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Decades ago in the United States, if you called an ambulance, the vehicle most likely to arrive was a hearse.

For much of the 20th century, more than half of the country's ambulance service was run by funeral homes — not because it was profitable, but because they had the only vehicle in town built to carry someone lying down, and no one else stepped up.

In this episode, host Dr Hamish McLean talks with Police Chief (Ret.) Scott Reinbolt — 25 years in law enforcement, now an adjunct professor of law enforcement at Ohio University — about the era he documents in his book, Humble Heroes: The History of Funeral Home Operated Ambulance Service. We cover how the system actually worked, why it finally collapsed under a convergence of new labour law, a landmark federal report, and a reimbursement system that never covered the real cost of care — and why the funeral directors who built it were largely excluded, blamed and forgotten once it changed hands.

This isn't just American history. The same questions - who builds an EMS system when no one else will, and what happens to that knowledge when the system finally changes - are ones EMS Global Foundation works through today in Mongolia, Central Asia, and the Pacific.

In this episode:
• Why funeral homes ended up running American EMS, and how the model actually worked
• The regulatory and financial convergence that ended the era
• What happened when incumbent providers were excluded from EMS reform
• What today's EMS system-builders can take from this history

About Before the Hospital: a podcast from EMS Global Foundation examining the governance, financing, and workforce decisions that determine whether prehospital emergency care systems succeed — particularly in low- and middle-income settings.

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