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MCMI, Rob Lawrence. “The Business Side of EMS.” JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News, 1 Jan. 2014, www.jems.com/equipment-gear/business-side-ems1/. Accessed 15 Aug. 2023.

Pew Research Center. “Do Americans Trust the Police?” Pew Research Center, 5 Jan. 2022, www.pewresearch.org/2022/01/05/trust-in-america-do-americans-trust-the-police/. Accessed 15 Aug. 2023.

Sokan, Kenny. “Why Fire and EMS Agencies Should Invest in Body Armor – and How to Afford It.” FireRescue1, 10 Sept. 2020, www.firerescue1.com/fire-products/firefighter-body-armor/articles/why-fire-and-ems-agencies-should-invest-in-body-armor-and-how-to-afford-it-ekopd1eaHfhBf6xS/. Accessed 16 Aug. 2023.

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Economy, health/safety, and social movement all come together to make the first responder world what it is. Economy affects first responders, and primarily EMS because more often than not, they are not government based. With less support and income, we are paid less and therefore have a higher turnover rate which leaves us shorthanded quite often. Health/safety has become a large issue as well due to the increased violence in the US. It is recommended for us to have bulletproof vests but they aren’t able to provide them due to finances so we are required to buy them ourselves. When you add these together as well as the increased violence in the US, you get the social movement of increased harm due to recent changes in general first responder responses. Police are not overly liked at the current moment and because of that, they prefer not to go on calls that they don’t believe they are needed. They will listen to the complaint via dispatch and then decide if they want it or if they believe it is a medical problem, in which case, we are sent. Due to this, we have had guns pulled on us and have been attacked. The more research we’ve done on these things, the more apparent it is that they all come together in one way or another. I think all of this creates our social location as well. The textbook talks about it being more our characteristics but also our social position in our society. While some characteristics can determine patients' trust in us, it isn’t the primary way we are placed in our social location.

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Abstract

Introduction: There is reason to believe that traumatic events experienced on the job make emergency medical services (EMS) workers more skeptical about their spiritual beliefs. Little is known about the spiritual lives and experiences of emergency medical technicians (EMTs). No studies have measured the responses of EMTs to the spiritual needs of their patients.

Purpose: This study investigates whether EMS workers are less spiritual than the average U.S. citizen, and what effect this has on prayer for patients and perceived happiness.

Methods: Data were collected in a major metropolitan EMS system from 125 EMTs and paramedics through a questionnaire about their beliefs and behaviors regarding their spirituality. Pearson product-moment correlation coefficients (r) were used to analyze variables. The religious attitudes of EMTs were compared with those of the general population as defined in the Gallup studies.

Results: Ninety-one percent of the EMS workers interviewed and 94% of Gallup's sample of the general population said they believe in God. The findings on other measures in the EMT sample also were very similar to those defined in the general population. Of the EMTs, 60% said they never have doubted the existence of God. Eighty-four percent believe God still works miracles, and 80% of the EMTs believe in life after death. Eighty-seven percent of EMS workers pray; 62% pray for their patients, and 54% pray for their coworkers. Frequency of church or synagogue attendance is positively and significantly correlated with the degree of perceived life happiness (r = 0.226, p < 0.025 > 0.005). Frequency of prayer also is correlated positively to perceived life happiness (r = 0.182, p < 0.025 > 0.005).

Conclusion: Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority of EMS workers pray for their patients.

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emergency medical technicians / psychology*

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national center for biotechnology information

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Spirituality of EMTs: a study of the spiritual nature of EMS workers and its effects on perceived happiness and prayers for patients - PubMed

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Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority o ...

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While views of and experiences with police vary substantially across demographic groups, there is support for a number of police reforms.

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Why fire and EMS agencies should invest in body armor – and how to afford it

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The role of fire and EMS personnel is changing and this extra layer of protection can save lives

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This section of the supplement is about the EMS business and the systems that support it. No, it's not! Deep down, it's about the money-making it, and, importantly, using it to achieve great patient outcomes.

In these cash-strapped times, I encourage every EMS leader to adopt the Richmond Ambulance Authority (RAA) fiscal philosophy: At RAA, we say we have a "bucket of money." If we submit complete, correct and billable call sheets, we fill the bucket. If we use personnel hours wisely and don't crash the trucks and take care of the equipment, we will use some of the cash in the bucket, but we will also have sufficient reserves for such things as newer, cooler equipment-and even pay raises. Put a hole in the bucket of money, however, through bad or poor practice, and the first things to go are the nice things.

