The birth of modern emergency medicine (Part 1)

Modern emergency medicine began on the battlefields of the Napoleon wars in the late 1700s. Physician Dominique-Jean Larrey was dismayed at the practices of the time, which left wounded soldiers on the field until the battle was over. By this time the danger to those who would pick them up lessened. Unfortunately, by this time many of the wounded were already dead.

Older battlefield medicine required soldiers to tend to their own wounds, perhaps aided by fellow soldiers, or, eventually, by a surgeon. As early as 1487, the Spanish army had ambulancias, but the word meant military field hospital. By Larrey’s time, with wounds being caused by guns and artillery rather than the earlier arrows and swords, wounded soldiers needed better help, faster.

Larrey rebelled against the military regulations requiring transport for the wounded to remain almost three miles back from the battle. It could be 24–36 hours before aid reached the men who needed it. He noted the light, wheeled horse-drawn artillery that could be moved rapidly during battles—called “flying artillery” for its speed—and applied the concept to vehicles that we would still today recognize as ambulances.

Larrey’s “flying ambulances” were horse-drawn carriages—two wheeled for maneuverability when possible, four wheeled when the extra stability needed. (Additionally, the larger vehicles carried food for the horses.) The word ambulance still carried the meaning of field hospital. They were not just transport, but transport that carried medical supplies and staff, with movable floors, to ease the patients in and out, and windows for ventilation.

Larrey’s system utilized 340 people, divided into three divisions of 113 men, each commanded by a chief surgeon, with twelve light and four heavy carriages. The crew included staff we would expect, like lesser surgeons and an apothecary to dispense drugs, and some that we wouldn’t: a farrier, a saddler, a boot maker. There was also a bearer of surgical instruments who played the trumpet and a boy who carried bandages and played the drum: the flashing lights and sirens of the time.

There was a set order in which the various members of the entourage traveled and everyone knew where he was supposed to be and what he was supposed to be doing. But Larrey was adaptable. He utilized camels as transport during battles in the Egyptian desert and donkeys in rugged mountains.

The “flying ambulance” service increased survival but also morale, a basic, though crude, measure of patient satisfaction. Soldiers were relieved to know that if they were wounded, help would come almost immediately. Larrey’s goal was to reach the injured within fifteen minutes, even while the battle was being fought all around them. Soldiers were also relieved of the duty to tend to their fallen fellows. Soldiers, wounded and not, were greatly aided by Larrey’s vision.


This is the first of two articles about the emergency medical techniques pioneered by Dominique-Jean Larrey, based on “The Revolutionary Flying Ambulance of Napoleon’s Surgeon,” by CPT Jose M. Ortiz, U.S. Army Medical Journal, Oct.-Dec. 1998.



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