Civilian
The first civilian uses of aircraft as ambulances were probably incidental. In northern Canada, Australia, and in the Scandinavian countries, remote, sparsely populated settlements were often inaccessible by road for months at a time, or even year round. In some cases in Scandinavia, as in Norway, the primary means of transportation between communities was by boat. As an early part of aviation history, many of these communities were served by civilian "bush" pilots, flying small aircraft, and transporting supplies, mail, and visiting doctors or nurses to isolated communities. These pilots probably performed the first civilian air ambulance trips, albeit on an ad hoc basis, but clearly, a need for such services existed. In 1928 the first formal, full-time air ambulance service was established in the Australian outback. This organization became the Royal Flying Doctor Service[2] and continues operating to the present. In 1934, the first civil air ambulance service in Africa was established in Morocco by Marie Marvingt.[3]
Air ambulances were useful in remote areas, but did they serve a practical purpose in the developed world? Following the end of the Second World War, the first civilian air ambulance in North America was established by the Saskatchewan government in Regina, Saskatchewan, Canada, which had its own issues of both remote communities and great distances to consider in the provision of health care to its citizens.[4] This service was still in operation in 2007. Back in the United States, 1947 saw the creation of the Schaefer Air Service, the first air ambulance service in the United States. This service was founded by J. Walter Schaefer of Schaefer Ambulance Service in Los Angeles, California.[5] Schaefer Air Service was also the first FAA-certified air ambulance service in the United States. It should be noted that, at the time of the creation of these services, paramedicine was still decades away, and, unless the patient was accompanied by a physician or nurse, they operated primarily as medical transportation services. A great deal of the early use of aircraft as ambulances in civilian life, particularly helicopters, involved the improvised use of aircraft belonging to branches of the military. Eventually this would become more organized. This mode of usage occurred not only in the United States, but also in other countries, and persists to this day.
Two programs were implemented in the U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi in 1969. Three helicopters were purchased through a federal grant and located strategically in north, central and southern areas of the state.[6] Upon termination of the grant the program was considered a success and each of the three communities was given the opportunity to continue the helicopter operation. Only the one located in Hattiesburg did so, thereby establishing the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services. The remaining challenge was in how such services could be operated most cost-effectively. In many cases, as agencies, branches and departments of the civilian governments began to operate aircraft for other purposes, these too were frequently pressed into service to provide cost-effective air support to the evolving Emergency Medical Services.