Pittsburgh's Freedom House Ambulance Service: The Origins of Emergency Medical Services and the Politics of Race and Health.

This manuscript explores the history of the Freedom House Enterprises Ambulance Service, a social and medical experiment that trained "unemployable" black citizens during the late 1960s and early 1970s to provide then state of the art prehospital care. Through archives, newspapers, personal correspondence, university memoranda, and the medical literature, this paper explores the comparable, yet different roles of the program's two leaders, Drs. Peter Safar and Nancy Caroline. Despite its success in demonstrating national standards for paramedic training and equipment, the program ended abruptly in 1975. And though Pittsburgh's city administration cited economic constraints for its fledgling support of Freedom House, black and majority newspapers and citizens alike understood the city's diminishing support of the program in racial terms. The paper discusses Safar and Caroline's well-intentioned efforts in developing this novel program, while confronting the racial, social, and structural constraints on the program and the limits of racial liberalism.

Somewhere in France (9 April 17): a centenary review of medical arrangements at Vimy Ridge.

SUMMARY: In April 1917, medical units of the 4 divisions of the Canadian Corps combined for the first time in support of a single action, the assault upon Vimy Ridge. Detailed planning, infrastructure development, information dissemination and rehearsal were features of preparations by the combat arms and medical elements of the Canadian Forces. Extraordinary coordination resulted in the rapid rescue and evacuation by Canadian medical services of 8000 casualties over 4 days. Characteristics of today's military medical services are evident in the work of the Canadian Army Medical Corps 100 years ago.

Ambulance services in London and Great Britain from 1860 until today: a glimpse of history gleaned mainly from the pages of contemporary journals.

Little has been published on the subject of civil ambulance services and their development from the mid-19th century in the UK until modern times. There is limited secondary literature available which provides useful background information on the subject and most organisations may give brief histories of their early days but these sources lack historical adequacy in terms of detail. This article shows part of the uncertain path which the history followed towards the service which we enjoy today. From the pages of the British Medical Journal and the Lancet and Hansard, the battle to set up the service is followed and an indication of the drivers towards change over the period is revealed in the attitudes expressed. In particular, the two World Wars are seen to be the stepwise stimuli to providing a necessary service to the British population where the will to achieve this had hitherto been lacking at a parliamentary level. The history of the London Ambulance Service is chosen because more is written about it in these journals but services in other British cities and the USA are mentioned since they played a part in influencing change.

Transporting Lazarus: physicians, the state, and the creation of the modern paramedic and ambulance, 1955-73.

In 1966, morticians provided 50 percent of ambulance services in the United States; today advanced care by trained medical professionals en route to the hospital is considered a basic standard of care. The creation of emergency medical services (EMS) provides an important case study for how physicians acting as "experts" helped to shape the creation of federal policy in the post-World War II years. This paper challenges a narrative of the development of EMS that has emphasized technology, individual agency, and the role of fortuitous chance as the prime movers of EMS development. Instead it argues that a key factor in EMS development was the National Academy of Science-National Research Council's Committee on Emergency Medical Services. Using the examples of paramedic training and ambulance design, this paper argues that members of the committee utilized complex mix of local experimentation and professional networking to suggest directions for the federal government's efforts to create national standards and guidelines for EMS. The NAS-NRC Committee retained a prominent role in EMS development until the passage of the Emergency Medical Services Systems Act of 1973, when federal interest in EMS largely shifted from prehospital transport to an emphasis on in hospital care and regional trauma systems planning.

[A.S. Puchkov as an organizer of the Moscow station of emergency medical care].

The article is devoted to the 125th anniversary of outstanding Russian physician, health administrator, honored physician Aleksander Sergeyevitch Putchkov (1887-1952). During thirty years, from 1923, he continuously headed the Moscow station of emergency medical care based at the Sheremetoyevskiy hospital, nowadays the N.V. Sklifosofskiy research institute of emergency care.

"Separate, but almost equal": the Army's Negro medical field units in World War II.

Before World War II, the Army had no African American medical units and no plans on how to utilize African American personnel. A first plan to sideline blacks into menial support positions was implemented but then overruled in the middle of the war. Separate units were formed, which performed some support functions, but also focused on preventive medicine work--mainly, insect control. Other duties included cross-loading litter patients in the evacuation chain, a laborious but morale-boosting job for which some units received commendations. Several ambulance companies were organized, performing solidly. In the face of official disapprobation and disinterest in African Americans serving, the men of these units sought to contribute to the war effort and took pride in doing their best.

Patient dumping in New York City, 1877-1917.

