Larrey's flying ambulances and triage

Dominique-Jean Larrey (1766 to 1842) joined the French Army of the Rhine as a surgeon in 1792. Military regulations then kept the ambulances, the mobile field hospitals, a league behind the army. The wounded lay on the field until the fighting ended and were then collected at a convenient spot, and the ambulances, held up by the baggage wagons in between, never arrived in less than 24 or 36 hours. After the capture of Speyer that autumn, Larrey wrote, a great part of the wounded died for want of assistance.

This gave him the idea of an ambulance that could carry the wounded away during the battle itself, a carriage suspended so as to combine speed with solidity and comfort. He built his flying ambulance during the Rhine campaign and took it to the advanced guard in the snow-covered mountains near Königstein. In Italy in 1797, on the orders of the commander in chief, he perfected the design and made it a permanent part of the army's organization.

Larrey also sorted the wounded by how badly they were hurt and treated the most urgent first, whatever their rank, where custom had been to treat officers before ordinary soldiers. The word triage comes from the French trier, to sort, and a 2006 review in the Emergency Medicine Journal traces the practice to Larrey around 1792; François Percy also helped build the army medical service's system for handling casualties. Larrey favored amputation within a day of injury, before infection set in, and at Borodino in 1812 he is reported to have performed about 200 amputations in a single day.

He served in the campaigns in Italy, Egypt and Russia and became surgeon in chief of Napoleon's Imperial Guard. His Memoirs of Military Surgery appeared in English in 1814. The sorting of casualties into immediate, urgent and non-urgent groups is still used in mass-casualty and battlefield triage.