A Brief History of the Ambulance

Ambulance wagons on the battle field of Bull Run. Image from the Library of Congress, New-York : Published by E. & H.T. Anthony & Co., American and foreign stereoscopic emporium, 501 Broadway, [1861]

Early Ambulance History


In 1864 the United States Congress enacted the Union Army Ambulance Corps. Getting sick and wounded soldiers to surgeons as quickly as possible proved to be a frustrating issue with both the Union and Confederate armies. The sheer ratio of soldiers to surgeons prohibited most surgeons from going directly to soldiers on the battlefield. This meant that other soldiers had to find a way to transport the sick and wounded, as quickly and efficiently as possible, so that they could receive the best possible care. In the summer of 1862, Dr. Jonathan Letterman was placed in charge as the director of medicine for the entire United States Army. Dr. Letterman also had carte blanche in developing a plan for addressing the incredibly poor medical conditions. Among the first additions that Dr. Letterman developed was the first-ever Ambulance Corps. The ambulance consisted of a single wagon pulled by either one or two horses with a covered rear in which a stretcher could be used to pick up a soldier and transport them.

Research has shown that some ambulances were built by the Studebaker Corporation for the Union Army in the early vestiges of war. Early Civil War ambulances contained special rockers that acted as unique stabilizers for the comfort of the injured soldier which on the two-horse journey to a field hospital. To make it easy to load and unload the wounded soldiers, the ambulances had two beds made of wood, like a shutter, with sliding handles upon each corner; this meant that the patient could be easily shifted without any potentially life-threatening shifting or jolting of the patient. The bed would slide into the ambulance on special rollers and, in the same way, they would be unloaded at the field hospital. The wagons had six attached seats with cushions with the ability to secure the patients in. The overall design of ambulance wagons kept the patients in mind but also providing a way to comfortably and securely transport patients so that they would not be driven against each other or jostled around over especially rough roads.

Dr. Letterman established a unique system of three stations. The first of these stations could be considered a “wound-dressing” station in which an ambulance wagon could bring the injured to get dressings and apply a tourniquet, if necessary. The wounded soldier would then go on to a field hospital, which was located on or very close to the battlefield, in which emergent operations (such as amputations) could be performed. The third station was a large hospital that was not located on a battlefield and usually within the local community; this would allow for soldiers who survived any surgical intervention to receive long-term care. As Dr. Letterman began fine-tuning his craft, historians have noted that he could be credited for bringing the “triage” system into modern medicine. That is, triaging involves examining a patient and determining their level of acuity. In essence, the “sickest” or most ill patients would be seen first while less seriously ill patients would wait longer so that medical staff could attend to the gravely ill. Today, this process is used in every emergency department in the United States to rapidly assess which patients need immediate care and which patients can safely wait.


Ambulances in Kentucky


As the 20th-century came upon us, Kentucky and other parts of the United States would continue to offer civilian ambulance services. These private ambulance services were typically operated to transport the sick and infirm from the scene of an accident (or the home) directly to the hospital. Initially, attendants were often untrained and thus were not able to provide any basic first aid to patients. The goal here was to get the patient to the hospital so that care could begin as quickly as possible. In more densely populated areas, ambulance services would sometimes have an attendant along with a physician or intern. These were often limited to ambulance services operated by hospitals. While ‘ambulances’ were not mass-produced yet, the burden often fell upon funeral homes. This was for a very simple reason: hearses. Hearses could serve double duty and they were the easiest motor vehicles to transport a prostrate/supine patient without having to modify or make expensive changes to a vehicle. These vehicles were frequently referred to as combination cars. A hearse would be used to transport the dead but could also be converted in a matter of minutes to work as an emergency transport vehicle. Combination vehicles typically had emergency flashing or rotating lights of amber or red colors. The former was often used during a funeral procession while the latter, alone or in combination with the amber lights, could be used for emergency transports. Many combination vehicles also contained two-way radios, a removable stretcher for patients (or to move a deceased person), easily modified seating in the rear (e.g. folding seats), along with a cabinet containing medical supplies that could also be hidden when not in use. Most combination vehicles were made using a Cadillac chassis while companies like Miller-Meteor, Superior, and Cotner-Bevington customized the vehicles.

Ambulance, Kerr Brothers Funeral Home (Lexington, Kentucky). Image from the University of Kentucky Special Collection, Photographic Images Archive, Collection on Lafayette Studios: 1930s Decade.