Although the term "patient dumping" was rarely used before the 1960s, the practice started much earlier. In the late 1870s, the New York Times began to report that private hospitals were using ambulances to shift poor, moribund patients to Bellevue, the city's preeminent public facility. Many trips had serious medical consequences. Private hospitals also instructed ambulances to take critically ill patients directly to Bellevue regardless of the distance. Efforts to combat such practices took various forms. When transfers resulted in death, Manhattan coroners held inquests. In 1902, the Commissioner of Charities issued an order requiring that he be sent a full report from the superintendent of any hospital in which a patient transferred from another facility died within three days after admission. Four years later, the city passed an ordinance imposing a severe penalty on any hospital official who transferred an ill patient. Those reforms were only partially effective at deterring such transfers.

Baron Dominique-Jean Larrey (1766-1842): founder of military surgery and trauma care.

Dominique-Jean Larrey was a distinguished surgeon in chief of Napoleon's army and a faithful servant of the Empire. His surgical skills and inventions, his absolute attachment and devotion to his profession, his humanitarian spirit and courage entitled him as one of history's greatest military surgeons.

Aspects of neutrality: two Dutch ambulances at the eastern front in the First World War.

The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.

Notes from a war diary--the filter system of sorting casualties from the battle of Cassino--Italy May 1944.

This is the second extract taken from the War Diaries of Brigadier JG Morgan CBE TD MD and is specifically taken from papers he used to prepare a talk for a Civil Defence Audience in the 1950's. Having introduced a system of filtering in Tripoli in 1943 when in command of 48th General Hospital, he was specifically appointed to oversee the medical arrangements for the Battle of Cassino and was awarded the CBE for his work which is outlined below. It has been prepared from the original documents and edited by his sons.

The history of organized medical transport in Minneapolis: 1867-1930.

When Minneapolis officially became a city in 1867, there were no hospitals or ambulance services within its limits. Four years later, in 1871, the first hospital in the city, Cottage Hospital, opened its doors to the public, shifting medical care from the family home to the hospital. The need then developed for organized medical transport. The period between 1880 and 1890 marked the beginning of limited ambulance service in Minneapolis. Over the next 40 years, many public and private institutions developed their own transport services. During that same time, skilled medical transport in which physicians and/or nurses went along on calls began, and the transport of patients transitioned from horse and wagon to motorized ambulances. These developments would set the stage for future innovations in Minneapolis' emergency medical system and ultimately improve patient care and survival.

Jean Dominique Larrey and his recognition in Mexico.

The figure of Jean Dominique Larrey, military surgeon who participated in the Napoleonic wars, is analyzed. The objectives of the study are to highlight their contributions, including the creation of ambulances that allowed the injured to be given prompt assistance. Also note the post-mortem recognition that Larrey had in Mexico through an academic group founded by the surgeon Francisco Montes de Oca y Saucedo. The facts cited show the progress of military surgery, its institutionalization and professionalization as well as the communication and updating of knowledge in one and another continent.

Se analiza la figura de Jean Dominique Larrey, cirujano militar que participó en las guerras napoleónicas. Los objetivos de estudio consisten en destacar sus aportaciones, entre ellas la creación de las ambulancias que permitieron dar una pronta asistencia al herido. Asimismo, señalar el reconocimiento post mortem que Larrey tuvo en México a través de una agrupación académica fundada por el cirujano Francisco Montes de Oca y Saucedo. Los hechos citados muestran el progreso de la cirugía militar, su institucionalización y profesionalización, así como la comunicación y la actualización de saberes en uno y otro continente.

[The civil ambulances during the Franc-Prussion war (July 19, 1870 to January 28, 1871)]. / Les ambulances civiles pendant la guerre franco-prussienne (19 juillet 1870 - 28 janvier 1871).

The civil ambulances joined together under the emblem of the Red Cross: the Company of Help to the Wounded Soldiers, directed from the Palate of Industry by Chenu and Le Fort; the Ambulance of the Press, directed by Ricord and Mgr Bailer; and multiple ambulances disseminated in Paris. They brought a decisive help to the French medical military Corps. On the ground, eigtheen civil Ambulances from Countryside formed in Paris looked after the casualties of the two camps: around Sedan, then in the battles of the Loire and the East, where 13 ambulances formed secondarily in province joined them. During the siege of Paris, flying Ambulances went out the ramparts and brought back the wounded to the Palate of Industry or to Longchamp 'street Press ambulancy. They were integrated in November in a great Coordination of 10 hospitals distributors, directed by Hippolyte Larrey. The surgical care, limited to the members, to the head and the neck, were simple, rapids and conservatives, and the number of amputations was limited. But secondary infectious complications were frequent, had a raised mortality, worsened by the associated diseases, infectious (smallpox, typhoid, pneumonia, and by the cold, hunger, denutrition. The war of 1870-1871 brought: a large humane progress due to the neutralization of the casualties, places and actors of care; a better approach of the infection and shown the need for an autonomy of the French Military Corps.