In the summer of 2003 Pro EMS and Cambridge Fire Department (CFD), with the support of Cambridge Emergency Communications and South Middlesex EMS submitted a proposal to develop a model EMS system based on our unique public/private partnership. At that time the current EMS system had served Cambridge well. With an increasing call volume and preparedness becoming a preeminent issue, it was apparent that CFD should begin providing ALS level care to address the myriad situations that the City of Cambridge could be confronted with. The addition of CFD ALS resources to an already highly functional EMS system represented an opportunity for Cambridge to increase the level of emergency care being delivered to its citizens. The new EMS system would serve as a model predicated on focus and flexibility.

In Spring 2005, after months of preparation, the new system went online. The system is based on the deployment of multiple, one paramedic (P/B) staffed resources and has proven to be highly effective. Participants focus on what they do best; CFD focuses on rescue, mitigation, and ALS first response to an incident as Pro EMS focuses on ALS patient care, patient transport, and EMS system functions.

This flexibility allows for delivery of the highest level of care to patients, in the most efficient manner with ALS reaching virtually every emergency patient in one of the busiest service areas in Massachusetts. In the vast majority of cases, we are better able to staff to the condition of the patient by providing two paramedics at the scene and two paramedics in the back of the ambulance to care for the highest acuity patients.

The effectiveness of Cambridge EMS relies on the presence of several key elements, all vital to the provision of the highest level of quality EMS for any community. These elements are derived from the NHTSA EMS Agenda for the Future. They are:

• Integration of Health Services	• Public Education
• EMS Research	• Prevention
• Legislation and Regulation	• Public Access
• System Finance	• Communications Systems
• Human Resources	• Clinical Care
• Medical Direction	• Information Systems
• Education Systems	• Evaluation

Specific elements and roles related to emergency responses within the Cambridge EMS system are:

---

Emergency Medical Dispatch
Cambridge Emergency Communications Department

Emergency Medical Dispatch: Trained Emergency Medical Dispatchers (EMDs) provide call-taking, dispatch to fire and rescue units, CAD entry, and pre-arrival instructions.

ALS and BLS First Response and Rescue
Cambridge Fire Department

Engine / Ladder Companies:
Staffing: 3 – 4 firefighters trained to the BLS Level.
Firefighters provide rescue, initial on-scene triage, and initiate medical care at the BLS Level (first responders and/or EMTs) utilizing SAEDs and BLS equipment.

Rescue Company:
Staffing: 4 firefighters including at least one Firefighter/Paramedic.
Firefighters with highly specialized training provide specialized rescue, fire suppression, hazmat response, special details, etc., and initiate medical care at the ALS level utilizing a full complement of ALS and rescue equipment. Rescue is also a transport capable ambulance during times of extreme system demand.

Squads:
Staffing: 2 Firefighters, at least one Firefighter/Paramedic.
Firefighter/Paramedics and firefighters with highly specialized training provide medical care at the ALS level, specialized ALS rescue, fire suppression, hazmat services, etc., utilizing a full complement of ALS and rescue equipment.

ALS and BLS Transport
Pro EMS Service

Paramedic Ambulances:
Staffing: 2 Paramedics or 1 Paramedic & 1 EMT.
Paramedics and EMTs initiate, continue and/or assume medical care, relieve front-line fire rescue personnel for additional responses, and transport patient to the hospital.

Basic Life Support Ambulances:
Staffing: 2 EMTs.
In periods of peak demand, EMTs initiate or continue medical care, relieve front-line fire rescue personnel for additional responses, and transport patient to the hospital.