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Era 2 of 6 · 1929–1965

Fragmentation and the Dark Age of EMS

A system without standards

Emergency medical care fractured across funeral homes, police departments, and volunteer squads with no unified training, oversight, or standards.

26 documented events
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Era 1
pre-1870s–1928
Ambulance Foundations
Era 2
1929–1965
Dark Age of EMS
Era 3
1966–1980
Birth of Modern EMS
Era 4
1981–1999
National Standardization
Era 5
2000–2019
Clinical Maturation
Era 6
2020–2026
Workforce Mobility
👤 EMS Pioneers
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If Era 1 was the birth of an idea — that organized emergency transport saves lives — then Era 2 is the story of how America nearly forgot it.

When the Great Depression hit, municipal budgets collapsed. Cities that had built ambulance services over decades were forced to cut them. Hospitals pulled back. Public health infrastructure crumbled. And the fragile progress that had been made in emergency care began to unravel. The systems America had exported to Europe — the systems those countries were now integrating into national healthcare frameworks — were dying in the cities that invented them.

Then came World War II — and a paradox. On the battlefield, military medicine leapt forward. Scalable evacuation chains, battlefield resuscitation, field hospitals, and MASH units saved thousands of lives. But back home, the war stripped civilian ambulances of their trained medical staff. Physicians and skilled attendants were redeployed overseas, and most domestic ambulances reverted to what they had been before the Civil War — simple transport vehicles with no trained responders and no medical equipment onboard.

Into that vacuum stepped an unlikely provider: the funeral home. By the 1950s, funeral directors were running the majority of ambulance services across the country. Why? Because hearses were the only vehicles long enough to carry a stretcher. The attendants had no medical training. The vehicles had no equipment. If you had a heart attack in most American cities, you were picked up by the same people who would bury you — and there wasn't much they could do in between. This was EMS at its lowest point — and it cemented the perception of ambulance services as transportation, not healthcare. A classification that would haunt the profession for the next seventy years.

But even in the dark age, seeds of revolution were being planted. During the Korean War, the military proved that helicopter medevac could save lives on a massive scale — evacuating over twenty thousand wounded soldiers to MASH units by air. In 1957, President Eisenhower became the first U.S. president to fly in a helicopter, signaling the reliability of rotary-wing aircraft that would later become essential to civilian EMS.

That same decade, Dr. Peter Safar validated mouth-to-mouth resuscitation, overturning decades of ineffective manual methods. Drs. Kouwenhoven and Jude discovered that chest compressions alone could maintain circulation during cardiac arrest — and together with Safar's work, modern CPR was born. Dr. R. Adams Cowley coined the "Golden Hour," the critical sixty-minute window that still drives trauma response today. And Safar partnered with Norwegian toymaker Åsmund Lærdal to create Resusci Anne — the first CPR training manikin — making it possible to teach lifesaving skills to ordinary people for the first time.

In 1959, at the request of the White House, the American Medical Association published a landmark report warning that ambulance services were being run by inadequately trained personnel with poor equipment — and calling for sweeping reforms in training, system design, and physician oversight. It was the first institutional acknowledgment at the national level that something was deeply wrong.

Meanwhile, in Chicago, Drs. J.D. "Deke" Farrington and Sam Banks asked a question that would change everything: why weren't the trauma care lessons from the battlefield being applied to civilian emergencies? In 1958, they launched the first civilian trauma training course for the Chicago Fire Department — the program that became the foundation for EMT certification.

And in Arizona, Tuskegee Airman Lincoln Ragsdale Sr. launched a commercial air ambulance service — bringing his military aviation skills to serve communities that the existing system had left behind.

By 1965, President Johnson signed the Medicare Act into law, creating the financial infrastructure that would eventually sustain ambulance services nationwide — though Medicare would classify those services as transportation, not healthcare. And as the Vietnam War accelerated helicopter medevac and advanced trauma techniques, a generation of military medics was preparing to come home — carrying skills and urgency that would ignite the modern EMS movement.

Era 2 is the dark age — but it's also the crucible. Every failure, every gap, every preventable death was building the case for the revolution that was about to come.