While many attendants who drove ambulances at funeral homes were not trained, the Journal of Emergency Medical Service (JEMS) showed that a 1966 report titled Accidental Death and Disability: The Neglected Disease of Modern Society would eventually change how ambulances and their attendants/technicians were operated and utilized. The report noted that more Americans died from car accidents in 1965 than were lost in the Korean War. Recommendations were made regarding the standardization of emergency training and thus this standardization would go on to become the first realized course of study for emergency medical technicians. According to JEMS, many have argued that this was the birth of modern emergency medical service.



The First Ambulance in Lexington?

On January 5, 1896, an article from an unnamed author in The Daily Leader (Lexington, Kentucky) noted,

“Lexington needs an ambulance more than anything else at present, and it is hoped that all interested in the cause of humanity will awaken to the necessity of a comfortable way of transporting the sick and wounded. Let all co-operate toward this worthy end.”

A month later on February 7, 1896, an article in the Courier-Journal (Louisville, Kentucky) noted,

“Mrs. Maria B. Dudley has offered to donate to the city of Lexington an ambulance if the city will furnish a horse, driver, and a stable.”

By early 1897, articles in The Morning Herald (Lexington, Kentucky) were mentioning the ‘ambulance’ making runs to patients. It was not uncommon for newspapers to publish information regarding whom the ambulance picked up and transported to the hospital. By December 14, 1899, an article in The Bee (Erlanger, Kentucky) noted that “The Lexington ambulance during its nearly three years’ use, has carried nearly 1,200 patients.” (Note, this article has “1,1997” and it is presumed to be 1,199 or 1,197.)

After the aforementioned 1966 study, many city and county governments began exploring the idea of providing their own, publicly-funded ambulance service. Up until that point, most ambulance services in Kentucky were privately owned, whether by a funeral home or a private agency. In 1972, it was announced that Lexington had planned on adding three ambulance-rescue vehicles, called emergency-care units, into operation. They would be maned with two-person crews that were physician-trained emergency medical technicians. The cost of each unit was $54,000. The Advocate-Messenger (Danville, Kentucky) also noted that most city firefighters were also trained in the use of these units. The private ambulance company, Statewide Ambulance Service, Inc. filed suit against the city of Lexington stating that “the city’s plans to buy ambulances with proceeds from a federal grant violated the “spirit” of federal law by allocating government money to “compete with private enterprise.” According to the Courier-Journal (Louisville, Kentucky), U.S. District Court Judge Bernard T. Moynahan rejected Statewide Ambulance Service, Inc.’s bid for a temporary injunction that would have blocked city plans to establish a public ambulance service. This would be a running theme among many privately owned ambulance services. Additionally, many would object to the standardization requirements to become emergency medical technicians. According to the Courier-Journal in early 1927, in most parts of Louisville, those who needed an ambulance had to get a ride in a police car instead. However, Park-Duvalle Neighborhood Health Center provided trained EMTs and four ambulances to provide services to areas in Louisville. City officials in Louisville proposed providing local support for the ambulance service as the growing trends of physicians summated that police emergency transportations of patients was ineffective and potentially dangerous.

Image from the Courier-Journal (Louisville, Kentucky)

In 1975, the city of Louisville began a pilot program in which twenty of its emergency medical technicians would participate in a 400-hour training program in advanced emergency medical care. The first of its kind in the Commonwealth, the program was offered through the University of Louisville’s Department of Emergency Medicine. Up until that point, Louisville contracted with several nurses that would be dispatched by trained technicians to calls in an equipped station wagon. If the nurse felt the patient needed to go to the hospital then an ambulance was sent to transport them. The new program allowed EMTs to administer drugs and operate life-sustaining machines, previously only used by a registered nurse or physician. Technicians were required to take an 81-hour course with the new advanced course making EMTs the equivalent of a registered nurse in the field. 1975 was also the year when Type 3 ambulances were introduced in Louisville. Type 3 ambulances permitted a walkthrough connecting the driver’s compartment and the patient’s compartment. Until 1984, EMTs were required to get recertified every two years until a state law permitted the use of continuing education rather than getting fully recertified every two years. This process remains similar in many professional occupations in Kentucky and throughout the country.

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Contributed by Shawn Logan | contact@kyhi.org

⁘ Works Cited ⁘

  1. Reilly, Robert F. Medical and Surgical Care during the American Civil War, 1861-1865. Proceedings, 29, no. 2 (2016): 138-42.
  2. Flannery, Michael A. Civil War Medicine: Approaches for Teaching. OAH Magazine of History 19, no. 5 (2005): 41-43.

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