iaa - Independent Ambulance Association

The voice of the regulated independent ambulance industry

Ambulance History

900 AD
Anglo Saxons devised the first ambulance – a hammock based cart – to transport people with psychiatric problems and leprosy.

7th century
During the Muslim conquests armies used a mobile dispensary to treat wounded soldiers on the battlefield.

11th century

At the Battle of Hastings, the Normans used a litter suspended between horses on two poles to carry their wounded.

Queen Isabella of Spain’s armies were the first to used ‘ambulancias’ for emergency pick ups of wounded soldiers from the battlefield

Napoleon Bonaparte’s chief physician designed the ‘ambulance volantes’ – a  horse drawn wagon – to rescue wounded fallen soldiers from the field.

A major advance in civilian ambulances was the introduction of a transport carriage for cholera patients in London.

Every regiment during the American Civil War had at least one ambulance cart.


The first tent field hospital ever used for battlefield wounded was at the Battle of Shiloh.

The first known hospital based ambulance service was at the Commercial Hospital, Cincinnati, Ohio.

The City of London’s Metropolitan Asylums Board started to use six horse-drawn ambulances to convey smallpox and fever patients from their homes to a hospital. From this can be traced London’s first full-time ambulance service.

The St John Ambulance Bridge was established to provide first aid ambulance services at public events in London.

An ambulance tram was introduced and able to reach all 16 hospitals in the city of London.

The British Army’s Royal Army Medical Corps started to use motor ambulance vans, some were based in Oxfordshire.

During World War 1 the Red Cross brought in the first widespread battlefield motor ambulances to replace horse drawn vehicles.

A fixed wing aircraft was first officially used as an air ambulance in Turkey, when an injured British soldier was transported from the battlefield to the nearest medical facility.

The earliest motor powered ambulances at Fordham Hospital in the Bronx- New York City

London County Council takes responsibility for the ambulances in London.

Early London County Council ambulance

……..20 years later

When war broke out in 1939 cars were converted into ambulances.

The first use of helicopters to evacuate combat casualties was by the United States Army in Burma during WW2.

The modern ambulance service was born when the National Health Service Act gave local authorities responsibilities for transporting patients to hospital..

Fleet of four Daimler ambulances operated by the City of Bath Ambulance Service

After the Harrow & Wealdstone rail crash, in which 112 people died and more than 300 injured, ambulances were restructured to be a "mobile hospital", rather than just transporting patients.

As the trend to treat patients on the move continued, ambulance design underwent major changes with the introduction of high-topped car-based ambulances, and later van and light truck chases were used.

The  independent ambulance industry is at least 40 years old - one of the first private companies,  Inter County Ambulance Service,  was started to serve GP's, NHS and private hospitals, as well as insurance companies and private individuals in and around the London area.

The first civilian, hospital-based medical helicopter programme in the United States began operation with a single helicopter, based at St. Anthony Central Hospital in Denver, Colorado.

London’s Air Ambulance, also known as London HEMS (Helicopter Emergency Medical Service), formed as the first air ambulance in the UK to carry a doctor trained in emergency medicine in addition to a paramedic at all times. Based at the London Hospital, Whitechapel.

The Care Quality Commission introduced regulations to register and monitor the independent ambulance industry.


The modern ambulance is now largely custom built to carry patients with specialist needs. For example, bariatric ambulances (shown here) are equipped with extra wide stretchers for patient comfort and dignity and winches to cut down the amount of manual handling a crew has to undertake.

For seriously ill patients, ambulances can be fitted with complete life support, ventilation and monitoring equipment as well as a baby pod incubator for transporting neonates and children less than 10 kg.


The Independent Ambulance Association was born to represent the regulated private ambulance industry.


The Future

Increasing paramedic skills, combined with equipment technology, will continue to drive ambulance change throughout the 21st century. A long term project is underway at the Helen Hamlyn Design Centre in London to redesign the entire system of mobile health care in the UK. The aim is to reduce pressure on hospitals and paramedics, improve safety and dignity of patients as well as reassess issues of hygiene, maintenance, and stock management.

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