1929–1939 1 event
National Event

The Great Depression – Collapse and Rebuilding of Public Health Infrastructure

The Great Depression devastated municipal budgets, forcing many cities to eliminate or reduce ambulance services. In response, the federal government expanded public works programs like the Works Progress Administration (WPA), which helped fund hospitals, health departments, and basic emergency transport systems. This period exposed the fragility of local emergency care systems and spurred later efforts to formalize and standardize EMS infrastructure.
1936 1 event

Denver Police Surgeon Robert Campbell Killed on Duty

In 1936, Denver Police Surgeon Robert Campbell was killed in the line of duty. His death is a reminder of what the police-run ambulance era asked of the people who worked in it. Denver's ambulances were staffed by the police department, dispatched into the same violence and hazard as any patrol call, and run on a scoop-and-run model that prized speed over everything else. Campbell's death put a name to the cost of that arrangement.
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The police surgeon was a role with no modern equivalent. He was a physician attached to a police department, expected to respond to the street rather than wait in a hospital, and in cities where the police ran the ambulances he was often the only medical training the service had. Denver would hand its ambulance duties to Denver General Hospital sixteen years later, in 1952.

See also: Denver Police Hand Ambulance Duties to Denver General (1952).

1937 1 event

First Air‑Conditioned Ambulance

In 1937, Hess and Eisenhardt of Cincinnati built the first U.S. ambulance equipped with air conditioning. The innovation significantly improved patient comfort and marked a shift toward viewing ambulances as true mobile medical units rather than just transport vehicles.

Source: Northwest Ohio EMS - History of the Ambulance

1938 1 event

Proposal for Chicago to Establish a Public Emergency Ambulance Service

In 1938, a joint committee representing the Chicago Medical Society, the Hospital Council, the American College of Surgeons, and the Chicago Council of Social Agencies recommended the establishment of a public emergency ambulance system operated through a dedicated department of the Chicago Board of Health.
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Chicago was at that time the only major U.S. city lacking a medically adequate public ambulance system for general emergency use. The proposal—led by Dr. Malcolm T. MacEachern of the American College of Surgeons—recommended starting with 20 city‑owned ambulances organized into zones based on population density, industrial centers, emergency frequency, and hospital locations.

Key Features:
  • Housing ambulances in or adjacent to hospitals approved for emergency transport
  • Reimbursement mechanisms for private hospitals providing indigent emergency care
  • Estimated budget: $173,300 for Year 1; $123,500 in Year 2; $130,700 annually thereafter

This proposal represented a formative moment in the professionalization of municipal EMS, embedding medical oversight, funding structure, and equitable access into public planning.

View the Original 1938 Proposal Document (PDF)

1939–1945 1 event
National Event

World War II – Mass Casualty Care and Evacuation Systems

World War II revolutionized emergency medical response with scalable evacuation chains, battlefield resuscitation, and expanded use of air transport for wounded soldiers. The development of field hospitals, medics trained in advanced first aid, and innovations such as the MASH unit laid the foundation for civilian EMS. These practices deeply influenced postwar ambulance design, trauma systems, and the concept of organized prehospital care.
1941 1 event

Hunton Life Saving & First Aid Crew Founded in Roanoke

On December 21, 1941 — two weeks after the attack on Pearl Harbor — Alexander A. Terrell founded the Hunton Life Saving and First Aid Crew in Roanoke, Virginia, making it the first all-Black volunteer rescue squad in the United States. Operating from the Hunton branch of the YMCA in the Gainsboro neighborhood, the crew of 19 volunteers grew to over 50 members, receiving their medical training from Burrell Memorial Hospital — the only hospital serving Black Virginians in the region. For 46 years, the Hunton Crew served a community that the existing emergency services infrastructure had excluded.
Hunton Life Saving and First Aid Crew members Hunton Life Saving and First Aid Crew in action
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Roanoke already held a singular place in EMS history: Julian Stanley Wise had founded the Roanoke Life Saving Crew in 1928, establishing the first sustained volunteer rescue squad in America. Thirteen years later, Terrell ensured that legacy would extend to the Black community. The Hunton Crew's founding makes Roanoke the birthplace of both the volunteer rescue movement and diversity in American EMS.

The crew later relocated to 830 Moorman Road NW and helped establish similar Black rescue squads across Virginia and provided guidance nationally. A Women's Auxiliary was organized in March 1956 by Bessye Terrell — among the earliest formal women's organizations in the rescue squad movement. Members faced racial hostility, with patients refusing care from Black rescuers on at least two documented occasions, yet the crew never stopped responding.

