In the years leading up to World War II, a Nassau County resident needing an ambulance relied for the most part on the ingenuity of the police officers responding to the emergency.
"Getting an ambulance, like getting a boat, often depended on the patrolman's initiative," a history of the Nassau County Police Department reads.
The search for a better system turned out to be the Emergency Ambulance Bureau of the Nassau County Police Department, which this year is celebrating its 60th anniversary. The first of a fleet of eight police ambulances arrived in April 1953 and were staffed by employees who received three weeks of first-aid training.
"They had bandages and simple equipment, and the procedure called for them [ambulance workers] to load them [patients] up and go like heck," said Sean Finnegan, the bureau's deputy commanding officer.
"Now the world has changed, and so have we: biological threats and what-have-you," he added. "You appear at the scene now and you have several people sick, you might not think food poisoning, which we would years ago. Now, it might be more serious. You might have to take precautions yourself."
Retired police Insp. John Fitzwilliam, who was with the bureau for 23 years, summed up its history this way: "Originally, we were basically a first-aid box on wheels. Now we're an emergency room on wheels."
In its first full year of operation, 1954, the eight ambulances responded to 2,351 calls, according to Nassau police records. Last year, with up to 29 ambulances available on any given day, the 155 bureau employees responded to 63,419 calls, Finnegan said.
The need for a coordinated ambulance service became apparent after World War II as the population of Nassau County ballooned with the growth of suburbia.
In those days, someone needing an ambulance called a county police precinct or local police department. The desk officer would then call the police dispatcher, who would call the nearest of the five hospitals that had ambulances, and the second-nearest if the nearest one was busy.
The biggest change in ambulance service was the development of rapid cardiac care in the 1960s, as Nassau became one of the pioneers in developing telemetry, in which electrodes were attached to a patient's heart and a signal sent by radio to a doctor at the hospital.
Fitzwilliam said the driving force behind telemetry was Dr. Costas Lambrew, then the head of cardiac care at Nassau University Medical Center.
Lambrew, who moved to Maine in 1977, said in an interview last week that a handful of other localities, along with Belfast, Northern Ireland, also were working on telemetry at the time.
"We met with the Belfast people when they came over here. They were fascinating. We started messing around with it," Lambrew said. "The rest is history. The concept of early treatment still stands. This was the beginning."
Those first telemetry devices were homemade and sometimes carried in a cigar box, Lambrew said. Now, every police car in Nassau County has an external defibrillator as standard equipment.
There have also been societal changes over the years. The use of seat belts, air bags and other safety features has reduced the severity of many injuries in car crashes, Finnegan said.
With all the advances in medical care and societal changes, Finnegan was asked what was the most difficult emergency to handle, in 1953 and also today.
"Worst case then and now? The worst case is any case where you have a child in bad shape," he said.