The growth of ambulance services is linked to the development of hospitals. In the mid-19th century, most people who had family or money were nursed at home and attended by the local doctor. ‘Colonial hospitals’, which cared for Māori and poor Pākehā, were set up in Auckland, Wellington, New Plymouth and Whanganui between 1848 and 1850. Increased demand for qualified health care led to the establishment of 38 general hospitals around the country by 1883. More were set up under local-body control after the Hospitals and Charitable Institutions Act 1885.
People with serious illnesses or injuries got to hospital for treatment by whatever means they could. Trains were fastest and most reliable, but people were also brought along rough roads by horse and cart or sledge.
Some hospitals bought their own horse-drawn ambulance – Palmerston North had one by 1901, Waikato by 1908, and Whanganui by 1912. Patients usually had to pay for both hospital care and ambulance transport.
Smaller hospitals such as Coromandel’s Mercury Bay Hospital had more basic services: for many years the ambulance was a handcart parked on the front verandah of the Whitianga Hotel. In an emergency the nearby Mercury Bay Timber Company mill whistle was blown to summon help. If there was a timber-cutting accident in the bush, relays of men carried the patient out on a makeshift sacking stretcher.
Around the time of the First World War, sick or injured people from Ōtorohanga were sent to Waikato Hospital on the early-morning train. A patient would be trundled from Frankton Station to Hamilton Lake on a luggage trolley. A house surgeon would be waiting at the water’s edge to row the new arrival across the lake to the hospital.
The Order of St John had been active throughout New Zealand since 1885, teaching first aid and home nursing in small towns with scant medical services. In 1892 the first St John ambulance brigade was formed in Dunedin, providing a free transport service to patients in emergencies.
More brigades, consisting of volunteer drivers and first aiders, were gradually set up around the country. Often St John contracted services to hospital boards. The board would continue to own and maintain the ambulances, which by the 1920s were motorised. More ambulances became available after the First World War, when the Defence Department lent its surplus field ambulances to hospital boards.
Although St John brigades came to dominate ambulance services in the 20th century, some hospitals continued to run their own ambulances. And in isolated districts without ambulances, people still travelled to hospital in cars or taxis, or on the back of trucks.
The need for a better emergency system in Wellington led to the establishment of the Wellington Free Ambulance in 1927. Its main advocate, Wellington mayor Charles Norwood, had been shocked to see an injured man lying beside the road, unable to be shifted because there was no hospital ambulance available. As well as helping to found the Wellington Free Ambulance, Norwood, a well-known car-assembly industrialist, donated vehicles to the fleet.
In the days of manual telephone exchanges, people needing an ambulance simply asked the operator, who would connect them with the local brigade. When automatic exchanges were introduced in the 1950s, people had to either know the local ambulance station number or look it up in the telephone book, losing crucial time.
The 111 number for calling all emergency services was introduced in 1958 in Masterton, and slowly spread to other parts of the country. 111 calls were automatically switched to a local staffed exchange, where an operator transferred the call to the appropriate service. The system could be unreliable – for instance if the exchange was only staffed by one person, who might be temporarily absent.
In Whangamatā between 1985 and 1988 the job of answering 111 calls was shared between several local people. The calls were transferred to their homes or businesses. One man ran a takeaway bar, and would answer the phone not knowing whether the caller wanted fish and chips or an ambulance.
From the 1950s air ambulance services using fixed-wing aircraft transferred critically ill patients in remote areas to larger hospitals. For example, the Kaitāia aero club operated an air ambulance from 1952 – first using a Fox Moth aeroplane and then a twin-engined Dominie.
By the late 1980s there were rescue helicopters. They could land where fixed-wing aircraft could not, so they were useful not just for hospital transfers, but for attending motor and other accidents and taking injured people to hospital much faster than a road ambulance could.
Once seen mainly as a means of transporting patients, the ambulance service is recognised in the 2000s as the first line of medical treatment in an emergency. Ambulance staff use specialist paramedic skills and sophisticated equipment such as defibrillators. Each day, an average of 1,100 people rely on the ambulance service to treat them and take them to hospital.
In 2008, 250 specially trained doctors and nurses in rural areas belonged to the PRIME scheme. When a medical emergency occurs, they are alerted at the same time as ambulance services, and go to the scene to provide specialist care before the ambulance arrives. The objective is to provide a rapid response to serious illness and injury in areas where it may take longer to get the patient to hospital.
In 2008 St John Ambulance provided around 85% of New Zealand’s road ambulance services, with the remaining 15% covered by Wellington Free Ambulance and the ambulance services of Taranaki District Health Board and Wairarapa District Health Board. Air ambulance services were provided by 18 rescue helicopter trusts, and 12 companies and clubs operating fixed-wing aircraft. These organisations were contracted by the government to ensure all regions had an ambulance service. Rescue helicopters also assisted with police and search and rescue operations.
