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HISTORY OF AIR AMBULANCE AND

MEDEVAC
As with many innovations in Emergency Medical Services (EMS), the concept of transporting the injured by aircraft
has its origins in the military and the concept of using aircraft as ambulances is almost as old as powered flight itself.
The first written record of the term "air ambulance" is in Jules Verne's Robur le Conqurant (1866), which describes
the rescue of shipwrecked sailors by an airship (balloon) named the Albatross. The first documented use of an air
ambulance occurred during the Siege of Paris in 1870. when balloons were used to evacuate more than 160 soldiers
from the besieged city.
During the Great War, the first true Air Ambulance flight was made
when a Serbian officer was flown from the battlefield to hospital by a
plane of the French Air Service. Records kept by the French 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 per cent to less than 10 per cent - a staggering reduction!

During the First World


War air ambulances
were
tested
by
various
military
organizations. Aircraft were still primitive at the time, with limited
capabilities, and the effort received mixed reviews. The exploration of
the idea continued, however, and by 1936 an organized military air
ambulance service was evacuating wounded from the Spanish Civil
War for medical treatment in Nazi Germany.

The first recorded British ambulance flight took place in 1917 in


Turkey when a soldier in the Camel Corps, who had been shot in the
ankle, was flown to a hospital in a de Havilland DHH within 45
minutes. The same journey by land would have taken 3 days to
complete. In Britain,
sick passengers were
ferried by air from the
Western
Isles
of
Scotland
to
the
mainland in the early
1930s. The first such
flight to be recorded
was on May 14, 1933
when a fisherman
suffering
from
a
perforated stomach, with consequent risk of
peritonitis, was flown
from Islay to Glasgow's Western Infirmary in a
DH Dragon owned by
Midland and Scottish Air Ferries.
In Switzerland, with
the early post World
evolved
from
the
rescue work. Initially
teams with equipment
that rapid first aid

the increasing interest in winter sports during


War 2 years, the use of air ambulances
increasing difficulties experienced in mountain
fixed-wing aircraft were used, landing medical
as close as possible to the injured parties so
treatment could be applied prior to evacuation.

To overcome a lack of

suitable landing sites close to the incident in

mountainous regions, it was even at one stage proposed to parachute medical personnel with equipment and sledges
into the rescue area. Although training was undertaken, there is no documentary evidence to suggest that this
technique was ever put into practice.
The first documented medevac by helicopter occurred during the
second World War. In April 1944, a US Army Air Forces aircraft with
three wounded British soldiers on board, was forced down in the jungle
behind Japanese lines near Mawlu in Burma.A new US Army Sikorsky
YR-4B helicopter, flown by Lt. Carter Harman, could carry only one
passenger but, over 25-26 April 1944, four return trips were made.
Following the end of the Second World War, the first civilian air
ambulance in North America was established by the Saskatchewan
government in Regina, Saskatchewan, Canada. Back in the United
States, 1947 saw the creation of the Schaefer Air Service, the country's
first air ambulance service. Founded by J. Walter Schaefer, of Schaefer
Ambulance Service in Los Angeles, Schaefer Air Service was also the
first FAA-certified air ambulance service in the United States. Paramedicine was still decades away, and unless the patient was accompanied by a physician or nurse, they operated
primarily as medical transportation services.
The first dedicated use of helicopters by U.S. forces occurred during
the Korean War, during the period from 1950-1953. While popularly
depicted as simply removing casualties from the battlefield (which
they did), helicopters also expanded their services to moving critical
patients to more advanced hospital ships once initial emergency
treatment in field hospitals had occurred. On August 4, 1950, just one
month after the start of the Korean War, the first rotorwing medical
evacuation was performed with a bubble-fronted Bell 47 (as seen in
the TV series M*A*S*H). The wounded were transported on basket
stretchers attached to the top of the landing gear on the outside of the
small helicopter (Figure 3-1). They were covered with blankets in a
nearly futile effort to maintain body heat and prevent wound
contamination. It is estimated that more than 20,000 injured soldiers
were evacuated by helicopter. The World War II casualty/death rate of
4.5 deaths per 100 casualties dropped to 2.5 per 100 casualties
during the Korean War. While there were some technological
advances in medicine during that period, the improvement is largely attributed to use of the helicopter to evacuate
patients to definitive care more quickly. The external litter, however, did
not allow for medical care during transport.
The next major advance in AM transport occurred during the Vietnam
War, where the Bell UH-1 helicopter was placed into operation.
Affectionately known as the Huey, this aircraft was large enough to hold
patients inside, where medical personnel could begin treatment during the
flight to a field hospital. The mass deployment of these aircraft as
medevac units reduced the average delay until treatment to one hour. The
ability to carry patients inside the aircraft was a key element in the
reduction of mortality and morbidity. Military medics performed procedures
previously done only by physicians: they started central lines, inserted
chest tubes, and sutured bleeding wounds. This care, coupled with the
initiation of specialty hospitals for the treatment of different types of
injuries, resulted in a reduction in the mortality rate to 1 death per 100
casualties.
The first known civilian application of a medical helicopter was in 1958 in
Etna, California. Bill Mathews, a businessman, started a helicopter service
to ferry patients for Dr. Granville Ashcraft, the town's only physician. The
town druggist also used the helicopter to deliver drugs during
emergencies.

