Call 911

When we think we have it bad today it is good to remember how ambulances were called for and dispatched when they were first invented.  When Manhattan’s Bellevue Hospital began its ambulance service in 1869, the second in the country (after Cincinnati), they were impeded by the absence of telephones, which hadn’t been invented yet. Calling an ambulance in New York City worked like this: A patrolman would discover someone who is ill or injured and use a public telegraph station (itself a recent innovation) to contact his precinct, which would send out policemen with a stretcher. They would carry the patient to their home precinct where someone (not a doctor) decided if the person needed to go to the hospital. If so, they would telegraph the 18th Precinct—the one nearest Bellevue—which would send a runner to the gates of Bellevue Hospital with a piece of paper bearing the address of the precinct so the hospital could send an ambulance.  A fast runner could take 8 minutes to get to the hospital.  The whole process was almost an hour.

This cumbersome procedure was improved by the end of 1869, when precincts could telegraph the hospital directly. Bellevue could then send out one of its horse-drawn ambulances, supplied with tourniquets, splints, bandages, sponges, a stomach pump, 2 ounces of persulphate of iron (to staunch bleeding), and a quart of brandy, which would have been used as a cardiac stimulant, a sedative, a painkiller, and (perhaps) a means of improving patient satisfaction. This equipment was soon supplemented by a pair of handcuffs and a straightjacket.

When early telephones—public and private—began to replace telegraphs, you didn’t need the phone number because all calls went through the operator, so there was still no centralized service.

The impetus for many of the changes made to emergency services stemmed from a 1966 report called Accidental Death and Disability: The Neglected Disease of Modern Society. There had been more than 52 million accidental injuries in 1965, it noted, 107,000 of them fatal. Access to emergency medical care was more reliable on the battlefields of Korea and Vietnam than on the streets of many cities. Their many recommendations included the suggestion that there be one national number to call an ambulance, and 911 was established in 1968. Nevertheless, only 17% of the population had access to 911 in 1976, and even by 1987 it was still only accessible to 50% of people.

Communication between ambulances and hospitals also remained a problem. A dispatcher could call the ambulance, but the emergency medical workers could not call for backup or equipment. That same 1966 report commented (perhaps rather bitterly) that we had the technology to communicate with astronauts in outer space, but hospitals still learned of emergencies and mass casualties the same way everyone else did: from radio or television news reports.

So the next time you’re worrying about response time think of how far we have come.  Even if we do still have a long way to go.

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