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A Moving Tale: Jefferson’s Contribution to the History of Patient Transport

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Jonathan Letterman (1824-1872) (third figure from the right) in 1862 with General McClellan and President Lincoln.

Thomas Jefferson University has a notable history associated with ambulance service and the science of patient transport.

The modern ambulance service, like many medical innovations, was initiated in the military medical department. During the Napoleonic Wars in 1793, a French army surgeon, Dominique-Jean Larrey (1766-1842) devised a system known as the ambulance volante (flying ambulance). This modern kind of warfare--with armies numbering on a scale never before seen--resulted in appalling numbers of casualties. To deal with this new dilemma, Larrey created a corps of surgeons and nurses who accompanied the troops and treated their injuries on the battlefield.

A non-military event which also shaped emergency rescue was the establishment of the International Committee of the Red Cross. Henri Dunant (1828-1910), an ordinary Swiss businessman, was traveling by train through Italy in 1859 and found himself at a fresh battlefield where he witnessed the carnage of dead and dying bodies. They had been abandoned by their respective armies and tended only by the humanity of Italian peasant women, who could do little more than bandage and offer water. (Forty thousand died outright and 40,000 more died from lack of treatment.) A few years later he published “A Memory of Solferino” and conducted a letter-writing campaign which appealed to leaders and humanitarians to convene in Geneva in 1864 (ultimately referred to as “The Geneva Convention”) to establish protocols for saving military wounded and to attempt to “humanize war”. Subsequent conventions addressed internationally-recognized humane treatment of prisoners and other human rights. Dunant was the first recipient of the Nobel Peace Prize (in 1900). Building on this work were women like Florence Nightengale and Clara Barton.

During the time that Dunant wrote his moving account of the slaughter at Solferino, the U.S. Civil War was underway with very large battles and efficient new weapons that resulted in shocking numbers of injured and dead. The Union Army medical corps acknowledged the ineffectual efforts in the removal of casualties from the battlefield-where some soldiers lay unattended for as many as five days.

An 1849 graduate of Jefferson Medical College, Dr. Jonathan Letterman, was appointed Medical Director of the Army of the Potomac and addressed the epidemic problem with sweeping changes. Rather than relying on fellow soldiers to remove the wounded from the field, he created the Ambulance Corps of trained medical personnel whose sole duty was to remove the wounded via horse-drawn ambulances on a regular basis.

Major Letterman’s first test was at bloody Antietam in September 1862, where his corps successfully conveyed all of the casualties within 24 hours. Through the course of the war, his department assessed and improved upon various types of equipment. The “Letterman System” remained the standard model for casualty evacuation until World War I.

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Tripler ambulance was used through most of the conflict; deemed serviceable but heavy.
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“Autenrieth medicine wagon” was also developed under Letterman's direction.
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Wheeling ambulance was an improvement made near the war’s end.
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Pinckney’s Navy hospital ship, Red Rover

Dr. Ninian Pinckney (another JMC graduate of 1833) was commissioned a U.S. Naval surgeon soon after graduation. His career’s apex was achieved when he fitted-out and supervised the Mississippi River hospital ship, Red Rover, a former Confederate side-wheeled steamer, which he transformed into a paradigm for Navy hospital ships. He was so well-respected that he was made medical advisor to the entire fleet.

New York’s Bellevue Hospital takes claim for America’s first civilian ambulance service in 1869. Its developer, Dr. Edward Dalton (who served in the Civil War under Letterman) cited the “Letterman System” upon which he styled his urban service.

Among the earliest hospital ambulance fleets in Philadelphia were the vehicles of Jefferson Medical College Hospital (JMCH), which were comprised of horse-drawn and (by 1907) electric vehicles. The first electric ambulance in Philadelphia could carry 1,000 pounds at speeds up to 15 miles per hour.

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Horse-drawn vehicle from 1903 JMC yearbook
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1907 electric ambulance at the 1907 JMC Hospital
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JMCH’s “electric” staging a rescue at N. 23th and Olive Streets, ca. 1910.

In World Wars I and II, Base Hospital 38 was staffed by Jefferson doctors and nurses and had its own regimental ambulance. Again, military medical officers cited Letterman's plan as the basis of their organization.

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TJUH Heliport design (1970)
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TJUH helicopter landing (1971)

In 1971 Thomas Jefferson University Hospital proudly boasted that its helicopter airlift program was the first in the Delaware Valley. Construction of a heliport atop the Foerderer Pavilion was designed to serve the Intensive Care Nursery and “facilitate transportation of these high-risk newborns during the first critical hours of life.” Today, JEFFSTAT continues to lead the way in more efficient, safe, and swift service to emergency care.

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