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Emergency care of the sick and wounded in the field has deep historical roots as far back as the ancient times when Roman soldiers were carried off the field of battle on their own shields or by chariots and wooden carts. Homer describes medical care being provided in the field by surgeons for those who were too badly injured to be moved. The Brothers of the Benedictine Monastery of Saint Mary Latina began providing care in ad 1080, and later as the Knights Hospitaller1 of the order of St John began rendering emergency medical care on the battlefield and evacuating the victims to a hospital for continued care. Historical references demonstrate stretcher movements of nonambulatory injured or sick persons in Native American North America, India, Egypt, and Europe throughout early history and into the more modern times.2 In the 15th century, King Ferdinand and Queen Isabella of Spain established deployable field hospitals called ambulancia. George Washington's Continental Army possessed mobile field hospitals with organized systems for retrieving the wounded and delivering them to the field hospital for care. However, Napoleon's surgeon, Dominique-Jean Larrey, is credited with creating one of the first most recognizable EMS systems, centered on his ambulance volante (or flying ambulance) that had been inspired by his observation that the injured waited long time periods without care and that the same basic cart design was a proven mode for rapidly moving artillery.


  • Discuss key historical points in the evolution of EMS.

  • Name key leaders and their contributions.

  • Name key organizations and their contributions.

  • Discuss the evolution and changing role of the EMS physician.

  • Describe historical milestones for EMS physicians.


The American Civil War offered more experience with triage, field care, and movement to field hospitals for damage control medicine before movement to a hospital. Due to the success of this concept the US Congress passed “an act to establish a uniform system of ambulances in the United States” (also known as the Ambulance Corps Act) in 1864. During this time American hospitals began to develop their own ambulance services. World War I saw the use of motorized ambulances as a regular part of military operations. Despite the existence of ambulance services, and even rescue squads (like the Roanoke Life Saving Crew, Roanoke, VA, est. 1928), modern EMS in the United States did not take form until the late 1960s and early1970s. This chapter will focus on key events and developments in the evolution of modern EMS in the United States.

THE LATE 1800s

In 1864, President Abraham Lincoln signed into law “an act to establish a uniform system of ambulances in the United States.” Around the same time in Europe (1863) the Red Cross of Europe was founded. The 1860s would also see the first hospital-based ambulance ...

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