Hunton Life Saving and First Aid Crew

The Hunton Crew suspended operations on July 21, 1987, after 46 years of continuous service, due to an aging volunteer base. In 2019, Virginia erected historical marker K-83 at 28 Wells Avenue NW honoring the crew, based on research by former Roanoke Mayor Nelson Harris.

Virginia Historical Marker K-83: Hunton Life Saving and First Aid Crew

1945 1 event

WWII Strips Civilian Ambulances of Medical Staff, Reverting to Transport-Only

In the final year of World War II, most U.S. physicians were redeployed to military or hospital-based service. As a result, domestic (non-military) ambulances across the United States lost trained medical staff, including both physicians and skilled attendants.
World War II-era civilian ambulance
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This wartime reallocation of clinical personnel forced a nationwide regression in civilian ambulance function. Most ambulances—though not all—provided no medical care en route, serving instead as basic transportation vehicles. This echoed the pre-Civil War era, when patient transport occurred without trained responders or equipment.

The regression persisted into the 1950s and 1960s, delaying the evolution of prehospital emergency care. Reform did not take hold until a new generation of physician leaders—including Peter Safar, J.D. Farrington, Charles Rockwood, and Norman McSwain—pushed for training, system design, and medical oversight outside the hospital.

This period stands as one of the most consequential setbacks in EMS history, revealing how national crises can unintentionally reverse public health gains.

1947 4 events

First Successful Human Cardiac Defibrillation

In December 1947, surgeon Claude S. Beck restored a normal heart rhythm in a fourteen-year-old boy whose heart fibrillated during chest surgery at University Hospitals of Cleveland. Using experimental internal paddles, Beck achieved the first successful defibrillation of a human heart, proving that a fatal arrhythmia could be reversed.
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Beck's success, captured in his conviction that some hearts were too good to die, established electrical defibrillation as a survivable intervention and laid the clinical foundation for every later closed-chest, portable, and automated defibrillator used in prehospital care.

Encyclopedia of Cleveland History: Claude S. Beck

First Civilian Air Ambulance Service Launches in Los Angeles

In 1947, Schaefer Air Service was established in Los Angeles by J. Walter Schaefer, introducing the nation’s first civilian-operated air ambulance. This innovation brought fixed-wing aircraft into the realm of civilian emergency care, drastically improving response time for critical patients in remote or congested areas. The service pioneered a new era of rapid aeromedical transport, long before such programs became standard nationwide.
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J. Walter Schaefer’s vision for integrating aviation into medical transport set foundational standards for today’s modern air ambulance industry. The company would later expand to ground-based ambulance services and become a staple of California EMS history.

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Reed Ambulance Service Founded in Denver

Reed Ambulance Service was founded in Denver in 1947, entering a market where the city's own ambulances were still run by the police department. Private operators like Reed filled the gaps that municipal services left, and for the next four decades they were a significant presence in the region alongside Denver General. Reed was purchased by American Medical Response in 1993, part of the wave of consolidation that reshaped private EMS ownership nationwide.
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See also: American Medical Response Acquires Reed Ambulance Service (1993).

Charlotte Life Saving and First Aid Crew Organized

In April 1947, the Charlotte Life Saving and First Aid Crew was organized in Charlotte, North Carolina. A local transport firm donated a tract of land beside 1001 S. Clarkson Street for a crew hall, and the organization began with twenty-five active members and ten honorary ones, supported entirely by public subscription and with no paid staff. It was the volunteer answer to a city whose emergency transport was otherwise in the hands of funeral homes.
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The crew acquired an iron lung within about a year, and by 1952 was working with the Polio Foundation to supply and maintain iron lungs across Charlotte. It held the first one in the city. For most of its life it ran on donated equipment and volunteer labor, and its repeated appeals to city council for money are a recurring feature of Charlotte's mid-century record.

The crew answered calls for fifty-two years. It ceased operations on July 1, 1999, after its county contract was not renewed.

Sources: Charlotte Observer and Charlotte News contemporaneous reporting, 1947–1952.

