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first and foremost FD would need a medical director to begin the process of becoming an ALS first reponse agency. 2- FD must right their own general operating protocols 3- if FD is not intending on transporting patients that they have intiated ALS care on, most if not all transporting paramedics are very very uncomfertable taking over for someone elses work. because the ultimate reponsibility falls on the transporting paramedic. both in patient care terms and legally 4- Firefighter have significantly less experience in handling patients outside of the first responder level, when in fact most of the care takes place en route to the facility 5- The addional number of hours and time spent to keep FD skills current will require a significant amount of time in additona to their already busy educational, drill, QA/QI schedule just some thoughts from a previous firemedic

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