Ambulances were used as long ago as the eleventh and twelfth centuries, when men wounded in battle during the Crusades were carried by horse-drawn wagons behind the front lines for treatment. A similar system was used in 1487 by the Spanish forces during the siege of Málaga. The modern ambulance, providing swift and efficient transportation for medical treatment, evolved from a creation by Dominique-Jean Larrey (1766-1842) in 1792. Larrey, Napoleon's private surgeon, strove to improve battlefield treatment of wounded soldiers. Larrey's horse-drawn "flying ambulance" carried surgeons and medical supplies onto the battlefields during the Rhine campaign in 1792. For the Italian campaign of 1794, Larrey employed light ambulance carriages with stretchers to carry the wounded, and camels powered his ambulances in Egypt in 1799. With fellow surgeon Pierre Percy (1754-1825), Larrey formed a battalion of ambulance soldiers, including stretcher bearers and surgeons. Larrey's flying ambulances, and the swift medical attention they brought, greatly impressed Napoleon's troops and significantly boosted morale.

Ambulance service was expanded from the military to the civilian world in 1869 by Bellevue Hospital in New York City. Larrey's flying ambulance remained standard until the first motorized ambulances appeared around the turn of the century, pioneered by Panhard-Levassor of France. Until the mid-1960s, ambulances were mostly hearses, because these vehicles could transport a lying-down patient. Hearses afforded little room for supplies or attendants, however, let alone treatment en route. A National Academy of Science/National Research Council report in 1966 focused attention on the need for both professional training of emergency care technicians and standardization of ambulance design. This resulted in today's modern ambulance, with working space and sophisticated supplies and equipment operated by medical paraprofessionals, so that the ambulance is no longer simply a transportation vehicle--it is also a moving treatment center.

The first airborne ambulances were hot-air balloons used to evacuate the wounded from Paris during the Prussian siege in 1870. Helicopters began to transport wounded soldiers during World War II and became vital evacuation vehicles in the Korean and Vietnam wars. Today, air ambulances--both fixed-wing and helicopters--are increasingly used for quick transportation of civilian patients. Independent air ambulance companies dispatch professional medical teams nationally and internationally on fully-equipped, twin- engine jets, coordinating ground support for the critically-ill patient and their families.