One of the developments of World War I that still shapes health care today is what was once called the “motorized ambulance.” Automotive transport of the wounded supplemented and ultimately replaced the horse-drawn wagons used to evacuate casualties from the battlefield. Many famous people, among them Americans Walt Disney and Ernest Hemingway, served as ambulance drivers in the “Great War.”

Novelist and poet May Sinclair, who briefly served as an ambulance driver, wrote the evocative poem “Field Ambulance in Retreat,” with the lines:

The straight flagged road breaks into dust, into a think white cloud,

About the feet of a regiment driven back league by league,

Rifles at trail, and standards wrapped in black funeral cloths. Unhasting, proud in retreat,

They smile as the Red Cross Ambulance rushes by.

During World War I the Red Cross had 4,800 ambulance drivers providing first aid on the front lines; 127 lost their lives, as did 296 Red Cross nurses. The legacies of these ambulance drivers live on in their works and in the memory of their heroism. The ambulances on our streets today are another legacy of that war.

The "Great War" is also known as the first "modern war" because of the technologies deployed, among them, tanks, submarines, torpedoes, aircraft, and machine guns. Unlike those weapons, motorized ambulances saved lives—of soldiers and horses.

Horses played a critical role in World War I and earlier conflicts, but they also presented challenges—the need for sufficient food and water, the difficulty of dealing with their carcasses when they died, and problems accessing sufficient numbers as many were killed or wounded on the battlefields or while transporting troops and supplies. Motorized ambulances, first used by the Red Cross, offered a number of advantages for evacuating the wounded—among them, the ability to stop quickly, the capacity for operating in extremely hot weather, fast refueling, and reliance on gasoline rather than grazing pasture and heavy-to-transport feed. Yet motorized ambulances also presented difficulties; they could break down, get stuck in the mud, and run out of gas. All technologies have their limits.

Automobiles quickly proved to be cheaper and more efficient than their four-legged competition and horsepower replaced horse power beginning in the early 20th century. American car culture was on its way. A few American hospitals acquired and used motorized ambulances at the turn of the century; after World War I they became common, along with other motor vehicles.

The end of horse-drawn transport brought great relief to city dwellers, public health authorities, and others concerned about pollution. Horses produced 50 to 30 pounds of manure a day, and, in a city filled with thousands of horses, this posed a great threat to health. Disease-spreading flies breeding in the tons of horse manure, the resulting odors and water contamination, as well as the costs of street cleaning, led many to view the arrival of the automobile as the solution to a terrible environmental problem. It wasn’t a perfect fix, of course. Today we know that cars are responsible for 30 percent of all United States greenhouse gas missions, according to the Union of Concerned Scientists. Some low-emission ambulances have come into use today because pollution and fuel economy have become important concerns. Will electric vehicles replace those with gasoline-burning engines as motorized ambulances once replaced the horse-drawn variety?

Next time you pull over after hearing the siren and seeing the flashing lights of an ambulance, don’t worry about the minor delay. Stop and think about how this technology proved helpful on the battlefields of World War I, presented a solution to a critical urban problem of the 20th century—and is now part of the larger global climate challenge facing us today.

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