The bottom line: Running your EMS system like a business is an absolute necessity, especially in the current political and fiscal climate.

When we think EMS data, we automatically think response and intervention-the machines and monitors that spew out information to improve the next rotation of care. But EMS systems can only be successful if they have the right amount of appropriately qualified providers, in enough correctly maintained vehicles, loaded with sufficient amounts of equipment, with the means of recording the patients' history and demographics, to generate a fee for service, to fund the next turn of the response cycle.

All of these seemingly mundane functions create the conditions that enable EMS to physically happen and are the power behind the punch of service delivery. All require enormous amounts of attention to detail and most directly affect the bottom line. System efficiency can only occur if prudent leaders develop an understanding of a devil's amount of detail in these business areas.

In fact, the definition of the "quality unit hour" is simply two fully trained medics in a fully equipped vehicle for one hour. The unit hour is in fact a unit of currency because everything costs something. Unless that unit hour is deployed wisely, no income can be obtained.

Scheduling: The Most Important Asset

In any organization, EMS or otherwise, staff are the most important and the most expensive asset. Too many staff on duty for the level of call volume means unit hour utilization falls. Although crews may have a more relaxing day in that situation, cash hemorrhages from the organization.

So, scheduling the right amount of staff on duty is a critical financial activity. Before anyone is placed in a shift, a detailed demand analysis must occur to deliver the amount of unit hours needed for each day of the week (see graph below). Once the accurate demand forecast is known, then the placing of staff into shifts, stations or vehicles can begin.

The simplest scheduling systems include the basic sign-up sheet where volunteers identify their availability or the Excel-type spreadsheet systems that calculate hours worked. At the upper end of the spectrum, Web-based, interactive specialist software systems allow management to easily manipulate and extract information in a cost-effective manner.

A useful piece of technology developed in-house at RAA, with the cooperation of our scheduling vendor, is the ability to overlay demand analysis with the actual staffing on any particular day. The combination of these two data streams allows managers to see where "pinch points" or operational pressures will develop and facilitates getting the right amount of people on duty.

Billing: The Birthplace of the Budget

Medical billing is an entire industry in its own right; and it's critically important to EMS organizations. Many dyed-in-the-wool veteran providers, however, don't give a second thought to what happens after the call sheet has been completed and "sent to file."

Assuming the department actually bills for service (and most services now do), the bill is the birthplace of the budget. This year's income determines next year's spend, just as last year's activity informs you of this year's demand. Accurate report completion provides the billing department the best opportunity to correctly categorize the bill into the appropriate fee for service.

In addition, data analysis around the patients served, and bills generated, does more than just indicate potential income. The payer mix, once identified, provides a clinical cross-section of the population served; by understanding the Medicaid, Medicare or private-pay status of those served, managers can better understand the return on billing.

Example: No EMS system achieves a 100% income on the fees charged. The Medicare rate may be less than the bill, or local insurance carriers-particularly in the Affordable Care Act era-may not pay all that is expected. Analysis of both payer and the entity that pays out must be understood to identify the return on bills sent.

A thorough understanding of your billing time is also key. Knowing how quickly bills issued result in money back to your organization also assists in setting the budgetary tempo. Considerable analysis by both billing and finance staff as to the solvency this income brings determines the rate of service delivery.

Paid bills are the cash that fills the mythical bucket, so understanding billing data becomes a critical requirement. Just as response times or ROSC stats are important for the operational team, so is billing data for the admin team.

Vehicle Maintenance: Catch It Before It Fails

Preventive maintenance is the only way to ensure the patient never has to wait any longer than necessary for an ambulance, or worse, wait in a

broken-down ambulance on the side of the road for a replacement vehicle to arrive.

Data is as much a key requirement in caring for vehicles as a toolbox full of wrenches. In many states, comprehensive vehicle records are a permitting requirement, and they're certainly a "must have" to attract any form of formal accreditation, such as that awarded by the Commission on Accreditation of Ambulance Services.

