When Minneapolis officially became a city in 1867, there were no hospitals or ambulance services within its limits. Four years later, in 1871, the first hospital in the city, Cottage Hospital, opened its doors to the public, shifting medical care from the family home to the hospital. The need then developed for organized medical transport. The period between 1880 and 1890 marked the beginning of limited ambulance service in Minneapolis. Over the next 40 years, many public and private institutions developed their own transport services. During that same time, skilled medical transport in which physicians and/or nurses went along on calls began, and the transport of patients transitioned from horse and wagon to motorized ambulances. These developments would set the stage for future innovations in Minneapolis' emergency medical system and ultimately improve patient care and survival.