History of Emergency Medical Services

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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 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.  

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. 

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. 

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.

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.