Vehicle maintenance records provide evidence of failures and their frequency. They can reveal equipment trends and inform maintenance or replacement decisions. For instance, if you can identify when key components break on a particular type of equipment, you can design a service or replacement plan to take care of the problem before the equipment fails.

The term "unscheduled maintenance" is code for cash hemorrhage. If a truck and its crew have to leave the street with zero notice, unit hours (EMS currency) are wasted. The net effect is one less vehicle available on the street when the carefully constructed, data-driven demand analysis says you need them.

Poor maintenance, then, potentially equates to poor patient service and a reduced revenue stream. Use of a data system and the establishment of a "mean time between failures" (MTBF) chart for key equipment and abiding by it will ensure that unscheduled maintenance remains at a minimum. This alone will pay for your investment in a vehicle maintenance data program.

Many types of maintenance tracking systems exist in the marketplace, but consideration should be give to systems that capture:

"¢ Assets: Your vehicles by their VIN and type.

"¢ Retired assets: Keeping data on old vehicles and vehicle types allows for comparative analysis against new or updated units.

"¢ Work orders: Who did the work (one mechanic may fair better at a repair vs. another). Also, a record of parts used on every truck allows for cost-benefit analysis of the relative worth of a vehicle, particularly as they near end of life and determinations need to be made about disposal or continued service.

"¢ Preventive maintenance: Maintenance is the "public health" program for vehicles. A sufficient understanding of other fleet metrics will allow the timing and intensity of servicing to be adjusted to ensure a cost-effective level of treatment.

"¢ Inventory: Understanding inventory, both what is on the shelves and what has been fitted to the vehicle, informs stock control.

Supply Management: Money Management

Let's face it, EMTs and medics are hoarders. In environments where stations have their own running stores or the same crews look after the same vehicles day in, day out, there's a tendency to "add" equipment to the vehicle because "you never know." This might seem like a good idea, but there is a high probability that it will lead us to purchase more equipment and supplies than we need, only to watch it expire and be disposed of-the equivalent of throwing cash straight into the dumpster.

The key is to have a system that accounts for stock and identifies both fast-moving items (so you can ensure that sufficient levels are maintained) and slow-moving items (so you can ensure that such items are rotated to vehicles or stations that will use them before they expire).

Your data system should also analyze the frequency of equipment used. Example: The use of an expensive item, such as an IO needle, can be tracked against clinical activity to confirm that the expenditure of such high-dollar disposable equipment is appropriate. The RAA system identifies where and when high-cost items are used to ensure that they're not being employed where a more cost-effective device could be used.

Data and usage assessment also minimize equipment storage. The adoption of a "just in time" system means that only a few days of stock is stored on site and regularly circulated onto the trucks. An item of unused stock on the EMS store shelf is money that could be used for a better patient outcome elsewhere or increase your earned interest on those dollars.

In terms of logistics management, there are now a number of data-related products in the marketplace that will track, monitor and even locate pieces of equipment. Radio frequency identification (RFID) systems communicate with an electronic reader mounted in your ambulances to identify the presence of an item of stock or part. RFID can also be used to identify new stock arriving into your agency's "store" location and load it into the stock-management system; after the item is loaded onto the truck, RFID records its location, and the inventory status is updated.

Key pieces of equipment, such as expensive monitors, stretchers, stair chairs, suction units and first-in bags, can also be fitted with RFID chips and programmed to alert the crew if the vehicle moves away from the allocated device. If a piece of equipment is inadvertently left on scene, it will send an alarm before the crew get too far away, allowing them to retrieve it-clever stuff!

The same RFID system can also help you clinically monitor when the equipment leaves the vehicle to ensure that monitor and suction units leave the ambulance as the crew arrives at a cardiac or unconscious patient call. This helps ensure that cardiac patients are not walked down two flights of steps and out to the ambulance before being monitored or suctioned.

UPC (universal product code) bar coding is another stock-control system that is seen everywhere from supermarkets to the bottom of the computer this article was typed on. Code readers write to a database, which assembles stock control and is then able to report information trends, usage and expenditure.

Education & Credential Management

How quickly would your organization make it to the front page of the local paper if one of your providers made a mistake and then it came to light that they weren't even certified or up-to-date on the particular skill that caused the issue in the first place? How much more egg on the face would there be if management had no idea that said EMT or medic was not current or actually qualified to do the job? I can hear the litigation cash register "kerchinging" as I type!

