The first records of individuals being specifically assigned to deal with transportation of the sick and injured dates back to ancient Rome, when older Centurions disabled in battle were assigned to the task of removing the wounded from the battlefield and providing care. During the Crusades, the Knights Hospitaller of the Order of St. John of Jerusalem filled this same role. 
This organization evolved into what we now know as the St. John Ambulance Brigade.
Over 130 different ambulance operators at one time or the other have provided ambulance service in the Metropolitan Toronto area. Eventually, a single emergency medical service – Toronto EMS – took over as the sole provider of prehospital emergency care in the City of Toronto.
Early Toronto
Contagious disease was a major problem facing Toronto in the early 1800s. There was a severe shortage of money to provide public services and infrastructure. Garbage was piling up, dead carcasses of animals remained in the roadways, and puddles oozed stench, filth and deadly diseases. There were no sewers, and except for a couple of common pumps, the municipal water supply was questionable. The roads were muddy and barely passable, thus the name “Muddy York”. The only known good source of water was from a spring located at Davenport Hill and Spadina, however most citizens chose to obtain their water from the severely polluted Lake Ontario. These conditions, along with new arrivals suffering from various infectious diseases, led to a breakout of cholera. The newly formed “York Board of Health” was tasked with dealing with this deadly outbreak.
Toronto’s Ambulance Service in the 1800s
The first organized ambulance service in Toronto started on June 22, 1832 (Toronto was known as the Town of York at the time) by the Board of Health to transport victims of cholera. Mr. John Blevins was the “carter” of this vehicle. Our first Mayor, Mr. William Lyon McKenzie, also worked as an attendant on this cholera ambulance. This was the start of a civic ambulance service.
The Board of Health also recommended in their daily meeting on June 29, 1832, “that carters employed to convey the bodies to the graves and to the hospital be sworn in as Special Constables, and that a relief of 
Constables be provided for every four hours.” The work load that cholera placed on these men was so demanding that they needed this regular relief. We may never know how many carters were infected during this time.
During the summer of 1832 there were 535 cases of cholera resulting in 205 deaths. Toronto had a population of less than 10,000 at the time.
For the next forty years the ambulance service bounced between public and private run systems.
Toronto General Hospital Ambulance
In 1881 the Toronto General Hospital In 1881, the Toronto General Hospital started an ambulance service. This service would continue to operate until the early 1930s.
Toronto Police Ambulance
On June 1st 1888 the Toronto Police Ambulance Service was formed to deal with emergency calls in Toronto. The police eventually operated four horse-drawn ambulances during this time, gradually replacing them with motorized vehicles starting in 1913.
The first formal training for ambulance attendants was conducted in 1889. This training course was approximately five days long, and was conducted by St. John Ambulance for the Toronto Police Force.
Department of Public Health Ambulance
In 1889, the City Of Toronto’s Department of Public Health (DPH) took over the responsibility of transporting 
contagious patients. Previous to this the City had contracted this service to a funeral home operated by Michael McCabe. The first full-time employee of the DPH ambulance was an individual named Frank Hague, who operated the service from his home.
The 1900s
The first mechanized ambulance in the City of Toronto was introduced in February 1911. This ambulance, operated by A.W. Miles Funeral Home, was manufactured by the T. Eaton Co. built on a Chalmers automobile chassis. The inaugural run was on March 17, 1911.
In August of 1933, the Toronto Police turned their ambulance service over to the 
Public Health Department, expanding the Department’s role into responding to emergency calls. Along with a number of private ambulance services, the Department of Public Health provided ambulance service to the citizens of Toronto continuously from 1889 until midnight on December 31, 1966.
The first mechanized ambulance in the City of Toronto was introduced in February 1911. This ambulance operated by A.W. Miles Funeral Home, was manufactured by the T. Eaton Co. and it was built on a Chalmers automobile chassis. The inaugural run was made on March 17, 1911.
Over 130 different ambulance operators at one time or the other have provided ambulance service in the Metropolitan Toronto area.
In 1953, the Corporation of the Municipality of Metropolitan Toronto was formed by provincial legislation. This new tier of government was given responsibility for all major local services and infrastructure, such as water treatment, major roads and Police services. The ambulance services, however, 
were not amalgamated at that time. They contained minimal patient care equipment, the patient areas were cramped, and the services were all individually dispatched. Ambulance service remained fractured and sporadic, and delayed responses were common. Clearly, the system needed further improvement.
The Carl Goldenberg Report of 1966 recommended a number of changes take place in the operation of civic services in the
Metropolitan Toronto area. One of those recommendations directed the Municipality of Metropolitan Toronto to take over and operate all remaining public ambulance services, in addition to setting up and operating a central Ambulance Dispatch Centre to coordinate all ambulance calls in Metro Toronto.
