Various competing public and private organizations, such as health insurers, hospitals, municipal governments and the Red Cross, started providing ambulance services to their respective clients or populations, or concluded contracts with other parties to this end.
Faced with a rising number of traffic accidents as well as a polio epidemic in the 1950s, this lack of structuring of emergency medical services was deemed increasingly untenable.
[3] This compelled the Belgian central government to take material and legislative measures from the late 1950s to the mid-1960s to ensure the availability of emergency medical services throughout the country.
The responsibility to organize emergency medical services was first assigned to the municipalities, but due to many of them being unable to properly execute this duty, the central government changed tactics and started taking up a major role itself.
Lastly, the Belgian government invested in a large number of standardized ambulance vehicles which were lent by the country's health ministry to the various services active in the system.
Some other abuses and shortcomings within the system also started to receive negative publicity, such as the low level of training of ambulance attendants and the creep of commercial interests.
These events in turn spurred the nationwide rollout of plans for mass casualty incidents, as well as the development of a national radio communication network adapted to emergency services under the name 'NATINUL' (Dutch) or 'RINSIS' (French).
EMTs or literally translated 'rescuer-ambulancers' (Dutch: hulpverlener-ambulancier, French: secouriste-ambulancier, German: Sanitäter-Krankenwagenfahrer)[a] were from then on mandated to follow a 160-hour training and obtain professional certification.
New regulations and standards were also issued for the various services and hospitals active in the system regarding staffing, equipment and organization, vehicle appearance, and the fees charged to patients, amongst others.