Information technology systems abound with databases to capture employee credentials and manage them for you. Some products are even capable of generating email reminders to the provider and their supervisor that qualifications and certifications are nearing expiration.

This notification system is especially useful and cost effective in larger departments, where it can be difficult to track requirements for a large number of personnel. Although it should always be the provider's responsibility to remain current, the system can monitor who and what is expiring or up for renewal. This can save you from a lawsuit and that equates to big dollars.

The RAA system, for example, counts down a provider's time to certification or credential expiration. In the worst-case scenario where something expires (good management should prevent this, of course), the employee "clock-in" system, which is integrated with the credentialing system, refuses to allow the provider to book on-shift. With the plethora of required courses and state-mandated training providers must maintain today, a system that not only captures data, but also sends alerts, is the only way to go.

This section of the supplement appears last for a reason-not because it's the least sexy of the topics, but because readers must be left with the lasting impression that EMS is a business, and we need to run it as such.

Knowing our business means understanding every possible metric out there, even in the back office. And this applies to every type of EMS agency: Not-for-profit organizations need money to make payroll; volunteer organizations need money to buy equipment; in the public sector, the days of bailouts and bottomless municipal coffers are a thing of the past; and in the private sector, failure can lead to new ownership before you can say "hostile merger and acquisition."

Put simply: The consequences of not paying attention to the "business side" of the business are dire.

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This section of the supplement is about the EMS business and the systems that support it. No, it's not!

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How climate change effects the first responder world.

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Prepare to meet your community's climate change risk

Now is the time to create a climate-resilient fire and EMS department and community. To help you prepare, consider:

Community risk reduction programs

Preparing communities for severe weather events and WUI fires can lead to a safer response for fire and EMS personnel. Identify and assess your community's risk and then target educational programs and public messages to mitigate these risks. Emphasize defensible space, how to prevent accidental wildfire ignitions, evacuation planning and emergency notification.
Enroll in an NFA community risk reduction online course
Training

Based on the climate change risks you have identified, train personnel to meet these new challenges. If increased flooding is a risk in your area, train and equip personnel for swift water rescue. Similarly, if you are experiencing more severe thunderstorms and tornados, train for search and rescue. Make sure all personnel are trained to operate under the Incident Command System (ICS).
Enroll in an NFA ICS online course
Technology

Evaluate new or different technologies to meet the challenges of incident response in severe weather, such as high-water apparatus, battery-operated tools, photovoltaic power systems, FirstNet, hand-held GPS devices and unmanned aircraft systems.

Harden your infrastructure

Plan for how your department will maintain its operational capability during a prolonged disaster response and the health and safety impacts of that response on your personnel.

Ensure that fire station building and mechanical issues are addressed, including redundant power supply, and that your station is well supplied.

Make sure that equipment meets your response needs in this era of climate change.

Encourage personnel to create a family emergency plan.

Land management use and building codes

Sound land management use policies based on risk assessment help communities survive wildfire and flooding events. Adopting and enforcing modern model building codes increases public and responder safety and provides protection for properties.

Make sure you are part of these important discussions with community leaders and planners. The decisions made in these meetings can have long-lasting effects on your response to WUI fires and severe weather events.

Funding for your climate change needs

Your department can apply for funding under several Federal Emergency Management Agency (FEMA) grant programs to pay for personnel, training, equipment, community outreach programs, hazard mitigation projects and more. 2 grant programs to consider are:

Assistance to Firefighters Grants Program (AFGP)

This grant program provides 3 annual funding opportunities that fire departments can apply for to receive resources to equip and train emergency personnel, enhance efficiencies and support community resilience. Learn more about AFGP grants.

Building Resilient Infrastructure and Communities (BRIC)

This grant program supports hazard mitigation projects that reduce risks from disasters and natural hazards. Learn more about BRIC grants.

For more information about other FEMA preparedness and hazard mitigation grants, visit FEMA.gov.

Declare a climate emergency

If your jurisdiction has not already done so, declare a climate emergency for your department to help reduce carbon emissions.

Buy green apparatus and equipment, including station laptops and other office materials.

Choose suppliers who demonstrate good environmental practices.

Avoid disposable and single-use products like cups, plates and coffee stirrers in your station.

Recycle station materials when possible.

Raise awareness about the effects of climate change at public events and in your meetings with community leaders.