Ambulance New Zealand, a charitable trust, represented the collective interests of ambulance providers. Volunteers were still a major force in New Zealand’s road and air ambulance services. There were around 2,600 volunteers, and 1,300 paid staff.
In New Zealand and Australia a St John officer is sometimes called a Zambuk. The expression has its origins in the trade name of an ointment used in the early 1900s to treat bruises and sprains.
Three emergency ambulance communications centres, in Auckland, Wellington and Christchurch, were supported by around 140 call-takers and ambulance dispatchers. The communications centres carried out ‘telephone triage’ – assessing patient needs and the urgency of each situation so that priorities could be set.
In 2006/7 the ambulance service responded to some 280,000 accidents and medical emergencies, and air ambulances flew 8,095 missions.
In 2008 road ambulance services received 85% of their funding from the Department of Health and the Accident Compensation Corporation. The other 15% was from other sources including bequests and fundraising. Air services received only 40–50% of their funding from government; the rest came from public and corporate contributions. Compared with other countries, this was a low level of government funding.
In the early 2000s there was occasionally criticism of the time it took for an ambulance to arrive after an emergency call. Ambulances had sometimes responded to emergencies with one rather than the recommended two crew members. One reason for these problems was the growing difficulty of attracting volunteers. The ambulance service was heavily reliant on volunteer labour, and did not have the money to employ more paid staff.
Early hospital ambulances often had a medically untrained driver – at Whāngārei Hospital the first motor ambulance was driven by the gardener. When the St John ambulances began, crew got first aid training. This helped them to deal with some life-threatening situations such as haemorrhage or breathing difficulties, and to make patients more comfortable and calm.
In the 1960s morphine was often administered by ambulance officers for pain relief, but it could cause nausea. One officer recalled a journey where a patient was vomiting copiously. The ambulance screeched to a halt outside a church just as the congregation was coming out, and the driver emptied the brimming sick bowl into the gutter. The vehicle then sped away, having put a few people off their Sunday lunch.
Until the 1960s, however, pre-hospital treatment by ambulance staff was basic by today’s standards. One volunteer recalled, ‘En-route treatment of the patient relied heavily on ample reassurance, some oxygen, a few bandages, splints and very little else. Patients who were already suffering from shock, in some cases deteriorated considerably during the course of the trip.’1
In the mid-1970s there was strong public criticism of the uneven standard of ambulance services in New Zealand. Brigades were under strain because of new demands, including a rising road-accident rate. Proceeds from the first national telethon in 1975, held in aid of St John Ambulance, were used to set up the National Ambulance Officers’ Training School in Auckland in 1978. The school had its government funding cut drastically in the 1980s, affecting the extent and quality of its programmes. It closed in 1999.
The new focus on ambulance services did however lead to an upgrading of ambulance vehicles and equipment during the 1970s and 1980s, often as a result of fundraising by community service groups such as Rotary and Lions clubs.
Since 1999 New Zealand Qualifications Authority-approved training of ambulance officers has been carried out regionally in private training institutions. St John Ambulance and Wellington Free Ambulance provide training for their members, from pre-hospital emergency care (the basic qualification) up to paramedic level. Advanced paramedic training is gained through a Bachelor of Health Science (Paramedic), offered at the Auckland University of Technology and Whitireia Community Polytechnic in Wellington. All these qualifications involve extensive practical training and experience.
Advanced paramedics are qualified to administer a range of pain relief and cardiac drugs. They are also skilled in resuscitation methods, including intubation (inserting tubes into a patient’s airways to assist breathing). In 2008 there were approximately 200 advanced life-support paramedics in New Zealand – about 6% of ambulance staff. This is much lower than many other countries, where around half the ambulance workforce has advanced paramedic training.
Beasley, A. W. Borne free: the Wellington Free Ambulance, 1927–1994. Wellington: Board of Management of the Wellington Free Ambulance Service, 1995.
McLaren, Tom. The history of St John in Rangiora. Rangiora: Order of St John, Rangiora Sub-Centre, 1994.
The New Zealand ambulance service strategy: getting it done!: information package, November/December 2008. Wellington: National Ambulance Sector Office, 2008.
Rice, Geoffrey W. Ambulances and first aid: St John in Christchurch 1885–1987: a history of the St John Ambulance Association and Brigade in Christchurch. Christchurch: Order of St John, 1994.
Wright St-Clair, R. E., ed. St John in New Zealand: a history of the most venerable order. Wellington: Millwood, 1985.