The long road to first aid

Today, when someone collapses in a public place, is injured in a road accident, or suffers a serious wound, the expectation is immediate: someone calls for an ambulance, another looks for a first-aid kit, and often a trained person steps forward before professional medical help arrives. Emergency care has become such a familiar part of modern life that it is easy to forget how recent much of this system is.

For most of history, being injured far from a physician could mean waiting hours, sometimes far longer, for meaningful treatment. What happened in those first crucial moments depended heavily on where a person was, who happened to be nearby and what knowledge or equipment they possessed.

The first traditions of organized care

Long before first aid had a name, the problem of caring for the sick and injured had produced different answers across civilizations.

In ancient India, medical traditions developed detailed approaches to surgery and the treatment of wounds, while Buddhist teachings associated tending the sick with compassion and service. Emperor Ashoka’s third-century BC edicts also describe provisions for medical treatment, medicinal plants and wells, reflecting a broader concern with public welfare and care beyond the immediate household.

Elsewhere, similar responsibilities took institutional form in different ways. In the Islamic world, bimaristans and institutions known as dar al-shifa became established centers of treatment and medical learning, often supported through charitable endowments.

In medieval Christian Europe, monasteries cared first for members of their own communities and increasingly extended shelter and nursing to pilgrims, travelers and the sick.

These traditions differed greatly, but together they reflected the gradual extension of care beyond the household and the individual healer. Such institutions nevertheless remained the exception in a world where assistance still depended heavily on community, religion, status, or circumstance.

When care became a vocation

Among the institutions that emerged from this older landscape of care, the Hospitallers would develop one of the longest-lasting traditions. Their origins lay in an eleventh-century hospital in Jerusalem established to receive sick and poor pilgrims. In 1113, the community attached to it was formally recognized by Pope Paschal II as a religious order.

The Hospitallers did not invent organized medicine. They operated in a Levant where sophisticated Islamic hospitals already existed and Christian, Jewish, and Muslim medical traditions had long interacted. What distinguished the order was the place care occupied within its identity. The sick were referred to as “our lords,” and serving them was treated as a central religious duty.

By the late twelfth century, the hospital in Jerusalem had become a large and highly organized operation. Patients were given individual beds with sheets and coverlets, while physicians examined the sick and prescribed medicines and particular foods according to their condition. Regulations provided for fresh bread, meat, and other foods, with lighter meals for the seriously ill. Attendants remained on duty through the night, bringing water, replacing covers, and helping patients who were too weak to move on their own. Cloaks and footwear were provided for trips to the latrines, while cradles were kept for babies born in the hospital. Muslim and Jewish patients were also received alongside Christians.

This commitment survived even as the Hospitallers acquired a military role, maintaining fortresses and armed knights while continuing to operate hospitals and care for the sick and wounded. After the loss of Jerusalem forced them first to Acre and eventually farther west, hospital care remained part of their institutional life.

When care crossed the battle line

A major turning point in the history of first aid came in 1859, on the battlefield of Solferino in northern Italy. Fighting between French and Sardinian forces on one side and the Austrian army on the other left tens of thousands of dead, wounded or missing. Medical services were quickly overwhelmed, leaving large numbers of injured men without even the most basic assistance in the hours after the battle.

Among those who witnessed the aftermath was the Swiss businessman Henry Dunant. Confronted by wounded soldiers lying without adequate treatment, he helped mobilize local civilians to bring water, clean and dress wounds, carry the injured and provide whatever immediate care they could. The volunteers assisted soldiers from both sides, repeating the phrase “Tutti fratelli,” or “all are brothers.”

What Dunant saw exposed one of the central problems of first aid: the dangerous interval between injury and proper medical treatment. In his 1862 book, A Memory of Solferino, he argued that voluntary relief societies should be organized in peacetime so trained personnel would already be available when war came.

Those proposals soon became institutions. In 1863, a committee established in Geneva began the work that would lead to the International Committee of the Red Cross. A year later, the first Geneva Convention committed participating states to protect wounded soldiers and the medical personnel caring for them, regardless of which army they belonged to.

This added another principle to the developing practice of first aid. Immediate care should not depend on the uniform worn by the casualty. A wounded combatant remained an enemy in political and military terms, but once injured, his need for treatment increasingly stood apart from the cause for which he had fought.

When first aid became everyone’s skill

By the late nineteenth century, the need for immediate care was no longer confined to battlefields. Industrialization had filled mines, factories and railways with machinery capable of causing severe injuries, often in places where professional medical help could not arrive quickly. In 1875 alone, official returns recorded 765 railway workers killed and 3,618 injured in Britain.

It was in this environment that the St John Ambulance Association was established in 1877, with the explicit aim of teaching industrial workers how to provide treatment at the scene of an accident. Instead of waiting for a doctor or simply transporting an injured person elsewhere, workers themselves could be taught how to control bleeding, bandage wounds, immobilize injuries and prevent a casualty’s condition from worsening before professional care became available.

The language and methods of modern first aid were taking shape at the same time. British military surgeon Peter Shepherd drew on the work of Prussian surgeon Friedrich von Esmarch, who had trained soldiers in simple techniques such as bandaging and splinting under the term Erste Hilfe, or “first aid.” Shepherd brought the concept into English and, in 1878, helped teach some of the first organized first-aid classes for civilians in Woolwich.

Railway workers soon became among the most enthusiastic participants, and within the Association’s first six months, its new centers had already welcomed more than 1,000 pupils.

Medical knowledge that had largely remained in the hands of physicians, military medical personnel and specialized caregivers was now being deliberately simplified and passed to ordinary people. The first responder could be a miner, a railway worker or a passer-by standing beside an injured person.

From first aid to everyday life

During the twentieth century, first aid moved steadily beyond the industrial workplaces where many of its early civilian courses had taken root. Training spread through schools, workplaces, sporting organizations, military services and volunteer associations, while ambulance systems and emergency telephone networks became increasingly organized. The scale today is enormous: in 2023, more than 22 million people were trained in first aid by Red Cross and Red Crescent National Societies.

First aid also expanded beyond basic wound care and immobilization as medical knowledge advanced. Cardiopulmonary resuscitation gave ordinary people a way to respond to cardiac arrest, while improved approaches to bleeding, burns, fractures and shock reshaped first-aid training. More recently, automated external defibrillators have appeared in airports, stations, offices and other public spaces, allowing people with limited medical training to intervene in emergencies that once required specialized equipment.

Yet the purpose remains much the same as it was when civilians first began receiving organized instruction in the nineteenth century. First aid still occupies the critical interval between the moment something goes wrong and the arrival of professional medical care. That interval is now surrounded by systems earlier generations could scarcely have imagined: emergency numbers, ambulances, trained paramedics, first-aid kits and public defibrillators.

Behind them, however, lies a much longer history of people confronting the same immediate problem: what can be done when someone nearby is sick or injured and skilled medical help is absent or out of reach? Today, the answer increasingly begins with the person already standing beside them.