Although the Wright brothers did not first fly their first heavier- than-air aircraft until 17 December 1903, they had been preceded by the concept of air evacuation! As early as March 1784, following the balloon flight demonstrations of the Montgolfier Brothers before the Medical Faculty of Montpelier, physicians began to consider the benefits their patients could gain from flight. Jean-Francois Picot edited the results of this first medical investigation into flight in a work entitled "Testamen Medicum de Aerostatum ust Medicinae applicando," which theorized that not only could patients tolerate flight, but that they would in fact benefit from the purer air encountered. Although there is no evidence of the actual use of balloons for patient evacuation, during the euphoria over flight which was rampant in Europe at the time, in 1895 Charles Richet, a Frenchman, prophesised the eventual wide-spread use and acceptance of this form of transporting the sick and wounded. This prophesy was
enriched and expanded during the 1895-1910 period by Doctor DeMooy of the Dutch military, whose espousal of the concept of the evacuation of casualties by horse-drawn tethered balloons earned him the sobriquet of "the Jules Verne of aeromedical evacuation". The initiation of air ambulance services using heavier-than-air machines followed soon after the Wrights' feat. The first known practical proposal to transport patients by airplane was made in 1910, when Captain George Gosman, Medical Corps, and Lieutenant A.L. Rhodes, Coast Artillery Corps, built an airplane specifically for the purpose at Fort Barrancas, Florida (now part of Pensacola Naval Air Station). They were, however, unsuccessful in obtaining backing for the concept from the government. During 1912 and 1913, there was some non-governmental interest in the concept in America, but in Europe, Sanitary airships, as air ambulances were called in Europe, were discussed by the League of Nations, which, on 21 November, 1912, voted to sponsor an international conference on protection of the sanitary airships in time of war. France especially became enamored of the concept of the air ambulance, and by the onset of World War I had done much research into the subject, although again, as in the United States, mostly without government support. The enthusiasm over the ability to move patients by air was not restricted to Europe and the United States. In 1912, John Flynn, an Australian, saw an airplane fly and subsequently made known a vision of combining medicine, aviation, and radio to provide medical services. This dream later achieved fruition as the Royal Flying Doctor Service of Australia.World War I interrupted the theoretical and civilian development of air ambulance systems, but gave us our first examples of true combat evacuation of casualties by air. The use of aircraft as ambulances were rare, due primarily to the need for the aircraft in other roles although the traditional conservatism of the military obviously also played a significant role. So far as is known, aircraft were utilised tor evacuation to a significant degree only by the French during the war, although recommendations to this effect had been, as previously mentioned, made in the United States, as well as by Captain R.H. Cordner of the Royal Army Medical Corps. He had urged their use in an air ambulance role in the Journal of the Royal Army Medical Corps as early as 1913. In 1916, Dr. Chassaing of the French Chamber of Deputies (concurrently serving in the French Army Medical Department) supervised the conversion of a few Brequet aircraft for use as air ambulances. In 1917, he convinced the French government to build an airplane ambulance (Type Dorand AER), which was capable of carrying two litter patients and which was successfully used in evacuating patients from the Amiens front. One opponent to this development demanded to know of the Chamber of Deputies, in a comment, "are there not enough dead in France today without killing the wounded in airplanes? Sporadic, non-organised use of aircraft in an ambulance role by the British Air Service was reported in contemporary reports. Although their efforts were not utilized in the war, several physicians serving at airfields in the United States independently developed modifications of the Curtis JN-4 (''Jenny'') training aircraft to enable them to carry patients. Probably the first actual use of an aircraft to carry patients in the United States was in February 1918, when Major Nelson Driver, Medical Corps, and Captain William Ocker, Air Service, carried the survivor of an aircraft accident at Gerstner Field, Louisiana, to the hospital. Other conversions of the basic JN4-D air craft to an ambulance configuration were made at Ellington Field, Texas, (two versions, commissioned 1 April and 6 July 1918)22 and at Eberts Field, Lonoke, Arkansas, as well as at several other fields. On 23 July 1918, the Director of the Air Service ordered the conversion of an air ambulance at all airfields for use in responding to aircraft accidents.Such utilization was, however, only in isolated instances, and while these conversions proved the practicality of the concept of air evacuation, the only two instances of larger scale, systematic evacuation were carried out by the French. During the Serbian retreat of 1915, Captain Dangelzer and Lieuten ant Paulhan of the French Air Service evacuated over a dozen wounded men distances of 50 to 120 miles using converted service-type aircraft, and during the Riff Campaign in the Sahara (January 1918), the French used both service type and specially constructed ambulance aircraft both to carry physicians to 26 the wounded and to bring out the wounded from the nearly impenetrable mountains.

What has changed since the early days? Aircraft are more reliable and thus safer, medical equipment has been added to the aircraft contents, and perhaps most importantly, we now have trained personnel providing care in flight, rather than simply plopping a casualty into the dark interior of the fuselage of an aircraft and hoping they are still alive upon arrival. This is a fascinating story: some references are: "From Balloon to Black Hawk, Part I: The Origins"; Army Aviation Digest, 27(6): 41-48, June 1981.-- Parts II-IV in the next three issues. "Wings of Life and Hope--a History of Aeromedical Evacuation"; Problems in Critical Care, 4(4): 477-494, December 1990. "Kelly's Hospital Ship"; Aviation, Space, & Environmental Medicine, 63(12): 1115-1117, December 1992."Marie Marvingt and the Development of Aeromedical Evacuation", Aviation, Space, and Environmental Medicine, 74:863-868, August 2003. “The Aerochir: The First ‘Flying Hospital’”, Aviation Space and Environmental Medicine, 76:1174-1179, 2005. If you have more specific questions, please don't hesitate to ask-- I've been studying air ambulances around the world for many years.