1950 1 event

Charlotte Funeral Home Ambulances Face Discrimination Allegations

In September 1950, Charlotte's police and ambulance companies publicly denied allegations of racial discrimination in emergency response. The city's ambulance service was provided by funeral homes, four white-owned and three Black-owned, and the operators responded that they answered calls regardless of the victim's race, noting that they almost always had no information about race at the time of dispatch. The episode is a rare instance of the segregated structure of funeral-home ambulance service being argued in public, and it is the kind of question the scoop-and-run era seldom left a record of.
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The arrangement the allegations describe was the norm across the American South and much of the country. Funeral homes owned the only vehicles built to carry a person lying down, and in a segregated city that meant the ambulance a patient received depended on which funeral home was called. Charlotte's white-owned and Black-owned homes served the same city under the same model.

Ten years later the entire arrangement collapsed. In 1960 Charlotte's funeral homes announced they wanted out of the emergency ambulance business altogether.

See also: Charlotte's Funeral Homes Quit the Ambulance Business (1960).

Source: Charlotte News, September 12, 1950.

1950s 3 events

“Golden Hour” Concept Coined by Dr. R. Adams Cowley

Baltimore trauma surgeon Dr. R. Adams Cowley introduced the “golden hour” — the critical 60 minutes immediately following injury when rapid transport and care dramatically improve survival chances. He emphasized that this narrow window, which he called a “momentary pause in the act of death,” remains central to trauma response strategy. While some later studies questioned its universality, more refined analyses show the concept still holds true for many moderate-to-severely injured patients. Source

Rise of Funeral Home-Based Ambulances

By the 1950s, funeral homes were the primary providers of ambulance transport across much of the United States. Due to the availability of long-wheelbase hearses, which could accommodate stretchers, many communities relied on funeral directors to respond to emergencies—often without formal medical training.
Funeral home ambulance service, 1950s 1970s Cadillac Miller-Meteor funeral home ambulance Funeral home-based ambulance Vintage funeral home ambulance
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This era marked a gap in prehospital care: vehicles were fast and spacious, but lacked medical equipment, and attendants had minimal training. This model persisted until national EMS reforms emerged in the late 1960s and 1970s.

Photo credit: Gainesville Sun / Carilion Clinic

National Event

Korean War – First Widespread Use of Helicopter Medevac

During the Korean War, the U.S. military pioneered the use of helicopters for medical evacuation, significantly reducing mortality by rapidly transporting wounded soldiers to Mobile Army Surgical Hospitals (M*A*S*H units). Over 20,000 soldiers were evacuated by helicopters. This innovation laid the foundation for rotary-wing EMS, proving the life-saving potential of rapid air transport—a practice later adopted by civilian EMS systems worldwide.
1951 2 events

New Jersey Municipal Ambulance Services Documented

The National Municipal Review published an examination of ambulance services in New Jersey, documenting the patchwork of municipal, volunteer, and funeral home-based systems that characterized mid-century American emergency transport. The article captured the state of EMS during the "Dark Ages" period before federal standardization efforts began.

Read more

NJ Ambulance Services, National Municipal Review (PDF)

First Poison Control Center Opens in Chicago

In 1953, Dr. Edward Press and pharmacist Louis Gdalman opened the nation's first poison control center in Chicago, offering around-the-clock telephone toxicology advice. The model spread to hundreds of centers within a decade.
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The Chicago center created the telephone medical-advice and toxicologic emergency-response infrastructure that became a core component of American emergency medical systems, an early forerunner of coordinated prehospital medical direction.

National Library of Medicine: History of the Poison Control Movement

1952 1 event

Denver Police Hand Ambulance Duties to Denver General

In 1952, the Denver Police Department formally transferred ambulance duties to Denver General Hospital, ending sixty years of police-run emergency transport in the city. The change moved the ambulance from the custody of an agency whose business was law enforcement to one whose business was medicine. It is a quiet administrative act with a significant premise underneath it: that the ambulance belongs to the hospital, and that what happens inside it is care rather than conveyance.
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The handoff put Denver ahead of most American cities on a question that the rest of the country would not confront until after Accidental Death and Disability in 1966. It did not make Denver's ambulances advanced, and paramedics were still two decades away, but it settled the question of who owned the problem.

Denver General is today Denver Health, which operates the city's 911 emergency medical response and serves Denver International Airport and surrounding communities.

See also: Denver Acquires Its First Horse-Drawn Ambulances (1892).

