During the late 1960s the New Hampshire state trauma chairman for the American College of Surgeons (ACS) visited all emergency rooms in New Hampshire's 27 hospitals, and made constructive suggestions for improvement. To upgrade ambulance and pre-hospital care, they recommended backboards for ambulances to improve outcomes for patients with fractured spines. The majority of ambulances at that time were run by funeral directors.
During this time, Dr. McDade chaired the trauma section of the New Hampshire Chapter, ACS, and continued the efforts begun to upgrade pre-hospital care. "Littleton was a microcosm in trends in emergency medicine," he said. "We did a lot of 'firsts' in surgery north of Hanover."
In 1968, The American Academy of Orthopaedic Surgeons invited Tom Ross to participate in a pilot Emergency Medical Technician (EMT) course at Harvard University. Tom was one of 300 handpicked individuals from each state in the U.S. invited to attend this course.