At midnight on September 1, 1971—mandated by the changing times—the practice of hearses doubling as emergency transportation for patients to hospitals came to an end.

At 12:01 a.m. on September 2, Acadian Ambulance began operating in Lafayette, Louisiana, crossing a threshold into the 20th Century 911 Emergency Medical Services revolution.

Today, it seems nonsensical that the same enterprises charged with burying the dead would double as first responders for people in need of emergency care. But less than half a century ago, in ferrying patients from here to there, no distinction was made between the deceased and those in need of urgent care. Whether the vehicle was a hearse or a taxi cab, a driver’s license is all that was required.

Acadian Ambulance founder Richard Zuschlag understood that emergencies demanded a different, specialized capacity to respond. A former Westinghouse space and defense data specialist, passionate about the new frontiers of information technology, Zuschlag recognized that the disconnect between trauma and medical care could be bridged by an effective communications system. People with emergency needs require fast access to care, so those who could provide life-saving attention—hospital emergency rooms, fire departments, police departments, physicians and ambulance services—needed to be linked. These were commonsense notions, but in the early 1970s, “first responder” was a nascent concept. No one communicated with anyone, not even emergency ambulance personnel with their headquarters. No two-way radios. No Global Positioning System (GPS). No cellular technology. People who needed help relied on chance and frequently died.

In 1966, the National Academy of Sciences had declared trauma the “neglected disease of modern society.” In a landmark report, the Academy identified trauma as the major cause of death for a wide swath of the population ranging from infants to adults in their late 30s. Eliminating the mortuary emergency drivers was part of a bigger policy push to respond to the Academy’s recommendations and impose effective quality, training and delivery on emergency responders.

Backed by eight employees and two ambulances, Acadian would begin a journey that has earned the company, headquartered in southwestern Louisiana (about two hours from New Orleans), accolades for cutting-edge emergency medical care.

Around the same time Acadian was setting up shop, the Robert Wood Johnson Foundation was redefining itself as a national philanthropy. With a charge to expand grantmaking beyond its base in central New Jersey, the Foundation’s first national president David Rogers decided investments had to generate “catalytic effect” in improving the health and health care of America.

Federal, state and county governments were grappling with the challenges of EMS policy and the mammoth undertaking of creating the 911 system. With few adversaries and many proponents at the highest level of government, implementation progressed at a glacial pace. In 1972, only 12 paramedic units existed in the United States. As policy is often spurred by popular culture, the NBC primetime drama “Emergency!” helped to define the field. The show gave paramedics a human face: They were life-saving heroes. The triad of emergency need, medical services and institutional support—dramatized on network television—became the building blocks for immediate and long-term solutions.

What was television’s first reality series set the stage for the Foundation’s very first national investment. Zuschlag’s early contact with RWJF would prove fruitful. With a total investment of $65 million (in today’s dollars), the Foundation would tap Acadian for its inaugural demonstration grant in 1973. Grants to 44 communities in 32 states would follow. They were individually and collectively charged with creating a communications infrastructure to support what would become the 911 network. This strategic investment also forged what the Foundations considered its first coalition of “strange bedfellows”—a collaboration between regional and local governments, fire departments, police departments, hospitals, physicians and ambulance services. Within four years of the funding, which spurred essential government funding, a paramedic unit was stationed within 10 minutes of more than 50 percent of the American population.

Zuschlag credits the RWJF grant as the seed that created “the most sophisticated emergency communications system in the world.”

Half the grant funded radios at the local hospital, Zuschlag recalled. “With the rest of the money we put radios in the ambulances and developed a dispatch center.” Over the years, Acadian’s investment would include a network of eighteen 500-foot communications towers across 24,000 square miles of Louisiana bayous, swamps and remote parishes.

The infrastructure was solidified with satellite phones, wireless computer links and redundant hardware systems—an investment that proved vital to the command and rescue operation during Hurricane Katrina. Acadian was applauded in a New York Times column as a “lonely island of competence” in the disastrous aftermath of the storm.

RWJF, which sponsored 240 hours of cardiac training for Acadian medics in 1975, also honored Zuschlag and his team in 1977 for creating a model system for ambulance and hospital communications and provided funding to expand the organization’s dispatch center.

Some 40 years and 3,600 employees later, Acadian has expanded its coverage area throughout Louisiana, Mississippi and Texas. Its fleet has grown from two ambulances to 400, along with eight helicopters and a communications command center that provides emergency transport from ground, air and off-shore.

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