How Paramedics Work

Paramedicine Past

Ambulances might be loud, but at least they're not pulled by horses anymore like this early U.S. Army ambulance.
Ambulances might be loud, but at least they're not pulled by horses anymore like this early U.S. Army ambulance.

Paramedicine has been forged by war. In the 11th century, the Crusades gave birth to the Knights Hospitaller of the Order of Saint John of Jerusalem, a religious organization that developed some of the earliest known emergency medical practices for treating those wounded during the conflict's bloody battles. Among other innovations, the Knights Hospitaller invented the litter, a length of canvas suspended between two poles for transporting injured soldiers from the field of combat.

The Spanish improved on this concept in the late 15th century during the period of the Inquisition by setting up field hospitals known as "ambulancias," from which we derive the modern word "ambulance." But it wasn't until the Napoleonic wars in the early 19th century that the Grand Army's chief surgeon, Dominique Jean Larrey, realized he could improve outcomes for the wounded if he didn't wait until after the battle to treat them. He created horse-drawn "ambulances volantes," or "flying ambulances," to collect injured soldiers from the field even as the conflict raged. This concept soon made its way into civilian life when, in the 1830s, ambulance services formed in London to transport cholera victims to hospitals [source: Winston].

But, incredibly, it took an additional 130 years for the idea of staffing ambulances with trained medical personnel to gain ground. In 1967 Dr. J. Frank Pantridge of Belfast, Northern Ireland, published a landmark study of his successful use of a mobile coronary care unit staffed with a physician, nurse and ambulance attendant.

Change was in the air — just a year earlier in the U.S. the National Academy of Sciences published a report titled, "Accidental Death and Disability: The Neglected Disease of Modern Society." The report sounded the alarm, pointing out that car accidents killed more Americans in 1965 alone than were lost during the entire Korean War. One major reason for this was the dearth of proper emergency care.

Ambulances were often hearses staffed by morticians with no medical training. And when patients died, as they often did, they would leave the hospital in the same hearse in which they'd arrived. It was time, the Academy said, to create a standardized, nationwide system of emergency medical care. The Emergency Medical Systems Act was signed into law in 1973, and 1977 saw the publication of the first national standard curriculum for EMT-Paramedics. The revolution had begun [source: Winston].