EMS began in the United States in the 1970s with federal agencies pressuring the states to establish standards for ambulance services. The term EMS was formalized with the “EMS Systems Act of 1973.” Typically, states were able to set only minimum standards which might be described as the poorest you’re willing to accept. In 1982, at an American Ambulance Association workshop, the need for high-quality standards was identified. A working committee was established, and over the next eight years, standards were developed through consensus of EMS experts from all over the country. In other words, the best EMS thinkers and practitioners, working together, determined those standards that should be met by a quality service. In 1990, an independent Commission on Accreditation of Ambulance Services (CAAS) was established to begin the process of accrediting ambulance services using these quality standards. CAAS is sponsored by the American Ambulance Association, the American College of Emergency Physicians, the National Association of EMS Physicians, the National Association of State EMS Directors, the National Association of EMTs, and the International Association of Fire Chiefs, with liaison representation from The National Highway Transportation Safety Administration.