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We need to act fast to save lives. This is even more important in case of accidents, injuries, calamities, or sudden catastrophic conditions. Our actions begin at the site of the injury. We need to rescue victims, and provide medical care as we shift them to hospitals. Today we recognise prompt evacuation, swift transport and useful pre-hospital care as lifesaving. A global fleet of millions of first responders (fire-men, paramedics, law enforcing agencies) provide their services to save lives.
For centuries, we did not have any dedicated rescuers for population at large. Fire services took upon this role in 17-19th century, followed by law-enforcing agencies. In parallel, we developed a system of medical ambulances. We can directly contact a fire-brigade, policeman, or a medical ambulance. These three are our primary rescuers.
Fire and rescue
Saving people from raging fires was probably one of the early state sponsored rescue. As early as 6th century, Roman emperors assigned this task to battalions of slaves. After a long blip, organised private fire-rescue services appeared in 17th century London. Gradually we replaced buckets with leather pipes, brass-hose, and pumps. Over next century, such services were available in Paris, New York and Philadelphia. In early 19th century, cities and states took over, and further improved such services. Initially fire engines were horse driven carriages. However, by 1920s, these were replaced by motorised carriages. As buildings became higher, we added ladders.
Rescue and First-aid
Firemen were trained to douse fire. They would rescue lives, but till beginning of 20th century, they were not trained to provide medical aid. In-fact, concept of initial medical-aid right at the accident-scene is quite recent. French army introduced a systematic system of first-aid during Napoleonic wars in early 1800s. In 1854, inspired by the French, Britishers dispatched Florence Nightingale and 38 other volunteer nurses to the conflict area. This was first attempt to provide first-aid and nursing care to all ranks of British Army. In 1870s von Esmarch, a Prussian surgeon, started training specialised army units in different techniques of wound stabilisation and bandaging.
Founded in 1863, initial aim of the Red-cross was to care for the war-wounded. Red-cross popularised the concept of first-aid, and we started training nurses and later volunteers in basic wound management.
In years to come, armies or charitable organisations trained and engaged more first-aiders, such red-cross volunteers and boy-scouts.
From Fire engines to Ambulances
For many years, we used cattle-carts and horse-carriages to transport injured in warfare. But, this would happen only after hostilities got over. In early 1800s Dominique Larry changed it all by developing a system of horse-carriage vehicles. He introduced “ambulances volentes” or flying ambulances, that moved injured solders from active battlefields. Such battlefield ambulances became a common sight during American Civil war (1861-1885).
Civilian ambulances
Civilian ambulances were not far behind. City of London, used these in cholera epidemic of 1832. A few years later, in 1867 London had its first dedicated civilian ambulance. Later, hospitals in America started paid ambulance services. First such instance was in 1870, when Cincinnati General Hospital provided ambulance services to fetch sick patients. One could use telegram to summon an ambulance. Hospitals kept horses in harness, so that a carriage could be dispatched without delay.
St John’s ambulance service, was created in 1877. In initial years, focus of this service was to provide first-aid at the site of the accident. Such a service was also introduced in Australia in 1883, and two years later in New Zealand in 1885.
Around the same time, Vienna (1881) and Budapest (1887) had also initiated voluntary civil ambulance systems. In 1887, St John ambulance deployed a brigade of first-aiders on its own horse driven carriages. Thus, this was the first integrated ambulance service. This could provide some medical care before injured or the sick could reach a hospital.
Beginnings of pre-hospital care
As we entered 20th century, some cities in Europe and America had firemen, ambulances and first-aiders. There was a suggestion that a physician could be on-board an ambulance. This suggestion, had no takers. Meanwhile, we developed large motorised ambulances, and drivers could talk to hospitals through radio-communication. Till the end of second world war, first-aid was limited to dressing of wounds, and pre-hospital care was limited.
In 1966, US National Academy of Sciences published a white-paper about the condition of ambulances in the country. This paper titled “Accidental Death and Disability: The Neglected Disease of Modern Society” led to better equipped ambulances, and improvements in pre-hospital care. In 1967, Peter Safar, an Australian born anaesthesiologist in Pittsburg, US trained six lay-black men as first paramedics. These paramedics, who had received 300 hours of training, could help sick patients breathe oxygen, and could set up intravenous lines to improve circulation. In 1970 they secured an artificial airway en-route to the hospital.
Emergency Medical Services
In 1973, US Congress brought out an Emergency Medical Services (EMS) act. Fuelled by early stories of success and heroism, experts designed formal trainings for an emergency medical technician (EMT). A life-saving sequence of securing airway, breathing and circulation (known as CPR), was now ready to move from hospitals to paramedics and onward to lay-persons. Thus, in 1970s EMTs or paramedics started providing CPR much earlier. By 1980s, we trained more paramedics, marine lifeguards, and rescuers in these lifesaving techniques. A new profession was on the horizon.
Advanced rescue teams
In last 50 years, countries have organised their emergency response teams better. While local or regional administrations control emergency teams, many countries now have a single nationwide contact number (such as 911 in US (1968), and 108 in India (2005)). EMTs are trained to rescue, resuscitate, and connect to their base hospitals for medical advice. Further, modern ambulances are mini mobile hospitals, equipped with trained personnel, gadgets, and medicines. Depending on need, often transportation extends beyond roads to air and sea.
In 1991, United Nations established International Search and Rescue advisory group (INSARAG). Over last 30 years, this organisation serves as a focal point for international disaster rescue and relief operations. Its website lists various National rescue and emergency response agencies. In some countries these agencies are independent (such as FEMA in US (1979), or NDRF in India(2006)), and in others these are part of a national civil defence systems.
According to international estimates, about half of all deaths occur outside a hospital. In low-income countries, this proportion is about 80%, and is about 30% in high-income countries. Many deaths can be prevented, by an efficient pre-hospital care system. Today, we have evolved from first-aid, to advanced pre-hospital care models. It should be our endeavour to improve its quality and reach, even in low resource settings.