How EMS began

1. You findFrance, the 1790s. Wounded soldiers are lying on the battlefield with no way to reach a surgeon.You doThe earliest documented emergency medical service is built to carry them off the field to the surgeons. As the EMT textbooks tell it, the job was transport, not care at the scene.
2. You findThe American Civil War, and later the First World War, produce wounded in very large numbers.You doClara Barton organizes care for the Civil War wounded and goes on to found the American Red Cross. By the First World War, volunteer ambulance corps are an established part of military medicine.
3. You findIn Korea and Vietnam, the wounded begin to get real medical care in the field.You doThese wars bring the major advances in field care, and those advances carry over into the civilian trauma centers that follow.
4. You findAt home, cities start ambulance services in the early 1900s. Smaller communities get no service until the late 1940s, after the Second World War.You doCivilian service is still transport only, and in small towns it is often a funeral home's hearse or the fire department that provides it.
5. You findA patient today is found having a heart attack at home.You doCare of hospital quality begins at the scene and continues without interruption until the patient reaches the hospital. That is the defining shift in the history of EMS.

• The first EMS was about transport. The service documented in France in the 1790s carried the wounded off the battlefield to where surgeons could treat them.
• War drove the progress. Clara Barton and the Civil War, volunteer ambulance corps by the First World War, then the major advances in field care in Korea and Vietnam.
• Military lessons became civilian care. The advances in field care from Korea and Vietnam carried over into civilian trauma centers.
• Civilian EMS developed more slowly. City ambulances in the early 1900s were transport only, and small communities had no service until the late 1940s, often a hearse or the fire department.
• The defining shift is from "just transport" to care of hospital quality that begins at the scene and continues until the hospital.

The wrong idea: An ambulance has always been a place where treatment happens. The job of EMS is basically a fast ride with some care added on.

What is actually true: It is the other way around. For most of its history the ambulance was only a vehicle. Modern EMS is defined by care that starts at the scene and does not stop until the patient is handed over at the hospital. The ride is one part of that care.

EMS began as transport. The earliest documented service, in France in the 1790s, was built to carry the wounded off the battlefield. Clara Barton organized care in the Civil War and founded the American Red Cross, volunteer ambulance corps were established by the First World War, and Korea and Vietnam brought the major advances in field care that fed civilian trauma centers. Civilian ambulances stayed transport only for decades, often a hearse or the fire department in small towns. The defining shift is to care of hospital quality that begins at the scene and continues without interruption to the hospital.

The EMS system today →