EMS Hall of Fame: The Pioneers of Prehospital Care—Larrey, 9/11 Responders

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. 

Dominique Jean Larrey

“Ambulances volantes”

Dominique Jean Larrey (1766–1842) has been described as the “father of military surgery” and is credited with conceiving the first ambulances to evacuate wounded soldiers from fields of battle, the pioneering ambulances volantes of revolutionary France. 

Raised by a surgeon uncle after the early death of his parents, Larrey saw his own medical studies interrupted by war. His landmark contribution came in the 1790s, when he realized the carriages of France’s horsedrawn “flying artillery” could be adapted to move casualties from combat. He staffed them with trained crews of drivers, corpsmen, and litter-bearers and tried it at the 1793 Battle of Metz, and the idea’s success led to its adoption throughout the French army. Larrey also improved access to French field hospitals, bringing surgical capacity closer to the front, and established the idea of triage by severity rather than rank. 

He became surgeon-in-chief of the Napoleonic armies in Italy in 1797 and gained acclaim as an expert on wound management and limb amputation. He served Napoleon through 25 campaigns, 60 battles, and 400 engagements. His continuing medical exploits included the first successful pericardiocentesis for trauma, ligation of the femoral artery below Poupart’s ligament, identifying the diaphragmatic defect known as Larrey’s cleft, using positive-pressure breathing to treat chest wounds, and using snow and ice for anesthesia before and after amputation. 

At Waterloo in 1815 Larrey’s courage under fire led the Duke of Wellington to order his men not to fire in Larrey’s direction, but rather to “give the brave man time to gather up the wounded.” Captured by the Prussians, he escaped execution when he was recognized by a German surgeon who convinced field marshal Gebhard von Blucher—whose son Larrey had earlier saved upon his wounding and capture by the French—to spare Larrey’s life. von Blucher instead hosted Larrey as an honored guest and sent him home with money and new clothes. 

Larrey lived until 1842, writing, teaching, and serving as chief surgeon of the French army. 

The Responders of Sept. 11, 2001

America’s deadliest terror attack

On September 11, 2001, 19 terrorists with the Islamic extremist group al Qaeda hijacked four U.S. passenger jets and flew them intentionally into the World Trade Center and Pentagon. While passengers fought back and helped force the fourth to crash in an empty Pennsylvania field, the coordinated attack—the largest terror attack in U.S. history—nonetheless claimed 2,977 lives and injured more than 25,000 people. Among the immediate victims in New York City were hundreds of firefighters, dozens of police, and numerous EMTs and paramedics. 

Most of the public safety victims were killed when the World Trade Center’s Twin Towers collapsed—that claimed some 343 FDNY firefighters and 412 emergency workers overall. Eight EMTs and paramedics from other organizations also died. FDNY lost its department chief, first deputy commissioners, a marshal, and a chaplain, as well as other key leadership personnel. Others were sickened and killed by their search, rescue, and cleanup efforts following the attacks. 

The long-term impacts of 9/11 included advances in domestic security and a long-running global campaign against extremism. Emergency medical services institutionalized NIMS and the Incident Command System and prepared for larger acts of terrorism than previously imagined. Communications interoperability and personnel accountability, both problem areas on 9/11, became targets of improvement efforts. 

When the planes hit that morning, FDNY deployed 200 units—half its entire force. Many other responders freelanced to the scene independently. On scene firefighters and police from the NYPD and Port Authority worked without coordination, performing redundant searches hamstrung by incompatible radio systems. As conditions grew worse, the NYPD ordered its personnel out of the towers, but no warnings were passed on to FDNY commanders. Swamped 9-1-1 operators were also unable to relay key information. 

FDNY issued its own evacuation warning after the first tower collapsed, but even then malfunctioning repeater systems meant many firefighters never heard it. The second fell 29 minutes later. 

The New York City attack of 9/11 represented the single deadliest terror attack in human history and the deadliest incident ever for firefighters, and its impact on American safety and culture remains profound today. 

John Erich is the senior editor of EMS World.