By 1969, in Vietnam, the use of specially trained medical corpsmen and helicopters as ambulances led U.S.
researchers to conclude that servicemen wounded in battle had better rates of survival than motorists injured on
California freeways. This conclusion inspired the first experiments with the use of civilian paramedics in the world.
Two programs were implemented in the U.S. to assess the impact of
medical helicopters on mortality and morbidity in the civilian arena.
Project CARESOM was established in Mississippi in 1969. Three
helicopters were purchased through a federal grant and located
strategically in the north, central, and southern areas of the state.
Upon termination of the grant, the program was considered a success
and each of the three communities was given the opportunity to
continue the helicopter operation. Only the one located in Hattiesburg
did so, and it was therefore established as the first civilian air medical
program in the United States. The second program, the Military
Assistance to Safety and Traffic (MAST) system, was established in
Fort Sam Houston in San Antonio in 1969. This was an experiment by
the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian
emergency medical services. These programs were highly successful at establishing the need for such services.
Also, in 1969 the state of Maryland received a grant to purchase Bell Jet
Ranger helicopters and started one of the nation's first medevac programs.
The four helicopters, manned by paramedics, were strategically based
throughout the state for quick response to emergency situations. When they
were not carrying patients, the helicopters were used for law enforcement
and traffic control.
On November 1, 1970, the
first permanent civil air
ambulance
helicopter,
Christoph 1, entered service at the Hospital of Harlaching, Munich,
Germany. The first civilian, hospital-based medical helicopter program
in the United States began operation in 1972. Flight For Life Colorado
began with a single Alouette III helicopter, based at St. Anthony
Central Hospital in Denver, Colorado. In Ontario, Canada, the air
ambulance program began in 1977, and featured a paramedic-based
system of care. The system, operated by the Ontario Ministry of
Health, began with a single rotor-wing aircraft based in Toronto. An important difference in the Ontario program
involved the emphasis of service. 'On scene' calls were taken, although less commonly, and a great deal of the initial
emphasis of the program was on the interfacility transfer of critical
care patients.
Mercy Flight WNY was established by Douglas H. Baker in 1981 as
the first air-medical service in New York State and one of the first in
the country. From day one, Mercy Flight WNY has maintained its
independence of any hospital and is currently one of only a handful of
remaining not-for-profit providers. The majority of other US programs
are operated by either for-profit organizations or hospitals. (Right:
Patient being loaded in the early 80's. Paramedic on left Margaret
Ferrentino, was first female paramedic in NY State and is current
Mercy Flight VicePresident/CFO.)
Helicopters continue
to play a vital role in miltary medevacs. UH-60 Blackhawk helicopters
have been used extensively in Iraq and Afganistan to medevac
wounded soldiers from the battlefield. While both countries feature
harsh desert environments that take their toll on helicopters,
Afganistan's mountain peaks as high as 18,000 feet further
complicate the mission. Because of the vast, mountainous terrain,
evacuating casualties often extends beyond what doctors call the
"golden hour": that crucial 60 minutes during which a traumaticallyinjured person has to reach a hospital before their survival chances

plummet. So medics have begun doing emergency procedures inside helicopters that would normally wait for ER
doctors.
The United States has some 200 operations whose services are paid for primarily by the patients and their insurance
companies. As well as Switzerland, France, Austria, Italy Scandinavia and the former West Germany all have very
successful versions of the helicopter-based EMS, the benefits of which have in some instances been particularly welldocumented.
In Germany for example, there is now a network of helicopters which has evolved over the past twenty years to cover
the entire country. Statistics which have been gathered over this period of time show:

An average response time to the scene of the incident of just 10 minutes.

Intensive care stays in hospital have been shorted by between five and seven days.

There are 9% fewer wound infections.

A significant reduction in the number of deaths during transport to hospital.

Head injury mortality has been reduced by 15%.