1956–57 2 events

First External Defibrillation in Humans

In 1956, Dr. Paul M. Zoll demonstrated the first successful termination of ventricular fibrillation using external electrodes on the closed chest, building on his earlier external cardiac pacing work. The breakthrough proved the heart could be defibrillated without surgery.
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By moving defibrillation from the operating room to the body surface, Zoll made emergency-department and, eventually, field defibrillation possible, a direct prerequisite for the portable and automated defibrillators that define modern resuscitation.

Paul Zoll, cardiac resuscitation pioneer

Mouth-to-Mouth Resuscitation Validated

In 1956–1957, Dr. Peter Safar and Dr. James Elam scientifically validated mouth-to-mouth resuscitation through a series of clinical experiments and live demonstrations. Their work overturned prior reliance on manual or mechanical ventilation and established direct respiratory rescue as the most effective method for reviving patients in respiratory arrest. This breakthrough formed a foundational component of modern CPR protocols and directly influenced national lifesaving standards.
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Dr. Safar’s subsequent work helped shape the development of cardiopulmonary resuscitation (CPR) and laid the groundwork for the American Heart Association’s early CPR guidelines. His contributions earned him the title “Father of CPR.”

View source

1957 1 event
National Event

First U.S. President Flies in a Helicopter

On July 12, 1957, President Dwight D. Eisenhower became the first U.S. president to travel by helicopter, flying aboard a Bell UH-13J from the White House lawn. This historic moment demonstrated the reliability and versatility of rotor-wing aircraft, reinforcing their strategic value. Within a decade, helicopters would be widely adopted for battlefield evacuation in Vietnam—and later, for civilian EMS use in trauma and disaster response.
1958 3 events

"Equipment Too Poor, Too Late"

On April 16, 1958, two brothers, Tommy Shepard, nine, and Charlie Shepard, seven, drowned in a rain-flooded excavation on a highway construction site west of Charlotte. It took more than forty-five minutes to recover them. The chief of the volunteer Charlotte Life Saving Crew, B. C. Flowers, had been told on the phone that he would not need a boat or grappling hooks, so he set out with a resuscitator in a car that could not get through traffic. His account of the vehicle, given to a reporter two days later, is the plainest description of American prehospital care in the 1950s that exists: "It's an old 1951 Pontiac station wagon that's about to fall to pieces. The siren wouldn't work, and I couldn't get through the traffic. The radio is so old and in such bad shape, I couldn't hear anything on it."
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The Charlotte papers turned the deaths into a civic scandal within forty-eight hours, and what they exposed was not one bad night but a structural choice. Charlotte, the Observer wrote, was "one of the few cities in the United States which delegates primary responsibility for rescue and life-saving to a band of volunteers." The fire chief revealed that the City Council had rejected his request for a trained, equipped city rescue squad six years earlier, in 1952.

The crew that carried the city had about twenty volunteers, three failing vehicles, hand-me-down two-way radios, no headquarters at all, and a thousand dollars a year from the city that went to gas and repairs. The rescue boat was kept in the chief's mother's garage across town. In 1957 those volunteers had logged 6,235 unpaid hours, treated 910 first aid cases, answered 234 emergency calls, and been credited by Charlotte doctors with saving twelve lives.

Nothing changed. The Exchange Club bought the crew a new ambulance, a newspaper sale raised money for equipment, and the question of public responsibility was referred from committee to committee until it died. "It began to look today," the Charlotte News wrote in May, "as if the solution to problems of the Charlotte Life Saving Crew and Rescue Squad is dying a slow death from 'committee-itis.'" A year later the same paper wrote its epitaph: "When the hue and cry died down the squad was left exactly where it started as far as public support was concerned."

It would take a second death, in January 1960, to move the city.

See also: Charlotte's Funeral Homes Quit the Ambulance Business (1960).

Sources: Joe Doster, "Equipment Too Poor, Too Late," The Charlotte Observer, April 17, 1958, p. 41; Kays Gary, "Most Cities Maintain Official Rescue Squad," The Charlotte Observer, April 18, 1958, p. 1; John Kilgo, "Crew Put In 6,235 Hours — For Free," The Charlotte News, April 18, 1958, p. 17; Jerry Reece, The Charlotte News, May 13, 1958, p. 15; Bill Hughes, The Charlotte News, July 20, 1959, pp. 13 and 19.

