In 1889, a Chicago police ambulance carried tourniquets, splints, disinfectant, and trained personnel dispatched by telegraph. By the 1950s, the same city's emergency calls were answered by undertakers driving combination hearse-ambulances equipped with little more than a stretcher and a blanket.
How did America go backward?
In this episode of EMS Evolution, we continue our series from Donnie Woodyard's book, *The Dark Ages of Emergency Medical Services: How America Created, then Forgot, Its Early Emergency Medical Legacy,* with Chapter 3: The EMS Dark Age.
This chapter documents the collapse — not a gradual decline, but an active regression. World War II didn't just pause the development of civilian EMS. It gutted it. Physicians and trained ambulance crews were pulled into military service, municipal budgets already weakened by the Great Depression couldn't absorb the loss, and what replaced them was the funeral industry. By the 1950s, funeral homes were the primary ambulance providers across much of America — not because they were qualified, but because they owned the only vehicles long enough to fit a stretcher.
The incentive structure was as perverse as it sounds. Morticians raced each other to accident scenes — not to provide care, but to secure the funeral business if the patient died. The emergency call was, functionally, a sales lead.
Meanwhile, the Soviet Union maintained purpose-built ambulance systems throughout this same period. America's Cold War rival preserved what America abandoned.
The chapter also explores the few who kept the flame alive: the American College of Surgeons publishing standards no one followed, Peter Safar rediscovering mouth-to-mouth resuscitation — a life-saving technique so thoroughly lost it had to be scientifically revalidated — and Dr. Deke Farrington asking the question that would eventually spark EMS reform: Why aren't battlefield lessons being applied to civilian emergencies?
The answer was simple. The civilian system that should have received those lessons no longer existed.