The Department of Emergency Services
As a result of the Goldenberg Report, the Municipality of Metropolitan Toronto’s Department of Emergency Services (D.E.S.) was formed, under the direction of Commissioner John Pollard on January 1, 1967. Mr. Pollard, a retired army colonel, brought about a number of changes, including mandatory training for ambulance attendants, larger ambulances and the centralization of dispatch for all ambulances in Metro Toronto. The new Department also absorbed all of the remaining fire department ambulances, bringing to an end the era of fire service-based ambulance service in Toronto.
Ontario Government Funding
In 1968, the Ontario Ministry of Health began to take an interest in how ambulance service was provided. In addition to the establishment of regulations and standards, the Ministry of Health began to operate ambulance services 
throughout the province, either directly or under contract. In Toronto, this included the acquisition of the largest private ambulance firm, known as Amalgamated Ambulance Service Ltd., and the creation of the Ontario Ministry of Health’s York Toronto Ambulance Service. In addition, the Ministry established a mandatory 160 hour training program for all Ontario ambulance attendants. This training took place at both Canadian Forces Base Borden and the Metro Toronto Department of Emergency Services training school in Toronto. This advancement in training set a new standard of care that would be delivered by the ambulance staff of the day.
Advanced Care
In 1962, the first experiments in the pre-hospital care of cardiac patients were conducted successfully in Belfast, Northern Ireland. The City of Toronto 
conducted a similar experiment starting in July 1969 with a trial cardiac ambulance known as “Cardiac One” operating from 45 station on New Street. The ambulance crew worked with a hospital intern, carrying a large portable monitor to observe changes in the patient from the time of pickup to the time of arrival at the hospital. It would be another fifteen years before advanced care came to Toronto’s ambulances. In 1972 the Province of Ontario began to train ambulance crews through the community colleges.
This new program, which started in September 1972 at Humber College with a class of 25 students, provided 1,400 hours of
theoretical, practical, clinical and field training. Some of the first graduates of this course are still employed at Toronto EMS.
The college paramedicine program is now typically two years long, and still provides the standard for entry-level training into the field.
Amalgamation of Ambulance Services
In 1974, a number of tragic incidents involving the deaths of children and long ambulance response times caused the Province to make the municipality the sole ambulance service provider in Metro Toronto. As a result, the Department of Ambulance Services (D.A.S.) was formed in February 1975, amalgamating the five remaining private services (Hallowell, Kane, Locke-Metro, Ogden, and Watson), the Provincial York Ambulance Service, and the Department of Emergency Services ambulances into a single municipal ambulance service.
The infrastructure inherited by the new service included resources which were scattered across the city in makeshift facilities. Headquarters was housed in a decommissioned police station at 674 Markham Street, 
the dispatch centre was in rented space at the Toronto Transit Commission headquarters, the garage and stores were in a dilapidated warehouse at Spadina and Davenport, and the training school was in another former police station at 135 Davenport Road. Crews were housed in rented and borrowed facilities, trailers, and old service stations around the city.
Innovations by the new authority included centralized coordination, Emergency Support Units, a station construction program, public CPR education and a centralized emergency number (911). The new Toronto Ambulance Headquarters at 4330 Dufferin Street opened in 1981. For the first time, the critical functions of administration, dispatch, stores, vehicle maintenance, and training were housed under one roof, allowing the key functions to be fully integrated. The modern ambulance service had truly begun.
First Advanced Care Paramedics
In 1984, Toronto’s first Advanced Care Paramedics hit the streets, armed with an additional 1000 hours of training.
In 1995, Toronto EMS introduced defibrillation as an emergency skill for all paramedics. Later, in cooperation with the Ontario Ministry of Health, the standard paramedic skill set was expanded to include the administration of six of the most critical emergency drugs.
Toronto EMS Today
Today, under the direction of Chief Bruce Farr, Toronto EMS operates one of the finest Emergency Medical Service systems in the world. Toronto EMS operates from forty-five ambulance stations located across the city.
Our fleet of 208 vehicles includes 152 ambulances, 22 single-paramedic emergency response vehicles, 16 mountain bikes and a staff of 950 paramedics who provide pre-hospital care to the city’s residents and visitors. Computer-aided dispatch and automatic vehicle locating systems work together to ensure that response to an emergency is as timely as possible. Toronto EMS also provides medical support to the Toronto Police Service Emergency Task Force, the Public Safety Unit, CBRN (chemical, biological, radiological and nuclear response), the Heavy Urban Rescue Unit and the Toronto Police Marine Unit. Our training programs and community health initiatives are all in place to provide the citizens of Toronto with a better place to live.
Clearly, we have come a long way from the days of John Blevins with his horse and wagon. What does the future hold? Whatever changes occur, the staff of Toronto EMS will be there to meet them, just as they have for the past 175 years.
