The story of emergency medicine begins on the battlefield.

“He who desires to practice surgery must go to war,” wrote Hippocrates, the famous doctor of ancient Greece, in 400 BCE. Soldiers had to deal with all the same health issues as civilians—dehydration, malnutrition, infectious disease—as well as the infinite variety of war wounds.

Greek doctors knew that implements like spear tips and arrowheads had to be removed and that it was crucial to keep the wound clean. They also knew how important it was to prevent excessive blood loss. This kind of rapid care was an important factor in the success of armies like Sparta’s, for example.

Perhaps the first recorded use of paramedics, or something like them, comes from ancient Rome. When centurions grew too old to fight, they would be employed to clear the battlefield of the wounded. These retired warriors were trained in suturing and amputation—which, while unpleasant for everyone involved, likely saved a lot of lives.

Europe in the Middle Ages would sporadically be hit by devastating outbreaks of the Bubonic Plague. Often local authorities would arrange for care and transport of the sick during outbreaks. The standard of care, if there even was any, would usually be quite primitive. And often “transport” meant the removal of dead bodies. Still, the dedicated response to an emergency could be considered an early version of emergency medicine.

Finally, in the 18th century, emergency medicine started to become more systematized. The Napoleonic Wars were an important time for emergency medicine, mostly due to the efforts of French surgeon Dominique Jean Larrey (1766-1842). Larrey noticed how quickly French artillery moved across the battlefield and adapted their techniques for what he called “flying ambulances”—carriages that could get the wounded more quickly to treatment. Larrey also created a system of triage, or caring for the wounded in the order of the seriousness of their injury, regardless of rank or nationality.

Similar procedures were established during the Civil War by an American surgeon, Jonathan Letterman (1824-1872). And ambulances were of course common in 20th century American life, especially with the advent of the internal combustion engine. But it wasn’t until 1966 that a government report, Accidental Death and Disability: The Neglected Disease of Modern Society, shocked the American public. The report made the startling assertion that accidents were the “leading cause of death in the first half of life’s span.”

This shocking statistic led to the standardization of an EMT training curriculum that almost immediately resulted in saved lives. And today an American is much more likely to die of heart disease than by accident—a change that we owe to the professionalization of EMTs in America.

Hippocrates still has a point—the military remains crucial to the development of emergency medicine. But in our day emergency medicine has a huge effect on the length and quality of civilian life.


The Military Medicine of Ancient Rome.

Birth of EMS: The History of the Paramedic