New Technology and Paramedic Role Development

At this time, ambulances were a piece of new technology. They were two- or four-wheeled carriages, usually drawn by two horses, with a tube-like space on top of the carriage that could carry two patients.187 _{The vehicle was inseparable from the men who operated it—} the two acted together or not at all. The development and implementation of this technology therefore led to the development of a worker with a specified role to utilise this particular piece of technology.

This unique role was solidified over time. Within 50 years the soldats d’ambulance (ambulance soldiers) were the first formally noted workers to be exclusively associated with ambulances and although they were often men attached to the field hospital, they and their role were distinct from all other workers, including orderlies.188 In 1869, Dr Thomas Longmore wrote:

186 _{Dominique J Larrey, Memoirs of Military Surgery and Campaigns of the French Armies (RW Hall trans,}

Classics of Medicine Library, 1987) vol 1, 23–4 [trans of Mémoires de chirurgie militaire (first published

1814)].

187_{Panagiotis Skandalakis, Panagiotis Lainas, Odyseas Zoras, John E. Skandalakis, and Petros Mirilas ‘“To}

Afford the Wounded Speedy Assistance”: Dominique Jean Larrey and Napoleon’(2006) 30 World Journal

of Surgery 1392.

188 _{Thomas Longmore, A Treatise on the Transport of Sick and Wounded Troops’(Her Majesty’s Stationery}

Office [HMSO], 1869); RCP, Report upon the State of Hospitals in the Crimea and Scutari Together with

The personnel of ambulance establishments, the men to whom the duty is entrusted of picking up and carrying the wounded to the field hospitals, of attending upon them under the direction of the surgeons while they are in hospital and during their subsequent removals, are so inseparably connected with their appliances, which are placed in their hands for carrying on this service, that a description of the one would be necessarily very incomplete without a description of the other.189

Significantly, the size and shape of the conveyance popular at this time demonstrates that the ambulance attendants were in effect merely drivers and did not provide medical care en route to hospital as they do today. We can assume this because the tube in which patients were carried was too small to allow an attendant to sit with a patient and provide any care to them as they travelled. Definitive care did not commence until the patient arrived at the field hospital. Despite this, the ambulance attendant role was established with a unique purpose and specific function associated with it, and became an integral part of the military’s response.

In fact, the role became so important to successfully undertaking a large-scale military campaign that the failure to provide adequate ambulance resources to support the British Army during the Crimean War (1854–85) was examined as a key issue by the British government. The Crimean War is famously linked with the professional development of nursing because of the critical role played by Florence Nightingale in recognising the importance of providing care, comfort, hygiene and nutrition to sick and injured soldiers.190 However, the Crimean War also marked a point of professional development for ambulance officers, as assessed using the Freidson elements. The role of the ambulance officers at this time was, as it had been during the earlier era, the simple transportation of the sick to the definitive care of the nurse and the cure of the doctor. Nevertheless, this simple but vital role was recognised as being so significant that the failure of the British government to provide sufficient numbers of ambulance resources in the early part of the campaign was said to have contributed to significant losses.191 A parliamentary enquiry into the state of the hospitals in the Crimea heard that the lack of ‘ambulance wagons’ led to a delay in

189 _{Thomas Longmore, A Treatise on the Transport of Sick and Wounded Troops’(HMSO, 1869) 2–3.}

190 _{RCP, Report upon the State of Hospitals in the Crimea and Scutari together with an Appendix (HMSO,}

1855) 343. (emphasis added).

‘collecting the wounded and dressing their wounds’.192 _{The inquiry identified that not only} was there a problem with the ambulance vehicles, there was also an issue with ambulance staff who, according to the report, ‘did not answer expectations’.193 _{Ambulance personnel} and orderlies were taken from the rank and file of the army;194 they were men who came from the lower classes of British society and who were, ‘forced into the Army by starvation, unemployment and poverty and occasionally as an alternative to prison’.195 A Dr Hall gave evidence about the character of ambulance staff at the time, saying ‘from their habits and age they are quite unfitted for their situation’.196 _{BW Marlowe, Surgeon for the 28th} Regiment, wrote in his submission to the inquiry:

The men of the ambulance corps … can scarcely ever be depended upon: they are insubordinate, disobedient and so perpetually drunk and noisy as to have become a public nuisance.197

Another said that the ambulance men ‘do not prove the best attendants on the sick’.198 A number of submissions to the enquiry made reference to the excellent provision of services offered to the British by the French, with Dr Thomas Longmore making particular note of the fact that the French had an ‘active, trained and educated ambulance corps’ and that ‘some similar establishment would be of great advantage in the British service’.199 _{In part} because of their character and in part because of the ambulance men’s lack of training for the purpose, Dr Hall recommended that ‘we ought to have a corps that is enlisted and trained for the purpose’.200

The unique skills and knowledge required to do the job well included blacksmithing and farrier skills, the ability to fix the wheels of the ambulance should they become damaged and animal husbandry skills to take care of the horses that pulled the carriages.201 Without

192 _{Ibid 4–5.} 193 _{Ibid 4.} 194 _{Ibid 32.}

195 _{Harold E Raugh, The Victorians at War, 1815–1914: An Encyclopedia of British Military History (ABC-}

CLIO, 2004) xiv.

196 _{Ibid 5.} 197 _{Ibid 117.} 198 _{Ibid 98.}

199 _{RCP, Report upon the State of Hospitals in the Crimea and Scutari together with an Appendix (HMSO,}

1855) 101 (emphasis added).

200 _{Ibid 340.}

201 _{Ibid; It is interesting to note that the men were charged with and expected to be able to care for and treat}

employing men with those skills the ambulance corps was considered ‘of no service whatever’. 202 This was an acknowledgement that not only was the ambulance service important, but perhaps the first recognition that specialised knowledge and skills were required to do the job well and thus the training of ambulance attendants in those albeit humble but nonetheless specialised skills and knowledge was critical. This is evidence of a move towards the development of the Freidson element that professions undertake a period of training and can apply specialised knowledge and skills for a public service. There was also a recognition that ambulance attendants could and should do more than maintain ambulances, that is, that their skill set should become more sophisticated. The Crimea parliamentary enquiry recommended that the men of the ambulance corps should also undergo some training as hospital orderlies, a job that required some ability to assess the health and health needs of patients; thus the role of the ambulance attendant began to expand.203