Mod 1- lecture 1 History of Paramedicine

History of Paramedicine Before the Modern Age

• Paramedicine is a relatively new concept.
  • The term "paramedicine" is believed to have been invented around 1995-1996.
  • The term "paramedic" emerged in the 1960s and 70s. But the discipline and practice of "paramedicine" has only developed in the last 30 years.
• The history presented is primarily Anglo-European.
  • Many cultures globally have a rich history of healing and medicine, sometimes more advanced than Western traditions.
  • For example, Indian culture had advanced hospitals 1500 years ago.
  • Indigenous cultures practiced sophisticated, evidence-based healing long before Western medicine.
  • It’s important to consider diverse cultural histories of healing and pre-hospital care.

Origins of Pre-Hospital Care

• The origins of paramedicine can be traced back to military medicine.
  • Romans used older centurions to move wounded legionnaires for treatment.
  • In the Middle Ages, medicine began to rise around the 12th century with the emergence of universities teaching medicine and people were called physicians.
  • Physicians were primarily available to the aristocracy and those who could afford their services.
  • Working classes and peasants often relied on village healers called "medicus" that had practical paramedical skills to treat injuries and illnesses.
  • Medicus were also evident in monastic culture, such as the Order of St. John, which established hospitals for crusaders and the community.

Military Influence on Ambulance Services

• Modern ambulance services have roots in 19th-century military medicine.

  • Napoleon's army experimented with field ambulances in 1793 during the Battle of Metz.
  • The Battle of Solferino (1859) during the Italian War of Independence was a turning point with a high death toll.
  • 12,000 soldiers died and 28,000 were wounded.

• The wounded-to-death ratio at the Battle of Solferino was 2.4:1.

  • For every death, 2.4 people were injured but survived.
  • By contrast, the wounded to death ratio for The Vietnam War was 5.4:1 and the Iraq War was 7.6:1.
  • Advances in medicine and technology have increased survival rates.
  • Many wounded soldiers were left to die on the battlefield, which helped trigger more formal ambulance services.

• The International Red Cross emerged after the Battle of Solferino.

  • Henry Dunant, the founder, organized an ambulance service after witnessing the suffering of wounded soldiers left in the fields.
  • The Franco-Prussian War saw widespread ambulance charities, with donations of ambulances volunteers from Britain and other European nations to assist with combat.
  • These volunteer ambulance services became part of standard military training.

Transition to Civilian Ambulance Services

• Military surgeons recognized the potential for ambulance services in civilian life.

  • Incidents in Brisbane (1892) and Sydney highlighted the need for civilian ambulance services.
  • If soldiers receive ambulances and surgeons, why not civilians?
  • Rise of first aid training.

• First aid courses began in 1878 in Woolwich, UK, led by military surgeons Major Peter Shepherd and Colonel Francis Duncan.

  • Shepherd and Duncan had been part of early military medicine in the British Army, coming out of the Franco Prussian War, etc.
  • The initial focus was on teaching first aid to civilians in dangerous occupations like mining.
  • The first aid syllabus remained largely unchanged for over 100 years.
  • The First first aid kit was produced by Johnson & Johnson in 1888 because of the need for bandages and wound cleaning solutions.

• Civil ambulance services emerged, beginning with a station in Sydney at the corner of Pitt and George Streets.

  • First ambulance started with hand litters then progressed to horse carriages and then to automobiles.

North American Developments

• The military medicine concept also influenced North America.

  • Horse-drawn ambulances appeared during the US Civil War (1865).
  • Around the same time, the concept of first aid training emerged.

• Industry played a significant role in driving innovation of care.

  • Mining and railway construction were dangerous, prompting the development of first aid measures.
  • Johnson & Johnson created the first first aid kit for the US railway system.

• Hospital-based ambulance services began to emerge.

  • Cincinnati, Ohio, had the first documented hospital ambulance in 1865.
  • Toronto, Canada, followed with a hospital ambulance in 1881.

• Rescue squads, combining basic rescue and first aid, appeared in the 1920s and 30s.

  • One was in Roanoke, Virginia in 1928.
  • Community-based solutions for pre-hospital care.
  • Some combined with fire services, while others remained independent.
  • Culpepper and Chevy Chase Rescue Squad are examples of independent rescue squads.

• Funeral homes sometimes doubled as ambulance services, especially in rural areas.

  • Funeral homes doubling as ambulance services existed into the 1970s.

• Police ambulance services, featuring vehicles with stretchers, also existed.

• Ad hoc community approaches to ambulance services persisted in North America into the 1970s.

• The 1970s saw a shift towards standalone ambulance services staffed by healthcare practitioners.

• Canada had many private ambulance services, most of which have disappeared except for some in Saskatchewan.

• South Australia had a few private ambulance services until the 1960s or 70s.

• These community-driven solutions eventually transitioned into the modern concept of paramedicine in the 1960s.