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Is your fire and EMS department ready for climate change?

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Learn how climate change is having an increasingly significant all-hazards impact on the fire and emergency medical services (EMS).

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The violence and danger is increasingly daily towards the first responders, and not just police.

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Violence is the second most frequent cause of nonfatal injuries to emergency medical services (EMS) providers according to 2020 data from National Institute for Occupational Safety and Health (NIOSH) data tracking. Most of these injuries are caused by the patients EMS providers are treating.

Recommendations for personal safety vary from department to department and include:

Understanding that emergency scenes are dynamic and that violence to emergency responders is always a possibility.

Monitoring surroundings/situational awareness.

Creating distance and shielding while treating patients.

Wearing personal protective equipment (PPE) that can guard against a knife or a bullet.

Learning basic self-defense techniques.

An EMS department in Austin, Texas is implementing a training program that focuses on changing how violent patients are approached, including how to detect a possibly violent patient early in the incident.

Although important, situational awareness, self-defense skills, and PPE may not be the entire solution. The SAVER Systems Checklist shifts the responsibility of safety and health from that of the individual first responder to the organization. The checklist contains items organized by 6 phases of EMS response:

1. Pre-event.

2. Traveling to the scene.

3. Scene arrival.

4. Patient care.

5. Assessing readiness to return to service.

6. Post-event.

These items are the focus of safety actions that leadership can institute through training, policy and environmental modifications.

Drexel University's Center for Firefighter Injury Research and Safety Trends (FIRST), Stress and Violence in Fire-Based EMS Responders (SAVER) program, developed the checklist using the findings of the 2017 U.S. Fire Administration study, Mitigation of Occupational Violence to Firefighters and EMS Responders PDF .

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Violence is the 2nd most frequent cause of nonfatal injuries to EMS providers. Learn about training and tools to address this problem.

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Short article from West Virginia Education about the history of EMS, dating back to the civil war.

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EMS in America can be traced back to the Civil War era. All military personnel had to be examined by medical officers to qualify for duty. Also, ambulances were assigned based on the size of the regiment. Each ambulance team was trained in patient care to better take care of the soldiers. In 1865 Cincinnati incorporated the first civilian ambulance. Then, in 1869, New York City advertised a 30 second response time and provided an Ambulance Surgeon and a quart of brandy for their patients!

During World War I, signal boxes were used by injured soldiers to assist medical teams in locating them in the field of battle. Medical teams also used electric, steam, and gasoline powered carriages for transporting the injured. It was also the first war to utilize traction splints and other medical equipment. After the war, civilian ambulances carrying surgeons were equipped with radio dispatchers to better serve the community.

The transition to what we know as the modern day EMS started during the 1950's as an off shoot of 5 different types of businesses; towing operators, medical equipment companies, funeral homes, hospitals, and police/ fire departments. After many years of being unregulated, funeral homes began patient care and provided nearly half of the country's ambulances.

In 1960 John F. Kennedy declared that "Traffic accidents constitute one of the greatest, perhaps the greatest, of the nation's public health problems". Then in 1966 Lyndon B. Johnson and President's Commission on Highway Safety/National Academy of Sciences declares the carnage "the neglected disease of modern society." Soon after, the National Highway Traffic Safety Act was adopted which standardized EMS training, promoted state involvement, encouraged community oversight, recommended radio communication, and stressed a single emergency number.

Other federal initiatives were put into action that further helped define the EMS program. In 1972 the Heath Services and Mental Heath Administration under the Dept of Health, Education, and Welfare became the lead agency for EMS. Also the Physician Responder Program was implemented, which later morphed into paramedic programs and lead to close physician supervision.

1973 brought about the EMS Systems Act . The DHEW established 300 EMS systems throughout the country. The Department of Transportation adapted training curricula for EMT, EMT P, and first responder. Public Law 93-154 established new rules for EMS radio communications. General Services Administration also introduced ambulance specifications. The next step came in 1981 with the Consolidated Omnibus Budget Reconciliation Act which consolidated funding into state preventive health block grants, eliminated funding under EMSS Act, reduced compliance with federal guidelines, and lastly, abolished the federal lead agency.

In 1996 the EMS Agenda for the Future was drafted, which further connected the EMS with the other medical professions. That same year the EMS Education Agenda for the Future was drafted, which provided recommendations for Core content, Scope of practice and Certification of EMS professionals.