First Civilian Trauma Training for EMS – Chicago Fire Department

In the aftermath of World War II and the Korean Conflict, Drs. J.D. “Deke” Farrington and Sam Banks asked a critical question: why weren’t battlefield lessons in trauma care being applied to civilian emergencies? In 1958, they launched the first civilian trauma training course for the Chicago Fire Department, adapting military field medicine to urban emergency response. This pioneering program became the foundation for the EMT-Ambulance (EMT-A) certification. Dr. J.D. 'Deke' Farrington
Dr. Farrington teaching EMTs in Minocqua, Wisconsin – 1950s
Dr. Farrington teaching EMTs in Minocqua, Wisconsin – 1950s
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Dr. Farrington’s curriculum laid the groundwork for structured, medically supervised EMS training nationwide. His work directly influenced the formalization of EMS education in the 1970s and helped define the role of EMS in modern healthcare.

Learn more about Dr. Farrington’s legacy

Cardiac Massage (“CPR”)

Drs. Kouwenhoven and Knickerbocker, along with cardiac surgeon Dr. James Jude, discovered that chest compressions could maintain 40% of normal circulation during cardiac arrest. With the addition of mouth-to-mouth resuscitation inspired by Dr. Peter Safar’s work, this technique evolved into what is now known as cardiopulmonary resuscitation (CPR). The first successful human case occurred in 1959 when CPR revived a patient without the need for open-chest intervention.

Credit: National EMS Museum
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Historic CPR defibrillation image
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1959 2 events

California Enacts the First Good Samaritan Law

In 1959, California passed the first state statute explicitly labeled a Good Samaritan law, granting civil immunity to physicians who render emergency aid in good faith at the scene of an accident. Every state eventually adopted a version of the protection.
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Good Samaritan statutes removed a key legal barrier to bystander and professional intervention, becoming a foundational element of the legal framework that supports prehospital emergency care across the United States.

AMA Journal of Ethics: Good Samaritan Statutes

AMA Report on Emergency Medical Care

In response to a direct request from the White House, the American Medical Association published a landmark 1959 report titled “Report of the AMA’s Ad Hoc Committee on Emergency Medical Services.” The report warned that many ambulance services were being provided by inadequately trained personnel with poor equipment, and called for sweeping reforms in training, system design, and physician oversight. It laid the intellectual and institutional foundation for what would become the modern EMS system in the United States.
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The report emphasized the need for nationally coordinated standards, proper physician supervision, and a new healthcare role for ambulance services beyond simple transport—helping to elevate EMS as a legitimate component of medical care.

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1960 3 events

Lincoln Ragsdale Sr., Tuskegee Airman, Operates Air Ambulance

After his service as a Tuskegee Airman—a pioneering Black pilot trained at the Tuskegee Army Air Corps Field—Lincoln J. Ragsdale Sr. settled in Arizona in 1960 and launched a commercial air ambulance and ambulance service. Beyond medicine, he was a prolific entrepreneur and civil‑rights leader. His business enterprises—including a mortuary, real estate, multiple insurance firms, construction, restaurant/nightclub, and flower shop—were used both to serve underserved Black communities and to strategically integrate employees and clients across racial lines.
Lincoln Ragsdale Sr.
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Ragsdale’s ambulance service was part of a broader empire: mortuary services, insurance firms, a real estate agency, a flower shop, a nightclub, and more. He hired white workers and challenged segregation through economic influence, community advocacy, and political leadership.

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Resusci Anne: First CPR Training Manikin

Dr. Peter Safar partnered with Norwegian toy maker Åsmund S. Lærdal to create the world’s first CPR training manikin—Resusci Anne. This innovative tool integrated Safar’s pioneering technique of mouth-to-mouth ventilation with newly recognized chest compression methods, making it possible to realistically simulate lifesaving techniques for trainees. Resusci Anne revolutionized CPR education and became a foundational component of emergency medical training worldwide.
Resusci Anne CPR Manikin

