The History of the Air Ambulance

If the first thing that comes to mind when contemplating the history of air ambulance services is the cast of the television show M*A*S*H, set during the Korean war, you’re almost a century too late. Although the military connection to the inception and innovation of air ambulance services is perfectly accurate. The earliest reported use of air transport to move trauma victims for medical treatment appears to be during the Franco-Prussian war and siege of Paris in 1870. 160 injured soldiers were moved from the battlefield to army hospitals via hot air balloons. These efforts were built upon the Napoleonic war efforts to evacuate wounded soldiers to field hospitals via horse drawn wagons. The soldiers were moved to trauma centers for stabilization and then transported to the nearest available hospital.

The Wright brothers were the first to successfully demonstrate fixed-wing aircraft flight in 1903, and attempts (albeit unsuccessful) to employ planes as air ambulances debuted in the US in 1910. Army medical officers, Capt. George H. R. Gosman and Lt. A. L. Rhodes, used their own funds to build a plane to transport patients from the battlefield to medical care. Their first test flight at Fort Barrancas, Florida, flew only 500 yards at an altitude of 100 feet before crashing. This flight, followed by Captain Gosman’s unsuccessful attempt to obtain official backing for the project, delayed significant progress on the air ambulance concept until World War One.

Before the First World War the Chief of Dutch Medical Services, named deMooy, realized that surface transport of casualties was a major cause of death among combatants. He devised a large stretcher to be suspended beneath a balloon and pulled along by horses. WWI efforts produced much progress but results were spotty and the merits of the endeavor received mixed reviews.

A fixed wing aircraft was first officially used as an air ambulance in 1917 in Turkey, when an injured British soldier was transported from the battlefield to the nearest medical facility. The hospital was located three days away by road, but the patient arrived in 45 minutes by air, reportedly saving his life. French records at the time indicated that, if casualties could be evacuated by air within six hours of injury, the mortality rate among the wounded would fall from 60 percent to less than 10 percent.

Among the most influential and effective advocates for air ambulance services was Mademoiselle Marie Marvingt, of France. While she is famous in her homeland, she is nearly anonymous in the US. Born in February 1875, she became a world-class athlete achieving success in whatever sports were available to women at the time, and pushing the envelope where women were excluded. Marvingt won numerous awards in swimming, fencing, ski-jumping, shooting, skating, and the bobsled. She was the first women to climb most of the peaks in the French Alps, and in March 1910 the French Academy of Sports gave her a medal for all sports, the only one awarded for more than one sport.

Marvingt was a free balloon pilot and the first women to pilot a balloon across the English Channel and the North Sea, a surgical nurse, and the third woman in the world to receive her fixed-wing pilot’s license. She fought on the front lines disguised as a man and was the first women to fly a bombing raid during the war. She ordered the construction of an air ambulance in 1912, and devoted the remainder of her life to gaining its acceptance.

The United States began to use airplanes for evacuating the injured from the battlefield in World War I but found the fuselages were too small to accommodate stretchers, and the open cockpits exposed patients to the elements. By war’s end, the US Army realized the need to transport the wounded by air. In 1918 Major Nelson E. Driver and Capt William C. Ocker converted a Curtiss JN-4 biplane (nicknamed Jenny) into an airplane ambulance by modifying the rear cockpit to accommodate a standard Army stretcher carrying an injured person in a semi-reclined seat. The success of this effort resulted in an order directing all military airfields to provide air ambulance services.

The post WWI-era saw the development of governmental and non-governmental air ambulance services. An operation later named the Royal Doctor Flying Service began operations in 1928 in the outback of Queensland, Australia. A de Havilland 50 carried a pilot, doctor, nurse, and capacity to transport one stretcher patient. It reportedly made 50 flights in its first year, covering 20,000 miles and treating 225 patients for various injuries and illnesses. They estimated that 25 lives were saved during their first year.

1936 saw the first organized governmental air ambulance service during the Spanish Civil War. Wounded were removed from the battlefield for treatment in Nazi Germany.

The Korean War saw the first dedicated use of helicopters by the US in 1950. In addition to their use to transport the injured from the battlefield to field hospitals as depicted in M*A*S*H, helicopters were also employed to move injured soldiers from field hospitals to medical ships for more extensive treatment.

The use of aircraft as ambulances continued to evolve and by the Vietnam-era specially trained corpsman married with helicopters demonstrated great success in saving injured troops from the battlefield. US researchers concluded that injured soldiers had a better survival rates that motorist injured on California freeways. This lead to early experiments with civilian paramedics in domestic fire departments.

The civilian use of air ambulances continued to grow after WWII. The provincial government of Saskatchewan established the first civil air ambulance in North America in 1946, based in Regina, and is still in operation. A year later Schaefer Air Service became the US’s first air ambulance service based in Los Angeles, and was the first FAA-certified air ambulance service.