Prehospital Care

Dominique-Jean Larrey
Designed the Ambulance Volante or 'flying ambulances' to evacuate casualties from the battlefield. Introduced during the Itialian 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, quartermaster, noncommissioned officer, a drummer boy (who carried the bandages), and 24 infantrymen. The flying ambulances were a success, and this idea was subsequently taken up by other armies. Even in the harsh desert terrain, his flying ambulances would collect the wounded in less than 15 minutes.

Ambulance Volante

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.

Larrey was the first surgeon to treat battlefield casualties where they were injured, rather than awaiting for the finish of the battle at the end of the day, and also introduced the first descriptions of triage:

'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. 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 succeesing day. 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.

Matthew Wall
First reported successiful resuscitative prehospital thoracotomy
Houston, Texas, USA

Helicopter Emergency Medical Service
First successful resuscitative thoracotomy for cardiac stab wound
London, UK