Charlotte's Funeral Homes Quit the Ambulance Business

On January 11, 1960, Harriet Kaplan, twenty-nine, collapsed outside the Charlotte Coliseum and was dead on arrival at Memorial Hospital. Exhibitors who had watched went before city council to charge that the ambulance was slow, that it lacked equipment, and that its driver "knew absolutely nothing about first aid." The mayor appointed a committee, and the committee began drafting minimum standards for ambulances and attendants. Fourteen days later, on January 25, Charlotte's eleven funeral directors handed council a resolution reading "All emergency vehicles should be operated by the city," and gave it thirty-four days' notice that they were quitting. Cornered between a demand for standards and an operation that lost money on every call, the funeral-home era in Charlotte did not fade. It was pushed.
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The economics had never worked, and the morticians said so plainly. "The best accounting we can figure shows it costs us about $12.50 a call, no matter how many we make," one told the Charlotte News. "We charge $5 — the rest is loss." Councilman James B. Whittington, himself a funeral director, put the rest of it on the record: "All funeral directors want to get out of the ambulance business. We perhaps should not be in it, because our profession is to take care of the dead. But it's something that we've inherited." That sentence is the funeral-home era's own explanation of itself.

Nobody wanted what they were putting down. The fire chief declared that the city wanted no responsibility for ambulances. The police chief said he would hate to see the city enter a business that could run to $100,000. The city attorney said Charlotte had no legal authority to grant an exclusive franchise, and North Carolina's attorney general would soon say that municipalities had no authority to run ambulance services at all except under civil defense statutes. Everyone also remembered that a central private ambulance company had already been tried in Charlotte in 1956 and had collapsed in under six months.

The deal. The deadline slipped from March 1 to April 1, and in the end the undertakers kept running until their replacement was ready. Two bidders came forward: Lowell A. Voorhees of Roanoke, Virginia, who asked for no payment guarantee, and Roddy A. Brandes, a thirty-nine-year-old Charlotte native and president of a truck rental company, who toured ambulance operations in Greenville, Birmingham, Richmond, Baltimore, and Washington before bidding. Council chose Brandes and approved his contract on May 9, 1960: six ambulances, around-the-clock dispatch, drivers and attendants qualified for Red Cross instructor rating, governors limiting speed to sixty miles an hour, and a city payment of $10 on police and fire calls he could not collect.

What it cost to run. Ambulance Service of Charlotte began at midnight on July 10, 1960, with six ambulances and a twenty-seven-man crew, the only emergency ambulance service in the city. It nearly failed. In its first four months it served 1,718 people, of whom 743 did not pay, and Brandes was covering $2,100 a month himself. A first-year audit found 5,898 calls and a loss of $7,810 despite roughly $7,500 in city subsidy. His remedy was legal status: the ordinance council passed on November 27, 1961 made his company "a franchised company operating as a public necessity," like a taxi, so that refusing to pay an ambulance bill became prosecutable. Its equipment and personnel standards were based on those of the American College of Surgeons, and attendants had to pass a thirteen-point test and ride twenty-five trips as an observer before touching a patient. The lesson generalizes: the private ambulance company was not viable on fees alone, and only became viable when a government made payment enforceable.

Brandes went on to become the first chairman of the National Registry of Emergency Medical Technicians in 1970, and sat on the advisory committee of the 1965 North Carolina Ambulance Service Study. The man who took over Charlotte's ambulances when its funeral homes walked away helped build the national certification system that followed.

See also: "Equipment Too Poor, Too Late" (1958), Registry of Emergency Medical Technicians-Ambulance Formed (1970), and Organizing Ambulance Services in the Public Interest (1965) in the document library.

Sources: Kays Gary, "City Ambulance Service Is Criticized," The Charlotte Observer, January 12, 1960, p. 17; Jack Claiborne, "Ambulance Bill Must Get OK Of Morticians," The Charlotte Observer, January 15, 1960, p. 15; Dick Young and Bill Hughes, "Ambulance Service Issue Simmering," The Charlotte News, January 26, 1960, pp. 13 and 28; Dick Young, "Council Gives Green Light To New Ambulance Firm," The Charlotte News, May 10, 1960, p. 9; "City's New Ambulances Ready To Roll," The Charlotte News, July 9, 1960, p. 11; Dick Rigby, "Ambulance Co. Asks Help On Unpaid Bills," The Charlotte News, November 17, 1960, p. 27; Dwayne Walls, "Funeral Home Ambulances On Way Out," The Charlotte Observer, September 21, 1961, p. 13; Dwayne Walls, "Ambulance Service Gets More Backing," The Charlotte Observer, November 28, 1961, p. 15.

