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The first formally trained ambulance service owes its existence to military operations. The first formal emergency medical service is traced back to the middle ages during the crusades of the 11th century. The Knights of Saint John received instruction in first-aid treatment from both Arab and Greek doctors. These Knights of Saint John then acted as the first formally trained prehospital medical personnel, treating soldiers on both sides of the war on the battlefield and bringing in the wounded to nearby tents for further medical treatment.1 The military again played a significant role in the development of prehospital care in 1487 during the Siege of Malaga, in Spain. This was the first recorded use of an ambulance—a horse drawn cart with a trained attendant.2 In the 1700s, Napoleon Bonaparte appointed Baron Dominique-Jean Larrey to develop the first systematic collection of wounded on the battlefield. In 1797, Larrey created “ambulance volantes” or light with carriages with trained personnel to collect, transport, and treat injured.3 Larrey developed all of the precepts of emergency medical care that are used today by all modern EMS systems: rapid access to the patient by trained personnel, field treatment and stabilization, and rapid transportation back to the medical facility while providing medical care en route.4


  • Describe the factors that make military EMS unique.

  • Describe provider types and skill sets.

  • Describe basic principles of care under fire.

  • Describe essential equipment for care under fire.

  • Describe basic principles of patient extraction, forward treatment, and treatment destinations.

  • Describe the roles of EMS physicians in military EMS.

  • Discuss the approach to care of noncombatants and enemy combatants.

  • Describe the interoperability issues in military-civilian EMS deployment for domestic disasters.


At the beginning of the 1860s, the United States created the first field ambulance and attendant. The first recorded use of a field ambulance and attendant was during the Civil War. During the US Civil War, both sides attempted to emulate the medical practices of the Napoleonic wars. During the Battle of Bull Run, the ambulance service was being coordinated by the Quartermaster Corps. It was then transferred to Surgeon General Jonathan Letterman, MD, to organize, and he reinstated all of Larrey's concepts greatly increasing the survival rate of the wounded. In 1862, due to the unexpected size of casualty lists during the battle of Manassas where it took 1 week to remove the wounded from the battlefield, Dr Jonathan Letterman, Head of Medical Services of the Army of the Potomac, revamped the Army Medical Corps. His contribution included staffing and training men to operate horse teams and wagons to pick up wounded soldiers from the field and to bring them back to field dressing stations for initial treatment. This was our Nation's first Ambulance Corps. Dr Letterman also developed the three-tiered evacuation system.5-7...

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