Prehospital Care - When Urgent Medical Attention Saves Lives
Developments in prehospital care started to take place in the last few years of the 18th century.
There were several wars waged during the late 18th century that continued until the early 19th century.
Soldiers were left dying on the frontlines and in different combat zones.
One French doctor did something about it, which, upon consideration, would be equivalent to contemporary prehospital care.
A Civil War Ambulance
COPYRIGHT_SPINE: Published on https://spinal-injury.net/prehospital-care/ by Dr. Bill Butcher on 2022-10-24T11:17:12.411Z
A version of 18th-cetury prehospital care began in 1797.
Dominique-Jean Larrey (1766-1842) designed the ambulance volante or “flying ambulances” to evacuate casualties from the battlefield.
Larrey, a French military doctor and surgeon - he fought in the French Revolutionary Wars (1792-1802) and the Napoleonic Wars (1803-815) - introduced it during the Italian campaign.
The flying ambulances were horse drawn wagons for collecting and carrying the wounded from the battlefield to base hospitals.
He described this concept in minute detail in a report from the Italian Campaign of 1797. It consisted of a system of transport of medical supplies and supporting personnel.
The personnel included:
- a doctor
- a quartermaster
- a noncommissioned officer
- a drummer boy (who carried the bandages)
- 24 infantrymen
The flying ambulances were a success, and this idea was subsequently taken up by other armies.
Larrey was soon organizing flying ambulances for the entire French Army.
This transport system served not only as a boost in morale for the rank-and-file officers of the French Revolutionary Armies, but it also effected a greater and realistic opportunity for the treatment and survival of the wounded.
Dominique-Jean Larrey was the first surgeon to treat battlefield casualties where they were injured, rather than waiting for the finish of the battle at the end of the day.
He also introduced the first descriptions of triage. Below is a long explanation from him:
The best plan that can be adopted in such emergencies, to prevent the evil consequences of leaving soldiers who are severely wounded without assistance, is to place the ambulances as near as possible to the line of the battle, and to establish headquarters, to which all the wounded, who require delicate operations, shall be collected to be operated upon by the surgeon-general.- Dominique-Jean Larrey (1766-1842)
Larrey also specified who shall be prioritized:
Those who are dangerously wounded should receive the first attention, without regard to rank or distinction. They who are injured in a less degree may wait until their brethren-in-arms, who are badly mutilated, have been operated and dressed, otherwise the latter would not survive many hours; rarely until the succeeding day.- Dominique-Jean Larrey (1766-1842)
He reasoned out:
Besides with a slight wound, it is easy to repair to the hospital of the first or second line, especially for the officers who generally have means of transportation. Finally, life is not endangered by such wounds.- Dominique-Jean Larrey (1766-1842)
That was how prehospital care was carried out during Larrey’s time.