1963 3 events

Emergency Identification Symbol Adopted

In 1963, the World Medical Association adopted the universal Emergency Identification Symbol—three red bars in a circular pattern—as a visual marker to signal medical urgency and identify individuals with medical conditions. That same year, the U.S. Navy formalized the first paramedic training curriculum, building on battlefield care models and establishing training precedents that would later inform civilian paramedicine.
Emergency Identification Symbol
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The Emergency Identification Symbol became one of the earliest standardized visual cues in emergency medicine, preceding the now-familiar Star of Life. Its adoption marked an early step in creating a unified language for EMS alerts and patient identification.

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National Safety Council Model Ambulance Ordinance/Statute Approved

On April 3, 1963, the National Safety Council’s Traffic Conference Executive Committee approved a model ordinance (also adaptable as a state statute) regulating ambulance service. The effort began in 1956 as a Joint Action Program sponsored by the American College of Surgeons, the American Association for the Surgery of Trauma, and the National Safety Council; in late 1959, the group’s policy committee asked the Traffic Conference to develop the model. The draft emphasized use as a state law where feasible and was intended to promote uniformity throughout the United States.
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National Safety Council, A Model Ordinance or Statute Regulating Ambulance Service (1963)

Peter Safar's Visit to Russia & WADEM Origins

In 1963, Dr. Peter Safar—renowned for advancing CPR—visited the Soviet Union and collaborated with Dr. Vladimir Negovsky, a leading figure in reanimatology. Safar noted the Soviets’ use of purpose-built ambulances, far more advanced than the repurposed hearses common in the U.S. at the time. His global perspective on emergency care and disaster preparedness helped shape the vision for what would become the World Association for Disaster and Emergency Medicine (WADEM).
Read more in *Resuscitation*
Peter Safar and Russian ambulance
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1964 1 event

Personal Emergency Identification Systems Formalized

Dr. Burr published research on personal emergency identification systems, contributing to the growing standardization of emergency medical symbols and identification protocols. This work complemented the broader movement toward uniform emergency identification that would culminate in the adoption of the Star of Life symbol.

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Burr, Personal Emergency Identification Current, 1964 (PDF)

1965–1975 4 events

Navajo Nation Establishes Formal EMS Program

In 1965, the Navajo Police Department assumed formal ambulance responsibility across the Navajo Nation, establishing one of the earliest formalized tribal EMS programs in the United States. Before this, patient transport depended on traders, school employees, and missionaries. The program acquired 23 ambulance vehicles, developed operational protocols, launched EMT training, and built radio communications infrastructure — all serving 27,000 square miles of remote terrain. The Navajo Nation EMS program has operated continuously for over 60 years, representing one of the longest-running frontier EMS systems in American history.

Public Health Journal Calls for Ambulance Reform

In 1965, the American Journal of Public Health published a groundbreaking article advocating for a national approach to ambulance services and emergency care. This early scholarly work recognized the fragmented state of EMS and emphasized the need for better training, equipment, and integration into public health infrastructure.
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The article helped shift EMS from being viewed as transportation-only to a legitimate component of healthcare. It was an early voice in the growing national dialogue that would culminate in sweeping reforms by the end of the decade.

Read full article (PDF)

Medicare Act of 1965 Signed into Law

President Lyndon B. Johnson signed the Medicare Act into law on July 30, 1965, establishing a federal health insurance program for Americans over the age of 65. While primarily focused on hospital and medical insurance, the legislation also helped formalize reimbursement structures that would later include ambulance services—laying a financial foundation for EMS development.
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The Medicare Act became a major funding mechanism for EMS, particularly in the 1970s and beyond. As ambulance services transitioned into healthcare delivery systems, Medicare billing policies became essential for sustainability and professionalization.

Read the original Medicare Act (PDF)

National Event

Vietnam War – Medevac and Trauma System Innovations

US ground troops involved in the Vietnam War accelerated the development of helicopter medevac systems, advanced trauma life support techniques, and rapid battlefield triage protocols. The "Golden Hour" concept emerged, reinforcing the critical importance of timely care. Many returning military medics entered civilian EMS, bringing valuable skills and shaping the early paramedic profession. These wartime lessons directly influenced the creation of the first urban EMS systems in the 1960s and 70s.