While the rest of the world was only wondering how to help their neighbors who may become injured or critically ill, two people were taking action. Lewis A. "Tootie" Ballard, Chief of Salem Fire Department, and Minor Oakey, founder of Oakey's Funeral Home sat in a red sedan across from the Salem Court House talking about the feasibility of a life-saving crew for the town of Salem. It would be patterned after and very similar to the Roanoke Life Saving Crew, organized in 1928 by Julian Stanley Wise, and on November 15th, 1932 the Salem Life Saving Crew was established, with Minor Oakey serving as its first Chief.

Volunteers were recruited mostly from Salem's Fire, Police, and Street Departments and the Leas and McVitty Tannery. Weekly meetings were held on the second floor of the fire department and the few first aid supplies they had were kept in the back of that same, red sedan. Still, "patients" had to rely on private automobiles or the Roanoke Crew to transport them to the hospital.

Training the volunteers in first aid and life-saving techniques was necessary. Instructors of the Standard and Advanced First Aid courses, A.W. Reynolds and Jack Ferguson, both from the Roanoke Life Saving Crew, taught classes at the fire department on College Avenue. A course in life-saving was given at the nearby Roanoke College swimming pool. The volunteers learned how to rescue drowning victims, resuscitation techniques, and how to care for those in need. In those early days, as in the present, volunteers were faced with every kind of emergency call, from broken bones and critical illnesses to strangulation, heart attacks, and accidents in cars, at home, and in the workplace.

As time went on, additional equipment became necessary and this particular meeting place became inadequate due to the increased number of volunteers. Minor Oakey presented these problems to Salem's Town Manager, John Parran Broome, who had one floor in a building adjacent to the firehouse remodeled to meet the crew's specific needs. This first official location of the Salem Rescue Squad provided room for new equipment, including a boat, water rescue gear, an oxygen tent from the Southern Oxygen Co. in Roanoke, and an inhaler from a company in Pittsburgh, Pennsylvania.