In 1869, the Bellevue hospital medical college introduced the first ambulance service inthe United States. The service was established to transport civilians to the hospital. Interns rode in these ambulances doing whatever they could to comfort the patients. By the 1890s, this idea spread to other large city medical schools and hospitals. Yet by 1950, many small towns and rural areas still had no ambulance services, some offering little more than transport by the local funeral home. Over the next twenty years, however, great strides in ambulance transportation took place, most significantly, the extension of the hospital emergency room or department to the patient through the emergency medical services—EMS system. With this advancement, care could begin at the scene, continue during transport, and then be handed off to the staff in the hospital. By 1966, the National Highway Safety Act was passed, granting the responsibility fo developing standards for training assessment and care to the department of transportation—DOT. This standardized EMT-B training assessment and care. A fully standardized First Responder National Program was presented in 1994. Often, it seems that EMS response is a given, but its development and spread has taken a well over one hundred years.