rehospital emergency medical services (EMS) play an important role n the initial stabilization and transport of critically ill patients daily round the world. In the USA, there are an estimated 840,000 ertified first responders and, of these, there are greater than 192,000 MS providers. These individuals work for a variety of governmental nd private organizations such as fire departments, private companies, olunteers, hospitals, and third-party providers. All states require a rained and certified EMS responder to provide emergency medical are in the event of a weapons of mass destruction (WMD) incident nd the administration of antidotes as dictated by region. As a esponse to September 11, comprehensive competency-based curricula or terrorism preparedness have been created. The hallmark of an expertly trained EMS provider is the ability to ecognize rapidly and treat immediate life threats, initiate timely ommunication with receiving facilities to prepare them for patient rrival, and execute proper protocols in the event of a disaster or mass asualty. EMS providers require a unique skill set to deal effectively ith the complexities of the scope of their practice. They are under ignificant time pressure to triage and initiate treatment for unstable atients. This requires clear thinking and poise. They must be able to hink flexibly and cope with an array of environmental factors articular to the scene. Additionally, they need to be able to work ffectively while maintaining situational awareness of dangers to their ersonal safety. Finally, they need to maintain vigilance and be repared to react to the possibility that their scene response is otentially related to a mass casualty or disaster that they have never