Prior to the 1970s, ambulance service was largely unregulated. While some areas ambulances were staffed by advanced first-aid-level responders, in other areas, it was common for the local undertaker, having the only vehicles in town in which a person could lie down, to operate both the local furniture store (where he would make coffins as a sideline) and the local ambulance service. However, after the release of the National Highway Traffic Safety Administration's study, "Accidental Death and Disability: The Neglected Disease of Modern Society", (known in the EMS trade as the White Paper) a concerted effort was undertaken to improve emergency medical care in the pre-hospital setting.