeled design, and was a common sight on battlefield of that war.
The first known hospital-based ambulance service was based out of Commercial Hospital, Cincinnati, Ohio in 1865. 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. Dalton believed that speed was of the essence, and at first the horses were kept in harness while awaiting a call.
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.
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 Richester, 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 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
During 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 policedepartments to handle dispatch duties
In much of the world, ambulance quality fell sharply during the Second World War, as physicians, needed by the armed services, were pulled off ambulances. In the United Kingdom, during the Battle Of Britain, the need for ambulances was so great that vans were commandeered and pressed into service, often carrying several victims at once. Following the war, physicians would continue to ride ambulances in some countries, but not in others. Other vehicles, including civilian and police carswere pressed into service to transport patients due to a lack of a dedicated resource.
During the Korean War, the US Air Force produced a number of air-ambulance units for use in forward operating medical units, using helicopters for rapid evacuation of patients. The H-13 Sioux helicopter, made famous by the film and television versions of M*A*S*H, 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.
Ambulance design underwent major changes in the 1970s. High-topped car-based ambulances were developed, but car chassis proved unable to accept the weight and other demands of the new standards; van chassis would have to be used instead. The early van-based ambulances looked very similar to their civilian counterparts, having been given a limited amount of emergency vehicle equipment such as audible and visual warnings, and the internal fittings for carrying medical equipment, most notably a stretcher. s
The Committee on Trauma and the Committee on Shock, Division of Medical Sciences, National Academy of Sciences, National Research Council published the first document in 1966, entitled "Accidental Death and Disability: the Neglected Disease of Modern Society." The 37-page booklet commonly referred to as the "White Paper" addressed a huge and costly problem.
The "White Paper" stated that accidents were the leading cause of death for persons age one to 37, and the fourth leading cause of death for all ages in 1965. For people under 75, motor vehicle accidents constituted the leading cause of accidental death.
One response to these facts was the development of the first EMT curriculum. The reason why the "home" of EMS has been the U.S. Department of Transportation and National Highway Traffic Safety Administration was an unforeseen consequence of the funding for that early curriculum development.
Despite the documented regulations, some people believed more could be done in the out-of-hospital setting, including advanced airway management, vascular access and medication administration. This led to the creation and implementation of the emergency medical technician–paramedic (EMT-P) curriculum in the early 1970s, with pioneering work by Walt Stoy, PhD, and Nancy Caroline, MD. and others in Pittsburgh.
The first EMT-P curriculum included 400 hours of class, lab and clinical rotations in various hospital settings followed by a 100-hour field internship. As prehospital advanced life support (ALS) care gained favor within systems and communities, more paramedic programs sprouted up around the country.
By 1972, the expectation of advanced-level care on the streets and in the homes of Americans grew, fueled by the iconic TV show Emergency!, which portrayed paramedics providing care in an advanced manner never before seen, now watched by millions every Saturday night. For more than five years, America watched Johnny and Roy swoop in to save lives and help those in distress
Much has changed since the initial development of the EMT-P level of practice. The initial EMT-P curriculum was updated in 1985 and again in 1998. The 2000 EMS Education Agenda for the Future: A Systems Approach carried the vision of the 1996 EMS Agenda for the Future, and 2009 saw the most recent change in paramedic education in the form of the Education Standards. The Education Standards are less prescriptive than the original curriculum. This allows paramedic education to change as the practice changes. This also requires those running paramedic programs to keep current with advances in medicine and to be proficient in the writing of curriculum.
The Indiana Emergency Medical Services (EMS) Commission was formed by the General Assembly in 1974. As stated in its enabling legislation, the commission is responsible for the establishment and maintenance of an effective system of emergency medical services. This includes the necessary equipment, personnel and facilities to ensure that all emergency patients receive prompt and adequate medical care throughout the range of emergency conditions encountered.
The commission works to meet this mandate through the development of administrative codes and rules regulating Indiana's emergency medical services system as well as the provision of consultative services; promotion of training for emergency medical personnel; education of the public in first aid techniques; and coordination of emergency communications resources. The EMS Commission is also responsible for the regulation, inspection and certification of services, facilities and personnel engaged in the provision of emergency medical services. The commission must promulgate necessary administrative codes (rules) in order to fairly, equally and consistently regulate Indiana’s prehospital emergency medical care system.
The EMS Commission is comprised of 13 individuals appointed by the Governor. Title 16, Chapter 31 of the Indiana Code specifies the following categories be represented: a volunteer fire department that provides ambulance service; a full-time municipal fire or police department that provides ambulance service; a nonprofit provider of emergency ambulance service organized on a volunteer basis other than a volunteer fire department; a provider of private ambulance services; a state-certified paramedic; a certified emergency medical technician; a registered nurse who works in an emergency department; a licensed physician who has primary interest, training, and experience in emergency medical services; a chief executive officer of a hospital that provides emergency ambulance service; and a member who is not affiliated with the provision of emergency medical services and who is tasked with representing the public at large.