Upon entering the ambulance, the ambulance crew would then get the call from the police dispatcher. The Police would notify the Grady Hospital operator by phone, who would then page the ambulance crew over the hospital's P.A. Atlanta citizens would either call Atlanta Police of Grady Hospital for an ambulance. The ambulances in those days were units 591, 592, 593, 594 and 595 and were dispatched by the Atlanta Police on Decatur Street. Tom Moreland later hired Julius Day who, at that time, was the director of safety Service for the local Red Cross Chapter on 5th Street, to become the first official director of the now newly created Grady Ambulance Service. Somewhere around the early 1960s, the ambulance service was being looked upon to provide basic first aid to stricken citizens especially when interns were becoming less available to respond. There was only a stretcher, a fixed upright oxygen inhalator, a basic splint box and a "physicians black bag" as a first aid kit. In the early 1950s Grady began using low-roof white over red International "Travelall" trucks as ambulances that had a single roof mounted beacon and a siren mounted on the front fender. The ambulances were driven by security hospital employee's who wore the uniform of the Atlanta Police Department and were commissioned as an Atlanta Police "Special Officer" and also wore a duty belt with firearm, handcuffs and flashlight. With the municipal takeover, the ambulance service became a part of the hospitals security department and Tom Moreland was appointed as the first security department director who also oversaw ambulance operations. In the 1950s the service gradually changed over to GMC truck chassis when the hospital's operation was taken over by the City of Atlanta. That same year, a Grady Ambulance responded to " Five Points" in downtown Atlanta to transport " Gone With The Wind" author Margaret Mitchell to Grady where she later died from her injuries after being hit by a taxi. In 1946, many Grady ambulances responded to the tragic Winecoff Hotel fire in Downtown Atlanta which injured hundreds and killed 146 and is still regarded as the Nation's worst hotel fire disaster. In the 1930s and during World War II, Grady Hospital Ambulance Service used Packards as ambulances. Atlanta area funeral homes had also entered the arena of providing ambulance service as a community service using hearses that could be quickly changed to accommodate a Bumgartner or Washington Mortuary Company single level stretcher. And ambulance design also began to improve in the vehicles suspension and overall design of the Ford Model T. As motorized " horseless carriages" began to appear on Atlanta streets, so did the adoption by Grady to this "new fangled" technology. According to old records, as Grady Hospital entered the twentieth century in 1900, the ambulance service responded to 2140 ambulance calls. Like other hospital based ambulance service, interns or even surgeons would often ride the ambulance to the most severe ambulance calls and had a medical bag complete with instruments that had proven effective in treating civil war battlefield injuries several decades prior. By 1895 the city limits was expanded 9.6 square miles (25 km 2) and saw the annexation of West End in 1896. Its Northern limits did not extend much past 14th street and travelling further north quickly transitioned into rural countryside. In 1890, the population of Atlanta was recorded as 65,533 and included both the downtown area and Inman Park. Grady, along with Charity Hospital in New Orleans, Bellevue Hospital in New York City and Cincinnati General was among the first hospitals to operate ambulances in America.
Prior to 1892, the city did not have any formal ambulance service and regular horse-drawn wagons at best served to transport the sick and injured. Grady, (the editor of the Atlanta Constitution newspaper in the 1880s), Grady Memorial Hospital opened in May 1892 with 100 beds and established the first citywide ambulance service in 1896 with several horse-drawn modified enclosed wagons.
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