EMS Hall of Fame: The Pioneers of Prehospital Care—Dalton

The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This series honors these trailblazers. 

Edward B. Dalton 

Military, civilian ambulance innovator

Born to a family of doctors in 1834, Edward Dalton was an American physician who served in the Civil War before going on to create the first ambulance service in New York City. 

After graduating from New York’s College of Physicians and Surgeons and interning at Bellevue Hospital, Dalton enlisted with the Union Army at the war’s outset and ended up in charge of the Army of the Potomac’s field hospitals, overseeing the treatment of thousands of casualties. Largely victims of gunshot wounds and fractures, these patients were moved roughly from the front via stretchers, carts, and wagons, often being hurt further in transit. In response Dalton developed a military ambulance with a roof and suspension system to better absorb shocks. It became standard throughout the Army. 

After the war, at the recommendation of general and future president Ulysses S. Grant, Dalton was named head of New York City’s new Metropolitan Sanitary District and, amid a cholera epidemic, asked to create a civilian version of his ambulance operation. This launched in 1869, delivering patients to Bellevue. 

The initial vehicles were a pair of horse-drawn coaches equipped, per a History Magazine profile of Bellevue (www.history-magazine.com/bellevue.html), with “a quart flask of brandy, two tourniquets, a half-dozen bandages, a half-dozen small sponges, some splint material, pieces of old blankets for padding, strips of various lengths with buckles, and a two-ounce vial of persulphate of iron.” These accommodated two patients lying or eight sitting. Inside they had rolling beds that slid in and out on iron tracks, as well as auxiliary stretchers on rollers. A bell connected to a foot pedal served as a siren.

Dalton used a pair of Bellevue doctors as full-time ambulance surgeons. He wanted to fill out crews with rotating classes of new graduates of Bellevue’s surgical program, but according to Ryan Bell’s The Ambulance: A History, they resisted both the schedule (12-hour shifts with one day off every four weeks) and salary ($50 a month). Instead the service used residents in training, who were simply assigned (and by 1935 were still making $50 a month). 

Dalton’s ambulances were used extensively during the Orange Riots of 1870–71, and in 1870 his service answered 1,401 emergency calls. Based on the Bellevue program’s success, Brooklyn, then its own city, launched municipal ambulance services at its Long Island College Hospital and Eastern District Hospital in 1873, and others quickly followed. 

Dispatch in New York’s burgeoning system was built on telegraphic communications between the police and hospitals and fire department signal boxes located throughout the city. Street cops initiated calls through their headquarters that were forwarded to the nearest ambulance hospital. Alarms via the signal boxes went simultaneously to all participating hospitals’ surgeons, drivers, and gatekeepers. The horses that drew the ambulances were initially kept in harnesses while waiting for calls, but that gave way to a system that lowered the tack from a pulley on the ceiling. The horses could be ready in 30 seconds. 

New York City’s system did not represent the first civilian ambulance service in America—that began in Cincinnati in 1865. The Commercial Hospital of Cincinnati (now the University of Cincinnati Medical Center) developed it under the auspices of another war surgeon, Dr. Roberts Bartholow. Its driver was James Jackson. 

John Erich is the senior editor of EMS World.