National EMS standards for the US are determined by the U.S. Department of Transportation and modified by each state's Department of EMS (usually under its Department of Health), and further altered by Regional Medical Advisory Committees (usually in rural areas) or by other committees, or even individual EMS providers. In addition, the National Registry of Emergency Medical Technicians an independent body, was created in 1970 at the recommendation of President Lyndon B. Johnson in an effort to provide a nationally accepted certification for providers and a nationwide consensus on protocols. Currently, National Registry certification is accepted in some parts of the U.S., while other areas still maintain their own, separate protocols and training curricula.