The origins of EMS date back to the days of Napoleon, when the French army used horse drawn "ambulances" to transport injured soldiers from the battlefield. One of the first civilian EMS services can be traced back to 1869, when Dr. Edward L. Dalton at Bellevue Hospital, then known as the Free Hospital of New York, in New York City started a basic transportation service for the sick and injured. The component of care on scene began in 1928, when Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, which was the first land-based rescue squad in the nation. Over the years EMS continued to evolve into much more than a "ride to the hospital."  In particular in the US state of California and in Seattle, Washington state, projects began to include paramedics in the EMS responses in the late 1960s. Groups in Pittsburgh, Pennsylvania and Portland, Oregon were also early pioneers in pre-hospital emergency medical training. Despite opposition from firefighters and doctors, the program eventually gained acceptance.  Many EMS units are typically the same as a first aid, rescue, EMS, emergency or safety squad. However, a rescue squad may also rarely be part of a fire department, race car team, or military unit.  In a return to the military roots of EMS, the United States Army has developed the combat lifesaver program to instruct soldiers in advanced first aid and limited paramedic skills including intubation's. The combat lifesaver is intended to bridge the gap between self-aid / buddy-aid and the platoon medic on the 21st century decentralized battlefield.