2. Biblical times  Good Samaritan  Sumerians inscribed clay tablets that provided step-by step instructions for care based on symptoms given  Also instruction on how to create and adm. Medications  Similar to EMS protocols today

3.  The most significant difference between these first protocols and EMS today is a physical exam Egyptologist Edwin Smith  1862 purchases a papyrus scroll dating to about 1500 B.C.E.  Contained 48 medical case histories arranged in head-to-toe order of severity  Very similar to our PA today

4. “Book of Wounds”  One section of the scroll  Explains the treatment of injuries such as fractures and dislocations  King Hammurabi  King of Babylon  “Code of Hammurabi

5. 18 th and 19 th Centuries  Napoleonic Wars  Chief surgeon Jean Larrey formed the ambulance volante or flying ambulance which focused on providing emergency surgery as close to the battlefield as possible  Horse drawn cart  First to use triage and transport

6.  Clara Barton during the Civil War First civilian ambulance service  1865  Cincinnati Ohio  1869 the New York City Health Dept. Ambulance Service operated out of Bellevue Hospital  Specially designed horse-drawn carts

7.  Staffed with physician interns 20 th Century  WWI average evacuation time of 18 hrs.  WWII – battlefield ambulance corp Transported from front line to high level care  There were still delays, often days

8. Korean and Vietnam Conflicts  Advances were made  Battlefield treatment the air evac In Vietnam often within 10 to 20 minutes Throughout history significant advances occurred during wartime

9. TTo 1960 few places in the US had adequate pre-hospital care EEmergency care began in the E.R. RRescue techniques were crude AAmbulance personnel poorly educated EEquipment miminal

10.  No radio communication between agencies  No medical direction This brings us to.......

11. THE WHITE PAPER  1966  “Accidental Death and Disability: The Neglected Disease of Modern Society”  Published by National Academy of Sciences, National Resource Council