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It is therefore tolerably clear that whatever other qualities the transport conveyances possess,
they must be numerous.
One other point he laid stress upon, that the police are, and must be, the basis of any ambulance
system in London. It is the policeman who has to take the first step—often the making or marring
of the whole business—viz., to decide to move or not to move the injured person, and, if he must be
moved, to do it properly.
In most cases he must be moved a few yards out of the way of traffic, and the policeman as a
rule has to do it. Then comes the question of transporting him to a hospital. Shall the patient be at
once "got into" a hansom or four-wheeled cab, or, if a wheeled stretcher be not at hand, be allowed to
lie still till one is available. Momentous question for the patient!
At the root of both these points is "First-Aid" training. Without training the policeman
does not understand that, in many cases, to let the patient lie still until proper means of transport are
available is the best thing that can be done; without training he cannot splint the broken limb, or
stop bleeding, which in the majority of cases is an adequate preliminary treatment. Yet trained or
untrained the policeman as a rule is the person who has in practice to deal with the problem.
With training, we have present constantly in the streets of London somewhere about 2,500
men capable of rendering efficient preliminary treatment, in the great majority of cases, and in every
case of avoiding faults of commission which are at present the source of the most mischief, and of
safely conveying the victims of street accidents to hospital; moreover, such a corps can be provided
in no other way.
But even if an effective corps could otherwise be provided it is important to note that it would
not fully meet the needs of the case. In street accidents the policeman is the first on the spot. The
sufferer has to be moved out of the way of traffic; the policeman has to do it. In short, the policeman
in London is an indispensable part of an ambulance service, and he must be properly trained and kept
efficient; at present he often is not. What the proportion of untrained police is he could not say,
but it is considerable.
With regard to the "Bischoffsheim" service which was established in 1889, it was based on
the fact that the police were the personnel of the street service, and its object was to provide them
with proper transport materiel. The service has at present 55 ambulances distributed over the
metropolis, on which about 2,000 cases are transported every year. Its establishment cost about
.£1,500, and its annual maintenance about £300. Nearly all the first outlay and the whole of the
annual maintenance was provided by one person, Mr. H. L. Bischoffsheim, who is not only prepared
to continue to provide that annual sum but to increase it if necessary for the development of the
service. It should not be understood that Mr. Bischoffsheim would object to the service being
supplemented by a small number of horsed or motor ambulances, as it might well be that such an
addition would be useful; but he was satisfied after an extensive experience that the general
characteristic of the service must be a large number of light hand ambulances, supplemented, it may
be, by a few of the horsed or motor type.
The "Bischoffsheim" service originated from a paper on "The conveyance of injured persons
to the metropolitan hospitals," which he (Mr. Ryan) read before the Hospitals Association in 1889,
and its work has been carried on under his personal supervision from that date to the present time.
The cost of a street-station was from £20 to £25.
(3.) Dr. Danford Thomas, Coroner.
Dr. Danford Thomas said that practically London had no ambulance service for accidents and
other cases, and that much important time is lost. The present system with regard to infectious
cases is a very excellent one.
He thinks it would be publicly recognised as a proper and useful thing to originate the
organisation of a system in London. The police at present render very excellent service; they are on
the spot, and as a rule exercise discretion. The police should have the use of any horsed ambulances
that might be provided. There are plenty of hand appliances, but what is wanted is a horsed
ambulance. The great point is the need of some more rapid means of conveyance. Cabs are not
appropriate, and are used no doubt because they are hondy, but great injury may be done in cases in
which persons with, say a fractured thigh, are taken to the hospitals in cabs. Organisation and
horsed ambulances are undoubtedly wanted.
It would be better in many cases to wait a quarter of an hour to get a proper ambulance than
to use a cab at once, and it is wiser to let a patient lie still and wait until some suitable vehicle comes
along.
In New York, such a service as he indicated is provided, and horsed ambulance, doctor and
nurse, are ready at the hospital to go to any spot on receipt of a telephonic or other communication.
(4.) Dr. E. C. Perry, Superintendent of Guy's Hospital.
Dr. Perry said that the present ambulance services are most inadequate, that much suffering is
caused by the way in which accident cases are brought to the hospitals, and that there is considerable
risk in the use of cabs for the purpose.
He is of opinion that a proper system must be managed by a central body, and that the
London County Council is the most suitable body to undertake the work. The hospitals had no
funds for the purpose. Dr. Perry said he sincerely hoped that the Council would lose no time in
dealing with the matter, as it was very painful to watch the arrival of accidents at hospitals under
the present system. With regard to such a system a considerable staff and organisation would be
required, and both hand stretchers and horsed ambulances should be provided, the latter clearly
being best and likely to be frequently used. The number of cases brought to hospitals day by day
varies little, and a large number of accidents come from great distances.