It has been nearly four decades since President Lyndon Johnson's Committee on Highway Traffic Safety recommended the creation of a national certification agency to establish uniform standards for training and examination of personnel active in the delivery of emergency ambulance service. The result of this recommendation was the inception of the National Registry of Emergency Medical Technicians (NREMT) in 1970.

Since that time, pre-hospital emergency medical care has continually evolved and improved. The EMT has been acknowledged as a bonafide member of the health care team. Excellent training programs have been developed and a vital focus has been placed on continuing education. National standards have been established. Ambulance equipment essentials have been set. National accreditation of paramedic programs has been achieved, and professional associations for the EMT have been organized.

The NREMT, among others, has helped to establish, implement and maintain uniform requirements for the certification and recertification of emergency medical technicians. The NREMT has also been involved in numerous national projects and its staff participates on major national committees, playing an active part in the ever-continuing process of improving standards of emergency medical services.

An EMT-Intermediate is the level of training between Basic (EMT-B) and . There are actually two intermediate levels, the EMT-I/85 and the EMT-I/99 curriculum, with the 1999 level being the higher of the two. The standard curriculum for EMT-I from 1998 is defined by the U.S. Department of Transportation, but each state may not have implemented or approved this program. (Note: This level of EMT is not currently recognized in WV .)

EMT-I/85 is a level of training that will typically allow several more invasive procedures than are allowed at the basic level, including IV therapy, the use of multi-lumen airway devices (even endotracheal intubation in some states), and provides for enhanced assessment skills. The EMT-I/85 is typically allowed only the same medications an EMT-B is allowed to use (these being oxygen administration, oral glucose, activated charcoal, epinephrine auto-injectors (Epi-Pens), nitroglycerine, and Metered-Dose Inhalers (MDIs). Protocols for medications vary by state. For example, in New Hampshire, an EMT-I is allowed to administer Narcan, Atropine, Thiamine, and nebulized Albuterol in addition to the above listed medications. (Note: This level of EMT is not currently recognized in WV.)

The EMT-I/99 level is the closest level of certification to Paramedic, and allows many techniques not available to the EMT-I/85. Some of these techniques include needle-decompression of tension pneumothorax , endotracheal intubation, nasogastric tubes, use of cardiac event monitors /, and medication administration to control certain cardiac arrhythmias . (Note: This level of EMT is not currently recognized in WV)

are employed by various public and private Paramedics emergency service providers. These include private ambulance services, fire departments, the system, hospitals, law enforcement agencies, the military, various EMS-specific, public safety agencies. Paramedics may respond to medical incidents in an , rescue vehicle, helicopter , fixed-wing aircraft, motorcycle, or fire suppression apparatus .

Paramedics may also be employed in medical fields that do not involve transportation of patients. Such positions include offshore drilling platforms, phlebotomy , blood banks , research labs, educational fields, law enforcement and hospitals.

move patients by ground ambulance or aircraft to a Critical care transporters medical treatment facility . A nurse credentialed in critical care medicine may accompany the patient. Other critical care units use paramedics who have received critical care medical training, or continuing education courses in the Critical Care Emergency Medical Transport Program (CCEMTP).

Tactical paramedics work on law enforcement teams. These medics, usually from the EMS agency in the area, are commissioned and trained to be tactical operators in law enforcement, in addition to paramedic duties. Advanced medical personnel perform dual roles as operator and medic on the teams. Such an officer is immediately available to deliver advanced emergency care to other injured officers, suspects, victims and bystanders.

In-Hospital paramedics are increasingly employed in the emergency departments and intensive care units due to the nursing shortage . Often, paramedics operate with greater latitude and autonomy than many .

Paramedic salaries can range from zero for unpaid volunteer positions, to as much as $90,000 a year depending on location, experience, and supervisory responsibilities. (In WV, paramedics are trained by hospitals, usually in conjunction with higher education.)

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EMS in America can be traced back to the Civil War era. All military personnel had to be examined by medical officers to qualify for duty. Also, ambulances were assigned based on the size of the regiment. Each ambulance team was trained in patient care to better take care of the soldiers.

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Hit by a texting driver. We were all okay.

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My coworkers and I on the helipad.